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health  LIBRARY 

yr-HVERS!TY  OF  MARYLAND 


BALTIMORE 


Digitized  by  the  Internet  Archive 
in  2016 


https://archive.org/details/imjillinoismedic1341illi 


Illinois  Medical  Journal 

official  journal  of  the  ILLINOIS  STATE  MEDICAL  SOCIETY 


\olume  134,  Number  1 July,  1968 

Clinical  Articles 

DifferentiaHon  of  a Bifid  Ureter  from  Ureteral  Diverticula 

A Case  of  Post-Pericardiotomy  Syndrome  Pathogenical  Consideration 

Coronary  Artery  Occlusion  with  Myocardial  infarction  in  a Twelve  Year  Old  Boy 
Fusion  of  the  Labia  Minora 

Surgical  Grand  Rounds 

Abscess  of  Lung 

Medical  Progress 

^ The  Severely  Affected  Rh-Sensitized  Pregnancy 

SPECIAL  REPORT 

Convention  Highlights,  Summary  of  House  of  Delegates, 

Actions  on  Resolutions 


Complete  table  of  contents 


page  4 


health  sciences  library 

WWERSITY  OF  MARYLAND 
BALTHWQR^ 


burning 


itching 


S-iB 


discharge 
of 

trichomona!  vaginitis... 


Flsi^yl  metronidazole  brin 

^ tablets/ inserts 


clinical  cures  • microscopic  cures  • culture  cures 


For  the  most  widespread  form  of  vaginitis 
the  most  widely  successful  therapeutic 
agent,  Flagyl,  is  clearly  indicated. 

In  trichomonal  vaginitis,  most  physicians 
have  reported  a cure-rate  of  95  per  cent  or 
more  with  Flagyl  when  infected  male  part- 
ners are  treated  concurrently  and  when 
treatment  is  repeated  for  occasional  refrac- 
tory infections  in  women. 

This  high  rate  of  cure  obtained  with 
Flagyl  is  unparalleled.  Only  systemically 
active  Flagyl  reaches  the  hidden  reservoirs 
of  reinfection  in  male  and  female  genitouri- 
nary tracts. 

Indications:  Flagyl  is  indicated  only  in  the  treat- 
ment of  trichomoniasis  in  both  the  male  and  female. 

Contraindications:  Pregnancy;  disease  of  the  cen- 
tral nervous  system;  evidence  or  history  of  blood 
dyscrasia. 

Precaution:  Complete  blood  cell  counts  should  be 
made  before,  during  and  after  therapy,  especially 
if  a second  course  is  necessary. 

Side  effects:  Infrequent  and  minor  side  effects  in- 
clude nausea,  metallic  taste  and  furry  tongue.  Gas- 


trointestinal disturbances,  flushing  and  headache 
sometimes  occur,  especially  with  concomitant  in- 
gestion of  alcohol.  The  taste  of  alcoholic  beverages 
may  be  altered.  Other  effects,  all  reported  in  an  in- 
cidence of  less  than  1 per  cent,  are  diarrhea,  dizzi- 
ness, vaginal  dryness  and  burning,  dry  mouth,  rash, 
urticaria,  gastritis,  drowsiness,  insomnia,  pruritus, 
sore  tongue,  darkened  urine,  anorexia,  vomiting, 
epigastric  distress,  dysuria,  depression,  vertigo,  in- 
coordination, ataxia,  abdominal  cramping,  consti- 
pation, stomatitis,  numbness  or  paresthesia  of  an 
extremity,  joint  pains,  confusion,  irritability,  weak- 
ness, cystitis,  pelvic  pressure,  dyspareunia,  fever, 
polyuria,  incontinence,  decreased  libido,  nasal  con- 
gestion, proctitis  and  pyuria.  Elimination  of  tricho- 
monads  may  aggravate  candidiasis. 

Dosage  and  Administration:  In  women:  one  250- 
mg.  oral  tablet  three  times  daily  for  ten  days.  A 
vaginal  insert  of  500  mg.  is  available  for  local 
therapy  when  desired.  When  used,  one  vaginal  in- 
sert should  be  placed  high  in  the  vaginal  vault  each 
day  for  ten  days;  concurrently  two  oral  tablets 
should  be  taken  daily. 

In  men:  When  trichomonads  are  demonstrated, 
one  250-mg.  oral  tablet  twice  daily  for  ten  days  in 
conjunction  with  treatment  of  his  female  partner. 

Dosage  Forms:  Oral  tablets— 250  mg. 

Vaginal  inserts— 500  mg. 


SEARLE 


y ^0-^  gfj 


Research  in  the  Service  of  Medicine 


PUBLISHED  MONTHLY  BY:  BLUE  SHIELD  PLAN  OF  ILLINOIS  MEDICAL  SERVICE  • 425  NORTH  MICHIGAN  AVENUE  • CHICAGO.  ILLINOIS  60690 


Vol  2,  No.  7 


July,  1968 


Dear  Doctor: 

We  have  recently  offered  a new  Blue  Cross  and  Blue  Shield  program  to  supplement  the  benefits  of 
Medicare  for  our  direct-pay  over  65  subscribers.  Direct  subscribers  over  65  formerly  held  our  Series  65 
Major  Medical  Plan  which  included  deductible  and  coinsurance  features.  The  great  majority  have  con- 
verted to  our  new  Blue  Cross  65  and  Blue  Shield  65  which  is  simpler  to  understand,  superior  in  dollar 
benefits,  and  facilitates  claims  processing. 

Our.  new  Blue  Shield  65  will  pay  20%  of  the  physician’s  Usual  and  Customary  charges  for  the  full 
Medicare  scope  of  medical  and  surgical  services  for  hospital  bed  patients.  It  will  pay  20%  of  the  physi- 
cian’s Usual  and  Customary  charges  for  visits  to  certificate  holders  in  extended  care  facilities  while  the 
member  is  receiving  Medicare  benefits.  It  will  pay  20%  of  the  physician’s  Usual  and  Customary  charges 
for  surgical  .services  for  accident  care  in  the  doctor’s  office  or  in  the  outpatient  department  of  the  hospital. 

No  special  forms  are  required  for  this  program  whether  you  accept  Medicare  assignment  or  bill  your 
patient  directly,  simply  file  your  Blue  Shield  65  claim  on  our  regular  Physician’s  Service  Report  repro- 
duced below.  Indicate  the  service  you  performed,  your  fee  for  each  service,  and  the  dates  of  service. 

We  will  also  offer  this  superior  program  to  those  subscribers  over  65  who  are  Blue  Cross-Blue  Shield 
group  members.  We  feel  that  this  program  will  not  only  benefit  subscribers  over  65  but  will  facilitate  the 
completion  of  claims  for  you  and  your  office  assistant  by  using  our  standard  Physician’s  Service  Report, 

For  additional  information,  please  contact  one  of  the  Special  Representatives  of  our  Professional 
Relations  Department,  MO  4-7100,  extension  235,  Blue  Shield  Plan  of  Illinois  Medical  Service,  425  North 
Michigan  Avenue,  Chicago,  Illinois  60601. 


COMPLETE 

INFORMATION 

PHYSICIAN’S  SERVICE  REPORT 

NEEDED 

TO  SPEED  BtUe  SHIELD  PAYMENTS  fl  StUE  SHIELD  J-LAN  OF  ILLINOIS  MEOiCAL  SSHVICE 

TO  YOU  MAIL  TO  * V*  42S  N.  MICHIGAN  AVE..  CHICAGO.  ILLINOIS  6C69C 

* M04-7100 


Patient's  Name ^ 


Subscribef's 
Name  & 
Atiatesi 


WHERE  WAS  SERVICE  RENDERED? 

Name  of 

Hospital City..: 

DIAGNOSIS? ; 


CHECK  SERVICE  PERSONALLY  RENDERED  BY  YOU 

O Surgical  Sarvtca 
Q Fracture  or  Complete  Oidocation 

1 Number  of  day*  you  visited  petient___ 

Q Medical  ' Was  surgery  also  performed?  YesQ  NoD 
I If  yes,  by  whom? 

LJ  Obstetrical  Care 
0 Accident  Cart 

Date  of  accident; 

Q Anesthesia 
Q Pathofogy  Service 
Q X'Ray  Service  {Oiognostici 

Fracture  Of  Oi^ocaiior?  YssO  No  f~l 

Area  X-rayed Date 

O Radiation  Therapy 

MAMC  Am  Aooms  or  rnnicuM  wwo  nMOttfo  Mevtcc 


Age Sex 


GnouF.NO. 


soascflisgR  NO. 


lit  Th)»  • tVofiunni't 
I Coiriperaetlon  Case? 


Gy«  Dno  1 

LJ  PoCTiNy  I 


n 12}  (35  GOHIc*  (45  QHom* 


Admission  ' Oisrharae 

Date Date 


Give  Dates  and  Description  of  all  Services  You  Rendered: 


My  let  me  rtwcMaed  arvic*  .1  $ . l am  ltc»r>«0  10  B»ec- 

meeicin*  -n  *11  itt  hrenchet  ina  o«f »»n«(iy  performed  th*  anvic** 
0*Kr<Md. 

. ThHfee  n»tA$  □mASNOT  been  (mmI  ta  me. 


THIS  SPACt  FOR  8UJE  SHIELD  USE  ONLY 


A 


B&-11  R«v.  AOa 


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ASK  BLUE  SHIELD 


• • • ABOUT  MEDICARE 

Q How  should  I bill  my  pathology  and  radiology 
services  to  hospital  in-patients  when  Part  A bene- 
fits are  exhausted? 

A Radiology  and  pathology  services  should  be 
billed  on  SSA  1483  form  when  hospital  in-patients 
are  no  longer  eligible  under  Part  A.  All  services 
billed  on  SSA  1483  will  be  reimbursed  under  Part 
B.  Reasonable  charges  are  100%  reimbursable  but 
may  not  be  applied  toward  the  Part  B deductible. 
These  changes  became  ejBFective  April  1,  1968. 

Q I have  a patient  who  exhausted  his  hospital 
benefits  in  mid  December  who  wishes  to  apply  for 
the  additional  60  day  lifetime  reserve  available 
from  January  1,  1968.  How  are  charges  for  this 
service  handled  from  the  date  original  benefits 
were  used  until  he  chooses  to  use  the  additional  60 
days  of  lifetime  reserve? 

A Charges  for  the  period  between  the  time  his 
original  benefits  were  exhausted  until  he  draws 
from  his  60  day  lifetime  reserve  would  not  be  cov- 
ered. 

Q How  is  the  Part  B blood  deductible  and  the 
Part  B $50  deductible  and  co-insurance  related? 

A Reimbursement  for  blood  and  packed  cells 
furnished  after  the  patient  has  received  three  pints 
in  a calendar  year  will  be  subject  to  the  Part  B 
$50  deductible  and  co-insurance.  Expenses  incurred 
in  rneeting  the  blood  deductible  do  not  apply 
toward  the  Part  B $50  annual  deductible  or  for 
reimbursement  purposes  even  though  the  Part  B 
deductible  for  any  calendar  year  is  satisfied  in 
whole  or  part  during  the  last  three  months  of  the 
calendar  year.  There  is  no  carry  over  credit  allowed 
toward  the  blood  deductible  in  the  following 
calendar  year. 

Q Are  withdrawal  treatments  for  narcotic  ad- 
dicts covered  services  under  Part  B of  the  Medicare 
program? 

A Payment  may  be  made  for  withdrawal  treat- 
ments when  they  are  provided  by  the  physician 
or  are  provided  directly  under  his  personal  super- 
vision. 

Drugs  provided  in  connection  with  withdrawal 
treatments  are  covered  if  they  cannot  be  self-ad- 
ministered and  meet  all  other  requirements. 

Portable  X-Ray  Services 

Before  we  are  able  to  make  payment  for  portable 
X-ray  tests  made  in  the  home  or  extended  care  fa- 
cility, we  must  have  the  name  of  the  physician  who 
ordered  the  service  on  the  itemized  statement  or 
form  SSA  1490. 


Routine  screening  procedures  and  tests  in  con- 
nection with  routine  physical  examinations  are  ex- 
cluded from  coverage.  Bills  for  portable  X-ray  ser-] 
vices  involving  the  chest  should  include  the  reason 
the  X-ray  was  required. 

The  scope  of  covered  benefits  for  portable  X-ray  i 
is  defined  as:  ' 

1.  Skeletal  films  involving  the  extremities  (the 
arms  and  legs),  pelvis,  vertebral  column,  and  skull; 

2.  Chest  films  which  do  not  involve  the  use  of 
contrast  media  (except  routine  screening  procedures 
and  tests  in  connection  with  routine  physical  ex- 
aminations); 

3.  Abdominal  films  which  do  not  involve  the  use 
of  contrast  media. 


Name,  Address,  and  Signature  of  Phy- 
sician Needed  before  Medicare  claims  can  . 
be  processed,  it  is  necessary  for  the  Part  B carrier 
to  have  the  name  and  address  of  the  attending  phy- 
sician. When  claims  are  assigned,  payments  will  be  | 
mailed  to  the  physician  at  the  address  indicated  , j 
on  SSA  1490  Request  for  Payment  form. 

It  is  preferable  to  have  the  physician’s  signature  | 
on  form  SSA  1490  when  cases  are  assigned.  How- 
ever, he  may  authorize  a person  on  his  staff 
(nurse,  secretary,  billing  clerk,  etc.)  to  sign  his 
name  or  use  a name  stamp.  The  appropriate  box 
on  the  SSA  1490  should  be  checked  to  indicate 
that  he  is  a medical  doctor.  The  telephone  number  ^ ! 
may  facilitate  future  contact  when  necessary. 


Our  Government  Contracts  Division 

reports  that  Federal  Health  Insurance  benefits  un- 
der Title  XVIII,  Part  B of  P.L.  89-97  were  paid 
during  May  for  over  79,000  cases  in  the  counties  of  ] 
Cook,  DuPage,  Kane,  Lake  and  Will  for  an  amount  | 
exceeding  $4,400,000.  For  the  year  1968  through  | 
May,  payments  have  been  made  on  over  334,000  ] 

cases  for  about  $19,000,000.  | 

The  number  of  cases  processed  in  May  under  I 
Part  A exceeded  72,000  with  payments  to  providers  | 
amounting  to  about  $17,000,000.  For  the  year  1968  ' 

through  May,  over  347,000  cases  have  been  pro-  I 
cessed  and  payments  to  providers  have  exceeded 
$92,000,000. 


NOTICE 

To  help  speed  Medicare  payments,  physicians  : 
in  the  counties  of  Cook,  DuPage,  Kane,  Lake 
and  Will  may  obtain  a supply  of  SSA  1490  Re- 
quest for  Payment  forms  with  their  name  im- 
printed  on  them  by  writing  to  Government  Con-  ( | 
tracts  Division,  Blue  Cross-Blue  Shield,  300  ’ 

North  State  Street,  Chicago,  Illinois  60690. 


(This  is  not  an  advertisement) 


"This  way  please, 
to  help  your  overweights 
change  their'weiohs'" 


YOUR  SUPERVISION  . . . 

based  on  examination  and  evaluation  of  the 
patient’s  overweight  condition. 

OBEDRIN®-LA  . . . 

as  part  of  your  prescribed  regimen,  where 
indicated.  “Trickle-releases”  medication  for  all- 
day appetite  control. 

OBEDRIN  MENU  PLAN  . , . 

provides  adequate  protein  intake  and  helps 
‘overweights'  establish  better  eating  habits. 

DOSAGE:  Obedrin-LA— 1 daily,  usually  at  10  a.m. 
Obedrin  Tablets  and  Capsules— 1 tablet  or  capsule 
at  10  a.m.  and  3 p.m.  A third  tablet  or  capsule  may 
be  given  in  the  evening  to  discourage  late  evening 
snacks.  Obedrin  tablets  are  grooved  so  a half-tablet 
can  be  taken  if  it  is  found  sufficient  for  appetite  control. 
CAUTION:  Should  not  be  given  concurrently  with 
monoamine  oxidase  inhibitors.  It  should  be  used 
with  caution  in  patients  having  a sensitivity  to  sym- 
pathomimetic compounds  or  barbiturates,  and  in 
cases  of  coronary  or  cardiovascular  disease  or  severe 
hypertension.  Excessive  use  of  amphetamines  by 
unstable  individuals  has  been  reported  to  result  in  a 
psychological  dependence.  In  such  cases,  with- 
drawal of  medication  is  necessary.  All  medication 
should  be  used  with  caution  in  pregnant  patients, 
especially  in  the  first  trimester. 

SIDE  EFFECTS:  Insomnia,  excitability,  nervousness 
may  occur  if  dosage  is  excessive.  These  occur  infre- 
quently and  are  mild  with  the  recommended  dosage. 
SUPPLY:  Obedrin-LA— Bottles  of  50  and  250.  Obedrin 
Tablets  and  Capsules— Bottles  of  100  and  1000. 

"TRICKLE  RELEASE"  TABLETS 

Obedrin®- 

Each  two-layer  tablet  contains:  Methamphetamine 
Hydrochloride*,  12.5  mg.;  Pentobarbital*,  50  mg. 
fBarbituric  Acid  derivative;  Warning:  May  be  habit- 
forming);  Ascorbic  Acid,  200  mg.;  Thiamine  Mono- 
nitrate, 1 mg.;  Riboflavin,  2 mg.;  Niacin,  10  mg. 

Obedrin® 

Tablets — Capsules 

Each  tablet  or  capsule  contains  Methamphetamine 
Hydrochloride,  5 mg.;  Pentobarbital,  20  mg.  (Bar- 
bituric Acid  derivative;  Warning:  May  be  habit- 

forming); Ascorbic  Acid,  100  mg.;  Thiamine 
Mononitrate,  0.5  mg.;  Riboflavin,  1 mg.;  Niacin,  5 mg. 

CAUTION:  Federal  law  prohibits  dispensing  without  a prescription. 

*U.S.  Patent  Nos.  2.736,682;  2,809,917;  2,809,916;  2,809,918  and  pat. 
pend.  **U.S.  Patent  Nos.  2,648,609;  2,799,241 

MASSEIMGIL.I. 

TheS.E.  MASSENGILL COMPANY  • Bristol, Tennessee 
New  York  • Chicago  • Dallas  • San  Francisco 


for  July  1968 


21 


New  Test  Detects  Abnormal 
Development  in  Children 


A graphic  new  test  has  been  devised  to 
detect  abnormal  development  in  infants 
and  small  children,  the  U.  S.  Public  Health 
Service  announced. 

The  new  test,  called  the  Denver  Develop- 
mental Screening  Test,  is  simple  to  admin- 
ister, easy  to  score,  and  can  be  used  for  re- 
peated evaluations  of  the  same  child.  De- 
veloped under  a National  Institutes  of 
Health  General  Research  Support  Grant, 
the  new  screening  tool  has  been  recom- 
mended to  the  Nation’s  pediatricians  by 
the  American  Academy  of  Pediatrics  and 
is  now  being  used  in  Project  Head  Start. 

Under  the  test  format,  an  individual 
child’s  performance  can  be  compared 
quickly  with  other  children  on  a standard- 
ized scale  for  four  major  functional  areas: 
gross  motor,  fine  motor-adaptive,  language, 
and  personal-social. 

The  new  test  is  not  an  intelligence  test, 
according  to  developers  Dr.  William  K. 
Frankenburg  and  Dr.  Josiah  B.  Dodds  of 
the  University  of  Colorado  School  of  Medi- 
cine. It  is  intended  mainly  as  a screening 
device  to  detect  children  with  developmen- 
tal delays. 

Test  Is  Not  Diagnostic 

“It  enables  the  examiner  to  note  wheth- 
er the  development  of  a particular  child  is 
within  normal  range,”  said  Dr.  Franken- 
burg. “The  test  does  not  enable  one  to 
make  a diagnosis;  it  is  intended  only  to 
alert  the  examiner  to  the  presence  of  a de- 
velopmental problem  which  needs  further 
investigation.  Of  course,  when  develop- 
mental delays  are  detected  during  infancy 
and  the  preschool  years,  it  significantly  in- 
creases the  opportunities  for  effective 
therapy.” 

The  new  test  is  made  up  of  105  test 
items  selected  from  a number  of  develop- 
mental and  preschool  intelligence  tests. 
These  items  were  administered  to  1,036 
healthy  Denver,  Colorado,  children  be- 
tween the  ages  of  two  weeks  and  six  years. 
The  ages  at  which  25,  50,  75,  and  90  per- 
cent of  the  children  passed  each  item  were 
calculated  for  25  different  age  categories. 


In  the  final  screening  test,  which  resulted 
from  the  normative  data  gathered  by  the 
investigators,  each  item  is  represented  by  a 
horizontal  bar  placed  along  the  age  contin- 
uum. Various  points  on  the  bar  illustrate 
the  specific  ages  at  which  a percentage  of 
the  children  passed  an  item.  For  example, 
for  the  test  item  “Walks  Well,”  the  left- 
hand  end  of  the  bar  designates  the  age 
(11.2  months)  at  which  25  percent  of  the 
children  could  walk  well  and  the  right- 
hand  end  of  the  bar  the  age  (14.3  months) 
at  which  90  percent  of  the  children  could 
walk  well. 

Collar  Color  of  Fathers 

As  the  developmental  screening  test  was 
being  standardized,  the  investigators  also 
calculated  norms  for  boys,  girls,  children 
whose  fathers  were  “blue  collar”  employees, 
and  children  whose  fathers  were  “white 
collar”  employees.  According  to  Dr.  Frank- 
enburg, who  did  not  include  differences  in 
various  segments  of  the  sample  on  the  final 
test,  there  were  few  marked  differences  be- 
tween the  ages  at  which  boys  and  girls  per- 
formed individual  test  items. 

“During  the  first  two  years  of  life  there 
were  also  no  marked  differences  in  the  ages 
at  which  children  of  parents  from  different 
occupational  groups  could  perform  the  test 
items,”  said  Dr.  Frankenburg.  “After  two 
years  of  age,  the  children  of  white  collar 
workers  performed  a number  of  language 
items  at  an  earlier  age  than  children  of 
blue  collar  workers.” 

Using  General  Research  Support  funds, 
Drs.  Frankenburg  and  Dodds  are  currently 
investigating  the  development  of  1,000 
Denver  children  whose  fathers  are  in  un- 
skilled occupations  with  the  idea  of  pos- 
sibly creating  a separate  test  for  use  in 
examining  these  children.  Neurological 
and  developmental  problems  are  more 
likely  in  children  from  this  group,  accord- 
ing to  Dr.  Frankenburg. 

The  Division  of  Research  Facilities  and 
Resources,  National  Institutes  of  Health, 
administers  the  General  Research  Support 
grants  under  which  the  Denver  Develop- 
ment Screening  Test  was  devised. 


22 


Illinois  Medical  Journal 


Diagnostic  Products  Sales,  The  Dow  Chemical  Company,  Midland,  Michigan  48640. 


Announcing  the  blood  chemistries  anyone  in  your  office  can  do. 

Those  using  Diagnostest*  reagents  and  instruments.  We  train  your  nurse 
or  medical  assistant  to  use  this  simple,  accurate  system.  For  measuring 
hemoglobin,  glucose,  cholesterol,  urea  nitrogen,  total  bilirubin  and  uric 
acid.  You  get  results  in  minutes.  And  the  system  includes  everything  you 
need.  Write  today  for  full  information.  *Tr'  emari'  Chemical 


Philip  G.  Thomsen,  M.D. 


You,  the  members  of  ISMS,  talked  cold 
turkey  to  us  officers  two  years  ago.  In  a 
poll  conducted  by  Opinion  Research  Cor- 
poration, a cross-section  of  you  appraised 
the  society  on  many  points.  Many  of  your 
responses  were  disturbing.  For  that  very 
reason  they  have  goaded  us  to  think  . . . 
and  act. 

One  question  was:  How  well  does  ISMS 
represent  the  wishes  of  the  membership  as 
a whole?  Of  the  1,145  members  who  re- 
sponded, 9 per  cent  gave  the  society  an 
excellent  rating  on  this  score;  32  per  cent, 
good;  26  per  cent,  fair;  14  per  cent,  poor. 
The  remaining  19  per  cent  had  no  opinion. 

In  short,  we  could  do  a better  job  of 
learning  your  views  on  controversial  issues 
. . . of  putting  your  views  into  prompt  and 
spirited  action. 

And  that’s  just  what  we  intend  to  do  . . . 
in  a fresh  and  exciting  way. 

We’re  mailing  you  a questionnaire  this 
month  on  many  issues  that  are  vital  to  you 
. . . to  medical  practice  ...  to  medicine’s 
relations  with  the  public  and  with  the  state 
and  nation.  We’re  asking  you  to  register 
your  opinions  on  such  questions  as  rising 
health  costs  . . . the  physician  shortage  . . . 
abortion  . . . welfare  problems. 

You  need  not  sign  your  name  unless  you 


wish  to  do  so.  Your  sentiments  are  enough. 

Your  responses  will  guide  us  in  every 
area  of  action,  including  our  legislative 
goals.  They  will  guide  my  fellow  officers 
and  me  when  we  speak  for  the  society  at 
rostrums,  on  TV  and  radio,  and  to  the 
press.  They  will  permeate  my  addresses  be- 
fore county  medical  societies  and  civic 
groups. 

Phil  Thomsen  will  not  be  speaking  just 
for  himself  or  for  the  Board  of  Trustees— 
but  for  you.  And  by  talking  in  mighty  uni- 
son, your  society  will  be  heard  better  in 
the  General  Assembly  ...  in  state  and  fed- 
eral agencies  ...  in  journalistic  circles,  and 
everywhere  else. 

Let’s  scotch  the  widely-held  notion  that 
organized  medicine  speaks  only  for  a seg- 
ment of  its  members.  Give  us  a majority 
voice  by  filling  out  and  returning  the  ques- 
tionnaire. Help  me  to  work  for  each  of 
you  . . . and  all  of  you! 


26 


Illinois  Medical  Journal 


Illinois  Medical  Journal 


volume  134,  number  1 


July,  1968 


Differentiation  Of  A Bifid  Ureter 
From  Ureteral  Diverticula 

By  Arnold  B.  Rubenstein,  Victor  R.  Jablokow  and  Frederick  A.  Lloyd/ Chicago 


Ureteral  diverticula  have  been  classically 
divided  into  congenital  or  true  and  ac- 
quired, or  false  groups.  A congenital  ure- 
terial  diverticulum  contains  all  layers  of 
the  ureteral  wall.  The  false  diverticulum 
does  not  contain  muscular  tissue  in  its  con- 
figuration and  usually  is  located  proximal 
to  an  area  of  ureteral  obstruction.  It  is  an 
acquired  entity  that  results  from  the  evag- 
ination  of  mucosal  lining  of  the  ureteral 
wall  through  its  muscular  coat. 

The  differentiation  between  a bifid  ure- 
ter and  multiple  congenital  ureteral  diver- 
ticula poses  no  problem.i  ^ However,  con- 
siderable confusion  still  exists  as  to  the  dif- 
ference between  a blind-ending  bifid  ure- 
ter and  a single  congenital  ureteral  diverti- 
culum. In  1933  Kretschmer  emphasized  the 
difference  stating  that  the  bifid  ureter  is  an 
abortive  attempt  to  duplication  which  re- 
sults from  premature  ureteral  bud  cleavage 
or  'Wolffian  duct  budding.^  The  true  diver- 
ticulum can  occur  either  from  malforma- 
tions similar  to  those  of  an  incompletely 
formed  bifid  ureter  or  secondary  to  a con- 
genital weakness  in  the  ureteral  wall.^ 

Radiological  Examination  Necessary 

The  differential  diagnosis  of  a blind-end- 


ing bifid  ureter  and  a diverticulum  rests  en- 
tirely on  radiological  examination,  as  both 
have  similar  histologic  appearance,  and 
there  are  no  differentiating  clinical  symp- 
toms. Radiologically,  the  bifid  ureter  is 
long,  narrow,  and  is  usually  located  close 
to  the  ureterovesical  junction.  It  joins  the 
normal  ureter  at  an  acute  angle,  and  the 
length  of  the  bifid  ureter  is  much  greater 
than  its  luminal  diameter.^  The  single  con- 
genital diverticulum,  on  the  other  hand,  is 
commonly  a round  to  ovoid  extra-ureteral 
sac.  The  length  often  approaches  the  size 
of  its  lumen,  and  the  point  of  origin  is  not 
necessarily  at  an  acute  angle  from  the  nor- 
mal ureter.  Furthermore,  its  position  is  not 
always  juxtavesical. 

In  1947,  Culp  found  52  ureteral  diverti- 
cula reported  in  the  literature  to  that  date. 
Only  ten  of  them  were  true  congenital  di- 
verticula. Fourteen  of  the  52  were  actually 
bifid  ureters.^  Though  the  two  entities 
(bifid  ureters  and  ureteral  diverticula)  may 
have  a similar  etiology  and  may  be  varying 
gradients  of  the  same  abnormality,  ana- 
tomically they  are  distinct,  and  the  follow- 
ing two  cases  attempt  to  illustrate  the  dif- 
ferences. 


Arnold  B.  Rubenstein,  M.D.,  is  a Surgical  Resident  in  Urology-  at 
the  Veterans  Administration  Hospital,  Hines.  He  received  his  M.D. 
from  the  Chicago  Medical  School  and  served  his  internship  at  Michael 
Reese.  He  has  also  served  a residency  in  Urology  at  the  Mayo  Clinic. 
Also  participating  in  the  preparation  of  this  paper  were  Victor  R.  Ja- 
blokow, M.D.  from  the  Department  of  Pathology,  Hines  V.A.  Hospital 
and  Frederick  A.  Lloyd,  M.D.,  from  the  Department  of  Surgery,  Hines. 


for  July,  1968 


33 


Case  No.  1 

A 69-year  old  Negro  male  was  admitted 
because  of  frequency  and  dysuria  of  three 
months'  duration.  Physical  examination, 
including  prostate,  was  not  remarkable. 
Urine  analysis  revealed  pyuria  and  bacter- 
iuria,  and  a culture  grew  coliform  organ- 
isms. Cystoscopic  examination  was  within 
normal  limits,  but  an  excretory  urogram 
suggested  a duplication  of  the  ureter  on  the 
right  side.  The  retrograde  pyelouretero- 
gram  on  that  side  showed  a diverticulum- 
like structure  or  bifid  ureter  (Fig.  1).  The 
patient  was  explored,  and  the  ureter  was 
identified  in  the  retroperitoneal  space.  Ly- 
ing alongside  the  normal  ureter  and  slight- 
ly adherent  to  it  was  a sac-like  structure, 
approximately  five  cm.  in  length,  with  a 
lumen  which  entered  the  ureter  one  cm. 
above  the  entrance  of  the  ureter  into  the 
bladder.  The  lesion  was  excised. 


Fig.  1.  Retrograde  pyeloureterogram  show- 
ing diverticulum-like  structure  suggesting  a du- 
plication of  the  ureter  on  the  right  side. 


The  specimen  received  in  the  laboratory 
revealed  an  elongated,  cylindrical  structure 
4.5  cm.  in  length  and  approximately  0.6  cm. 
in  diameter.  The  structure  had  an  opening 
at  one  end  while  the  other  end  was  closed 
in  a sac-like  fashion. 

This  diverticulum-like  structure  had 
smooth  mucosal  lining  with  focal  hemorr- 


Fig.  2.  Section  through  the  wall  that  con- 
tains all  normal  layers  of  the  ureter. 


hagic  discoloration.  Histologically  it  was 
lined  with  transitional  epithelium.  The 
wall  contained  all  layers  of  the  ureteral 
wall  (Fig.  2). 

The  patient’s  post  operative  course  was 
uneventful,  and  he  was  discharged  without 
symptoms.  Patient  has  had  no  complaints 
twenty  months  after  surgery,  and  urine  cul- 
tures have  remained  sterile. 

Case  No.  2 

A 38-year  old  white  female  patient  was 
admitted  because  of  sudden  onset  of  right 
lower  quadrant  pain  extending  into  the 
right  flank.  She  stated  that  for  the  last  sev- 
eral months  she  had  experienced  inter- 
mittent right  lower  quadrant  pain  but 
never  as  severe  as  the  present  episode.  Urine 
analysis  was  normal.  Excretory  urogram 
was  done  and  revealed  a diverticulum-like 
structure  located  at  the  junction  of  the 
middle  and  lower  thirds  of  the  right  ure- 
ter. The  patient  was  taken  to  surgery,  and 
a twisted,  infarcted  dermoid  cyst  (benign 
cystic  teratoma)  of  the  right  ovary  was 
found. 

Right  salpingo-oophorectomy  was  done. 
Patient  tolerated  procedure  well  and  has 
been  asymptomatic  for  twenty-one  months. 
No  definitive  therapy  for  the  ureteral  di- 
verticulum was  attempted. 


34 


Illinois  Medical  Journal 


Discussion 

With  the  presentation  of  the  above  cases, 
an  attempt  is  made  to  differentiate  between 
the  bifid-type  ureter  and  a true,  single,  con- 
genital ureteral  diverticulum.  As  illus- 
trated in  our  radiologic  studies,  the  lesion 
of  Case  No.  1 originated  adjacent  to  the 
bladder  and  was  long  and  narrow.  This  was 
consistent  with  a bifid-type  ureter.  Case 
No.  2 demonstrated  a shorter  lesion  with  a 
wider  lumen  that  originated  at  the  junc- 
tion of  the  middle  and  lower  thirds  of  the 
normal  ureter.  This  fit  the  criteria  of  a ure- 
teral diverticulum. 

As  was  illustrated  by  Fig.  2,  the  wall  of 
the  blind-ending  bifid  ureter  contained  all 
normal  layers.  The  histologic  pattern  of 
Case  2 is  expected  to  be  the  same,  but  no 
specimen  was  obtained  because  of  an  acute 
condition  in  another  organ  system.  This 
case  was  asymptomatic  urologically,  and  so 
one  wonders  whether  or  not  the  congenital 
diverticulum  may  be  more  common  than 
reported,  in  that  many  cases  lack  clinical 
symptoms.  In  the  case  reported,  the  lesion 
was  discovered  fortuitously. 

Summary 

Two  case  reports  of  ureteral  lesions  are 
presented  attempting  to  illustrate  the  ana- 
tomic differences  between  a bifidrtype  ure- 
ter and  a single  congenital  ureteral  diverti- 
culum. 


References 

1.  Williams,  J.  T.,  Goodwin,  W.  E.:  Congenital 
Multiple  Diverticula  of  the  Ureter,  Brit.  J. 
Urol.  37:299-301,  June,  1965. 

2.  Norman,  Calvin  H.,  Jr.  and  Dulowy,  Jerome: 
Multiple  Ureteral  Diverticula,  J.  Urol.  96:152- 
154,  1966. 

3.  Kretschmer,  H.  L.:  Duplication  of  the  Ureters 
at  their  Distal  Ends,  J.  Urol.  30:61-63,  1933. 

4.  Rank,  W.  B.,  Mellinger,  G.  T.,  Spiro,  E.: 
Ureteral  Diverticula:  Etiology  and  Considera- 
tions, J.  Urol.  83:566-570,  1960. 

5.  Culp,  O.  S.:  Ureteral  Diverticula:  Classification 
of  the  Literature  and  Report  of  an  Authentic 
Case,  J.  Urol.  58:309-321,  1947. 


Fig.  3.  Excretory  urogram  reveals  a diverti- 
culum-like  structure  of  the  right  ureter  at  the 
junction  of  the  middle  and  lower  thirds. 


Exercise  Care  in  Writing  Orders 


False  entries,  alterations  or  erasures  without  satisfactory  explanation  will 
cause  the  entire  record  to  be  suspect  and  can  destroy  the  doctor’s  credibil- 
ity as  a witness.  Erasures  are  more  difficult  to  explain  than  parts  which  are 
simply  crossed  out.  If  an  alteration  becomes  necessary,  a single  line  should 
be  passed  thru  each  sentence  with  no  effort  made  to  obliterate  the  words. 
The  signature  of  the  person  making  the  correction  should  follow  together 
with  the  date  of  the  change. 

Legible  writing  is  essential  when  orders  are  to  be  carried  out  by  others. 
This  is  especially  true  where  symbols  or  abbreviations  are  used.  A nurse 
misread  the  dram  symbol  in  a prescription  as  an  ounce  symbol  and  admin- 
istered three  ounces  of  paraldehyde  instead  of  the  prescribed  three  drams. 
A written  It.  (for  left)  was  read  as  an  rt.  (for  right),  and  the  wrong  foot  was 
operated.  The  Doctor  and  the  Law,  The  Patient’s  Record  In  Court.  No.  2, 
by  the  Law  Department  of  the  Medical  Protective  Company,  Fort  Wayne, 
Ind.  (1968). 


for  July,  1968 


35 


THE  VIEW  BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Diagnostic  Radiology,  Cook  County  Hospital, 
and  Clinical  Professor  of  Radiology,  Chicago  Medical  School 


Fig.  1 


History.  This  34-year-old  male  patient  was 
brought  into  the  hospital  following  an  auto- 
mobile accident.  He  complained  of  short- 
ness of  breath  when  lying  on  his  left  side. 
Physical  examination  revealed  some  dull- 
ness at  the  left  base.  The  blood  pressure 
wass  100/60. 


What’s  your  diagnosis? 


Fig.  2 


Fig.  3 


(Answer  on  page  102) 


36 


Illinois  Medical  Journal 


Medical  Progress  in  the  Severely  Affected 
Rh-Sensitized  Pregnancy 

By  William  M.  Alpern^  M.D.,  Allan  G.  Charles,  M.D.,  Emanuel  A.  Friedman,  M.D., 
Med.Sc.D.,  Antonio  Scommegna,  M.D.,  Alan  R.  Silverman,  M.D.,  and  Paul  Wu,  M.D./ 

Chicago 


The  patient  with  Rh-isoimmunization 
presenting  with  an  infant  with  far-ad- 
vanced erythroblastosis  in  utero  is  a special 
problem  warranting  intensive,  aggressive 
care  and  attention.  Recent  advances  not- 
withstanding, if  we  are  to  continue  to  im- 
prove the  previously  very  poor  outlook  for 
these  infants,  we  must  delve  deeply  to  assess 
our  approach  and  seek  means  to  correct  de- 
ficiencies. Additionally,  unexplored  areas 
of  potential  relevance  are  probed. 

Case  Presentations 
(Dr.  Alan  Silverman) 

Case  1.  B.  W.  (M.R.H.  # 237-217)  is  a 
34  year  old  white  female,  gravida  3,  para  3 
with  one  living  child.  Her  estimated  date 
of  confinement  was  April  17.  She  is  Rh  neg- 
ative and  sensitized.  She  was  admitted  on 
March  8.  This  patient  gives  a history  of 
fetal  loss  with  her  last  pregnancy.  An  am- 
niocentesis performed  elsewhere  at  3 3 1/2 
weeks’  gestational  age  showed  a spectro- 
photometric  optical  density  peak  at  450m^ 
of  0.26  units.  This  was  repeated  on  March 
3 at  34  weeks  and  revealed  a curve  consis- 
tent with  meconium.  The  urinary  estriol 
on  March  7 was  5 mg./24  hr.  On  admission 
the  patient’s  general  physical  examination 
was  within  normal  limits.  The  fetal  weight 
was  felt  to  be  small.  Fetal  heart  tones  were 
normal.  Fetal  movements  were  good.  The 
cervix  was  long  and  closed.  Her  admission 
diagnosis  was  severe  erythroblastosis  fetalis, 
with  the  fetus  in  dire  jeopardy.  On  March 
8 the  patient  underwent  classical  cesarean 
section  plus  bilateral  Irving  tubal  ligation. 
The  post-operative  course  was  uneventful 
and  she  was  discharged  on  the  seventh  post- 
operative day. 

The  infant  girl  weighed  1540  gm.  and 
was  described  as  pale  with  a good  cry.  The 
cord  hemoglobin  was  2.3  gm.%  with  a hem- 
atocrit of  11%.  The  infant  underwent  an 
immediate  exchange  transfusion  with 
packed  red  blood  cells.  The  pre-exchange 


A SYMPOSIUM 

hemoglobin  was  5 gm.%;  the  post-exchange 
23  gm.%.  The  pre-exchange  bilirubin  was 
8.4  mg.%,  with  a free  fraction  of  4.1  mg.%; 
post-exchange  7.5  mg.%  with  a free  fraction 
of  3.0  mg.%.  The  same  evening  the  infant 
underwent  a second  exchange  transfusion. 
The  pre-exchange  transfusion  bilirubin 
was  10.8  mg.%;  post-exchange  8.0  mg.%. 
The  infant  was  digitalized.  Two  days  after 
delivery  the  infant  was  noted  to  have  cof- 
fee-ground emesis.  Her  bilirubin  was  25.2 
mg.%  with  a glucuronide  fraction  of  16.8 
mg.  %.  Liver  damage  was  suspected  be- 
cause of  the  increased  glucuronide  fraction 
and  a possible  bleeding  tendency. 


Medical  Progress 


Harvey  Kravitz,  M.D. 
Medical  Progress  Editor 


The  infant  was  noted  to  have  a high- 
pitched  cry  and  this  brought  up  the  ques- 
tion of  a possible  central  nervous  system 
bleed.  On  the  third  day  after  delivery  the 
infant  underwent  another  exchange  trans- 
fusion. Pre-exchange  bilirubin  was  17.5 
mg.%;  post-exchange  11.5  mg.%.  Subse- 
quently on  the  same  day,  the  infant  was 
noted  to  have  abdominal  distention.  A flat 
plate  of  the  abdomen  was  normal.  The 
SCOT  and  SGPT  were  elevated,  confirm- 
ing the  possibility  of  liver  damage.  On 


for  July,  1968 


37 


March  21  the  hemoglobin  was  down  to  9.5 
gm.%.  This  was  a decrease  of  4.3  gm.%  in 
5 days.  The  infant  was  transfused  with 
packed  red  cells.  Because  of  persistent 
heart  murmur,  a cardiological  evaluation 
was  obtained.  The  impression  was  a pos- 
sible patent  ductus  arteriosus,  but  no  fur- 
ther treatment  was  advised  at  this  time. 
The  infant  was  discharged  on  April  10,  at 
age  one  month  in  good  condition.  Coombs 
test  at  this  time  was  still  strongly  positive. 

Case  2.  L.  B.  (M.R.H.  # 161-244)  is  a 
34  year  old  Negro  female,  gravida  11,  para 
8,  abortus  2,  with  3 living  children,  blood 
type  B,  Rh  negative,  and  serology  negative. 
Her  estimated  date  of  confinement  was 
May  11,  1967.  She  was  first  seen  in  the  pre- 
natal clinic  in  December,  1966  during  her 
early  second  trimester.  Her  past  obstetrical 
history  reveals  3 living  children,  3 still- 
births, 2 neonatal  deaths  and  2 abortions. 
Her  first  pregnancy  was  in  1949  and  was  as- 
sociated with  antepartum  bleeding  for 
which  she  was  transfused.  The  infant  was 
stillborn.  This  was  followed  by  2 normal 
term  deliveries;  then  there  was  2 erythro- 
blastotic  infants  both  of  which  died  (the 
second  after  exchange  transfusions  at  the 
age  of  2 months).  Her  sixth  and  seventh 
pregnancies  terminated  in  first  trimester 
abortions.  Her  eighth  pregnancy  was  un- 
eventful and  her  ninth  and  tenth  both 
terminated  in  stillbirths.  She  had  renal  in- 
fection with  a positive  urine  culture  during 
this  pregnancy,  treated  with  Ampicillin. 
Her  husband  is  Rh  positive,  homozygous. 
Her  Rh  antibody  titer  at  18  weeks’  gesta- 
tion was  1:32  and  remained  at  1:64  to  the 
thirtieth  week. 

On  February  24  at  29  weeks’  gestation,  an 
amniocentesis  revealed  yellow  fluid.  Spec- 
trophotometrically,  at  450m^  the  delta-O.D. 
was  0.23  units,  consistent  with  a severely 
affected  infant.  At  30  weeks’  gestation  on 
March  4,  the  patient  had  an  intrauterine 
fetal  transfusion  with  140  ml.  of  type  O, 
Rh  negative  packed  red  cells.  On  March  19 
the  patient  was  readmitted  for  a second  in- 
trauterine transfusion  at  32  weeks’  gesta- 
tion. This  time  the  fetus  was  transfused 
with  160  ml.  of  packed  red  cells.  The  pa- 
tient was  discharged  with  plans  to  readmit 
in  2 weeks  for  delivery. 

At  29  weeks  the  estriol  was  2.2  mg/24  hr. 
which  is  normal;  at  30  weeks’  it  was  3.4  and 
6.9;  at  32  weeks’  it  was  4.9  and  4.1.  Simul- 
taneously, there  were  progressively  rising 


pregnanediol  levels. 

On  April  3 she  was  readmitted  at  34 
weeks’  gestation.  The  estimated  fetal 
weight  was  4p^  lbs.  The  cervix  was  long 
and  closed.  On  April  5 the  patient  under- 
went a low  cervical  cesarean  section  plus 
bilateral  tubal  ligation.  The  mother’s  post- 
operative course  was  uncomplicated  and 
she  was  discharged  on  her  seventh  post- 
operative day. 

The  infant  weighed  2005  gm.  It  was  pink 
with  good  respiration  and  good  heart  beat. 
There  was  no  splenomegaly.  The  liver  was 
palpated  1-2  cm.  below  the  right  costal 
margin.  The  general  physical  examination 
was  within  normal  limits.  There  were  2 
puncture  marks  noted  on  the  right  lumbar 
region  and  one  in  the  right  inguinal  area. 
Cord  blood  revealed  a hemoglobin  of  17.8 
gm.%  and  a hematocrit  of  48%.  The  cord 
blood  was  type  O,  Rh  negative,  Coombs 
negative.  It  contained  98  per  cent  adult 
hemoglobin.  The  bilirubin  of  the  cord 
blood  was  2.9  mg.%.  On  the  first  day  of 
life  the  infant’s  bilirubin  rose  to  18  mg.%; 
then  down  to  15  mg.%;  and  finally  to  12.4 
mg.%  and  remained  at  these  levels  for  the 
rest  of  the  course.  An  x-ray  on  April  6 was 
obtained  because  the  infant  had  abdomin- 
al distention,  and  it  was  interpreted  as 
normal.  At  age  20  days  the  infant  was 
feeding  well,  color  was  good,  cry  was  good. 
The  blood  type  was  still  0,  Rh  negative. 

Principles  of  Management 
(Dr.  William  M.  Alpem) 

These  two  cases  are  actually  quite  simi- 
lar, but  the  time  of  appearance  at  the  clinic 
is  the  critical  distinguishing  aspect.  Both 
had  a history  of  previous  fetal  losses  due  to 
erythroblastosis  and  presented  with  current 
evidence  of  severe  intrauterine  erythroblas- 
tosis. The  first  patient  was  seen  originally 
at  34  weeks’  gestational  age.  We  felt  that, 
with  evidence  of  a high  optical  density 
peak  of  the  amniotic  fluid,  it  was  perhaps 
a little  too  late  to  do  an  intrauterine  trans- 
fusion. The  reasoning  behind  this  was  that 
the  mortality  from  a preterm  delivery  at 
this  time  would  probably  be  equal  to  or 
less  than  that  associated  with  intrauterine 
transfusion.  The  original  amniocentesis 
was  done  at  another  hospital.  We  repeated 
the  tap  and  found  that  the  analysis  was 
compatible,  in  our  opinion,  with  the  pres- 
ence of  meconium  in  the  fluid.  We  were  un- 
able to  interpret  the  graph  further  from  the 


38 


Illinois  Medical  Journal 


standpoint  of  bilirubin  analysis.  Perhaps 
this  meant  impending  fetal  distress  or 
even  demise.  An  estriol  determination  re- 
vealed a rather  low  level.  Amniography  did 
not  show  evidence  of  hydrops  fetalis. 
Prompt  delivery  was  felt  to  be  indicated. 
As  was  described,  at  delivery  the  infant  was 
seriously  ill.  Under  expert  pediatric  man- 
agement, it  survived. 

We  performed  an  amniocentesis  on  the 
second  patient  at  28  weeks’  gestational  age. 
Here,  too,  the  fluid  analysis  showed  a high 
bilirubin  peak.  The  history  of  fetal  loss 
was  similiar  to  the  first  case.  Amniocentesis 
was  repeated  to  verify  the  fact  that  severe 
fetal  embarassment  existed.  We  elected  to 
perform  an  intrauterine  transfusion.  The 
patient  at  that  time  was  in  her  twenty-ninth 
week  of  gestation.  We  carried  out  2 intrau- 
terine transfusions  2 weeks  apart,  and  de- 
livered the  patient  approximately  3 weeks 
after  the  last  intrauterine  transfusion. 
There  was  some  difficulty  with  the  second 
intrauterine  transfusion.  However,  after 
managing  to  place  the  needle  in  the  peri- 
toneal cavity,  the  blood  was  administered 
with  ease.  The  baby  was  delivered  by  ce- 
sarean section  at  a similar  period  of  preg- 
nancy as  the  first  case  presented,  namely  35 
weeks.  The  infant  demonstrated  erythro- 
blastosis. Its  clinical  condition  at  birth  was 
nevertheless  quite  good.  It  had  a good  cord 
hemoglobin  and  it  responded  well  to  neo- 
natal care.  The  verification  of  our  in- 
trauterine transfusion  was  by  determining 
the  presence  of  98  per  cent  adult  hemoglob- 
in in  the  cord  blood  sample.  Ordinarily, 
fetal  hemoglobin  constitutes  about  95  to  98 
per  cent.  The  adult  hemoglobin  is  evidence 
of  circulating  transfused  blood,  because 
adult  blood  was  used  to  transfuse  the  fetus. 

Optical  Density  Peaks  Established 

We  have  cared  for  159  Rh  sensitized 
pregnant  patients  over  the  last  few  years. 
On  the  basis  of  our  experience,  we  have 
constructed  a probability  graph  com- 
paring the  optical  density  of  the  am- 
niotic  fluid  with  the  cord  hemoglobin  at 
birth.  We  have  divided  this  basically  into 
3 categories:  low,  mid  and  high  range 
values  of  optical  density  peaks  at  450m^. 
The  low  range  is  from  zero  to  0.07  units. 
In  this  range  will  usually  fall  all  Rh  nega- 
tive infants  and  all  mildly  affected  or  un- 
affected Rh  positive  infants.  This  graph  in- 
dicates a predictable  hemoglobin  range  of 


12.5  gm.%  to  above  18  gm.%,  which  is 
rather  good  for  a newborn  infant.  The  mid- 
range values  are  from  0.07  to  0.17  units. 
The  lower  the  optical  density  value  in  the 
midrange,  the  less  affected  the  infant,  and 
the  higher  value,  the  more  seriously  in- 
volved. The  range  of  hemoglobin  in  this 
group  is  from  approximately  11  to  6 gm.%. 

The  high  range  of  values  is  from  0.17 
units  up.  Herein  lie  the  seriously  ill  in- 
fants who  will  most  likely  succumb  if  no 
treatment  is  performed  or  early  delivery  is 
not  carried  out.  We  have  a small  group  of 
control  studies  in  the  very  beginning  of  our 
investigation  when  we  were  not  perform- 
ing intrauterine  transfusions.  Many  of 
these  cases  came  to  us  quite  late  and  they 
all  had  values  above  0.17  units.  Therapy 
was  rather  simple  in  that  most  of  the  time 
nothing  was  done  or  delivery  was  effected 
too  late.  All  of  these  infants  succumbed  to 
their  disease.  Most  were  stillborn.  The  ones 
that  were  born  alive  were  usually  hydropic. 
The  hydropic  infant  is  basically  untreat- 
able. 

Therapy  for  the  3 ranges  is  rather  simple. 
The  patient  in  the  low  range  from  0 to 
0.07  can  safely  be  delivered  at  or  near  term 
either  by  elective  induction  of  labor  (if 
conditions  are  favorable)  or  by  awaiting  the 
spontaneous  onset  of  labor.  The  cases 
whose  values  fall  between  0.07  and  0.17 
should  be  watched  very  closely.  Amniocen- 
tesis should  be  repeated  each  week  or  two 
depending  on  whether  the  value  is  in  the 
lower  or  the  upper  part  of  the  midrange. 
The  therapy  here  consists  mainly  of  pre- 
term delivery  between  34  and  37  weeks.  In 
our  experience  the  great  majority  of  these 
patients  will  be  delivered  by  abdominal 
route,  because  at  this  stage  of  pregnancy 
we  feel  that  a difficult  or  lengthy  induction 
of  labor  probably  jeopardizes  the  fetus  to 
some  extent.  In  the  upper  range  we  feel 
that  there  are  two  forms  of  therapy  avail- 
able to  the  patient.  If  the  patient  presents 
prior  to  her  thirty-second  week  of  preg- 
nancy, we  feel  that  intrauterine  transfusion 
is  probably  indicated.  After  32  weeks  of 
gestation  (and  closer  to  34  weeks),  imme- 
diate delivery  is  probably  indicated  if  hy- 
drops fetalis  is  not  present.  The  cases  pre- 
sented were  managed  with  these  two  types 
of  therapy. 

Results  Reported 

Our  results  in  these  159  cases  include  an 


for  July,  1968 


59 


uncorrected  mortality  of  approximately  35 
per  cent,  representing  55  babies  that  were 
lost.  Although  this  does  not  sound  like  a 
very  good  figure,  it  reflects  the  special  pop- 
ulation of  severely  affected  infants  with 
which  we  are  dealing.  Most  of  the  cases  are 
referred  to  us.  In  the  last  two  years,  most 
have  been  of  the  severe  variety  and  many 
have  appeared  too  late,  with  hydropic  or 
dead  infants  when  they  were  first  examined 
by  us.  When  one  divides  our  material  into 
the  low,  mid  and  high  ranges,  the  figures 
are  a little  more  encouraging.  The  low 
range  0 to  0.07  represents  75  cases  of  which 
74  survived.  The  one  infant  lost  was  de- 
livered at  term,  after  a spontaneous  labor, 
and  died  during  an  exchange  transfusion. 
In  retrospect,  it  is  the  feeling  of  the  group 
that  the  exchange  transfusion  was  perhaps 
not  indicated  and  this  infant  might  have 
survived  had  it  not  been  done.  There  is 
still  a definite  risk  in  exchange  transfusion 
and,  therefore,  it  should  not  be  undertaken 
lightly.  The  uncorrected  mortality  among 
the  75  patients  in  the  low  range  was  1.3  per 
cent.  Actually  this  should  probably  have 
been  zero. 

In  the  midrange,  we  have  the  moderately 
sick  and  sometimes  quite  sick  infants. 
There  were  31  patients  in  this  group,  and 
11  infants  succumbed.  One  probably  died 
as  a result  of  amniocentesis.  We  probably 
lacerated  a placental  vessel,  although  this 
could  not  be  definitely  demonstrated.  This 
infant  died  within  24  hours  after  the  am- 
niocentesis. The  mortality  in  the  midrange 
is  35  per  cent.  This  is  quite  high.  However, 
many  were  very  sick  infants  and  the  ma- 
jority of  these,  surprisingly,  were  neonatal 
deaths.  Most  occurred  near  the  beginning 
of  our  series.  Since  then  we  have  better  or- 
ganization, including  a “team”  approach, 
and  a better  idea  of  how  to  take  care  of 
these  seriously  ill  infants.  Our  mortality 
has  improved  in  the  last  year  or  two. 

In  the  higher  range  (above  0.17)  we  have 
52  cases.  Many  of  these  have  been  referred 
after  an  amniocentesis  had  been  performed 
at  another  hospital  where  it  was  recognized 
that  the  patient  needed  intrauterine  trans- 
fusion. Of  52  patients,  we  lost  43  babies. 
This  represents  a mortality  of  82  per  cent. 
This  is  an  improvement  over  the  previous 
nearly  100  per  cent  mortality.  Of  the  9 sur- 
vivors, 7 had  intrauterine  transfusions  and 
2 had  premature  deliveries. 


Laboratory  Aid 
(Dr.  Antonio  Scommegna) 

It  has  been  reported  in  the  literature 
that  estriol  determinations  in  erythroblas- 
tosis are  not  as  revealing  as  they  might  be 
in  other  conditions  such  as  diabetes,  toxe- 
mia or  postmaturity.  The  reason  for  this 
is  presumed  to  be  that  there  is  a possibility 
that  the  mechanism  involved  in  the  normal 
production  of  estriol  is  augmented  in  ery- 
throblastotic  babies.  In  fact,  in  mildly  af- 
fected babies  we  have  seen  the  highest 
values  of  estriols  that  we  have  recorded  in 
our  laboratory.  This  is  perhaps  related  to 
the  fact  that  these  babies  have  large  pla- 
centas and  large  livers.  We  know  that 
aromatization  of  neutral  steroids  (which 
are  the  precursors  of  estrogens  and  estriol 
in  particular)  takes  place  in  the  placenta 
and  hydroxy lation  in  position  16,  which 
is  necessary  for  estriol  production,  takes 
place  in  the  liver.  The  mechanism  is  a 
question  of  production,  so  to  speak,  and  is 
very  effective  in  these  babies  due  to  the 
large  placenta  and  large  liver. 

However,  once  the  fetus  has  been  jeopar- 
dized, that  is— the  fetus  is  suffering  or  in 
severe  danger,  we  see  a decrease  in  the  es- 
triol. This  has  been  recognized  in  other 
series  as  well.  Notwithstanding,  the  value 
of  estriol  determination  in  erythroblastosis 
is  still  very  limited.  One  of  these  cases 
shows  when  it  can  be  useful.  Although 
amniocentesis  is  a much  more  powerful 
tool  in  diagnosing  and  managing  these  in- 
fants, when  the  amniocentesis  for  some  rea- 
son is  unreliable,  whether  because  there  is 
contamination  by  meconium  or  by  blood, 
estriol  might  be  useful.  In  these  cases,  low 
estriol  or,  much  more  importantly,  a drop 
in  estriol  can  indicate  fetal  jeopardy  and 
immediate  delivery  is  sometimes  indicated, 
as  in  the  first  case. 

It  is  difficult  to  explain  the  low  estriol  in 
the  second  case.  Here  the  outcome  was  good 
in  spite  of  the  rather  low  estriol  noted 
about  the  twenty-ninth  to  thirtieth  week  of 
gestation.  Most  cases  with  low  estriol  excre- 
tion levels  have  terminated  in  fetal  or  neo- 
natal death.  However,  in  this  case  I think 
the  intrauterine  transfusion  might  have 
been  instrumental  in  saving  this  baby.  The 
estriol  level  went  up  somewhat  but  cer- 
tainly it  was  always  in  the  low  range.  We 
would  have  predicted  fetal  death  if  it  were 
not  for  these  intrauterine  transfusions.  The 
urinary  estriol  might  help  somewhat  in 


40 


Illinois  Medical  Journal 


these  cases.  However,  its  value  is  secondary 
to  the  other  armamentarium  that  we  have 
available. 

Of  importance  in  these  cases  might  be 
amniotic  fluid  estriol.  We  do  not  have 
enough  data  as  yet,  but  it  seems  that  there 
is  a much  larger  decrease  in  the  amniotic 
fluid  estriol  as  compared  to  urinary  estriol. 
This  drop  may  also  occur  earlier.  Another 
noteworthy  feature  is  the  pattern  of  con- 
jugation of  estriol  in  the  amniotic  fluid. 
In  erythroblastotic  infants  this  may  be  dif- 
ferent from  normal  conjugation  in  that  the 
glucosiduronate  fractions  appear  to  be  de- 
creased. However,  these  data  still  are  pre- 
liminary. 

Intrauterine  Transfusion 
(Dr.  Allan  G.  Charles) 

We  have  performed  50  intrauterine 
transfusions  on  34  different  patients  so  far, 
of  which  we  only  have  7 survivors.  This  is 
an  uncorrected  fetal  survival  rate  of  only 
20  per  cent.  However,  two  of  the  babies 
that  were  born  alive  and  died  could  well 
count  as  successes.  One  had  a very  high 
cord  hemoglobin  with  a high  percentage  of 
adult  hemoglobin,  but  the  baby  unfortun- 
ately had  congenital  absence  of  the  kid- 
neys and  therefore  had  no  chance  from  the 
very  beginning.  The  second  baby  illustrates 
how  vulnerable  we  may  be.  This  is  one  of 
the  reasons  we  try  to  time  our  deliveries 
for  early  in  the  week  and  early  in  the  day. 
This  baby  was  born  with  a reasonably  good 
hemoglobin,  but  developed  kernicterus  be- 
cause the  pediatricians  following  the  baby 
were  misinformed  by  the  laboratory,  the 
bilirubin  being  reported  low.  When  it  w^as 
discovered  that  there  were  laboratory  er- 
rors, the  baby  already  had  developed  ker- 


nicterus and  died.  Therefore,  if  these  2 cases 
were  counted  as  technical  successes,  the 
overall  survival  rate  would  have  been  27 
per  cent.  This  includes  10  cases  in  which 
there  was  hydrops  fetalis  with  no  hope  for 
survival.  We  did  these  cases  and  have  in- 
cluded them  in  our  series.  The  hydropic 
babies  are  the  easiest  babies  to  transfuse  be- 
cause the  large  abdomen  is,  of  course, 
much  easier  to  reach  with  a needle.  How- 
ever, although  many  of  these  cases  were 
born  alive,  they  were  very  severely  affected 
and  in  addition  had  had  very  difficult  de- 
liveries because  of  soft  tissue  dystocia.  We 
have  become  much  more  selective  recently 
and  no  longer  transfuse  hydropic  fetuses.  In 
the  absence  of  hydrops,  the  overall  survival 
rate  was  38  per  cent  corrected  or  30  per  cent 
uncorrected.  The  fetal  deaths  due  to  the 
procedure  itself,  including  all  babies  dying 
shortly  after  the  procedure  regardless  of 
actual  cause,  totalled  4 in  the  50  intrauter- 
ine transfusions,  an  8.0  per  cent  mortality 
rate  per  transfusion.  This  is  much  lower 
than  the  average  20  per  cent  recorded  by 
Bowman  and  Friesen  in  Winnipeg.  It  is 
important  to  realize  that  every  time  an  at- 
tempt at  intrauterine  transfusion  is  made 
a similar  risk  rate  exists. 

We  have  devised  a classification  which 
categorizes  patients  for  intrauterine  trans- 
fusions in  the  same  way  cases  of  carcinoma 
of  the  cervix  are  staged.  It  is  not  quite  the 
same  to  do  an  intrauterine  transfusion  on 
a 24  week  fetus  (according  to  Bowman  and 
Friesen  with  a mortality  rate  per  procedure 
of  50  per  cent)  as  doing  it  on  a 32  week 
fetus.  There  is  a real  need  for  a more  uni- 
form method  of  reporting  the  results  based 
on  the  degree  of  severity  or  the  timing  of 
the  need  for  transfusion.  Clearly,  the  ear- 


Authors  (from  left)  Emanuel  A.  Friedman,  M.D.,  Professor  and  Chairman,  Department  of  Ob- 
stetrics and  Gynecology,  Chicago  Medical  School  and  Michael  Reese  Hospital;  Allan  G.  Charles, 
M.D.,  a specialist  in  OB-GYN,  graduate  of  New  York  University  School  of  Medicine  and  attending 
at  Michael  Reese;  William  M.  Alpem,  M.D.,  Clinical  Assistant  Professor  of  OB-GYN  at  the  Chicago 
Medical  School  and  Associate  in  attendance  at  Michael  Reese  Hospital;  Antonio  Scommegna,  M.D., 
from  the  University  of  Bari,  Italy,  attending  physician  in  OB-GYN,  Michael  Reese  Hospital  and 
Director  of  the  Section  on  Gynecic  Endocrinology;  Alan  R.  Silverman,  M.D.,  Chief  Resident  in 
OB-GYN  at  Michael  Reese  Hospital,  a graduate  of  the  University  of  Cincinnati.  In  addition,  Paul 
Wu,  M.D.  from  the  staff  of  Michael  Reese  contributed.  All  physicians  are  affiliated  with  the  Chi- 
cago Medical  School. 


for  July,  1968 


41 


Her  the  transfusion,  the  more  severe  the 
cases. 

Four  of  our  earlier  losses  were  due  to  pre- 
maturity. We  seem  to  have  reduced  this 
problem  by  the  use  of  Ampicillin  and  isox- 
suprine.  We  are  not  sure  whether  this  is 
factitious,  or  represents  an  actual  improve- 
ment in  our  technique,  or  is  the  result  of 
the  use  of  Ampicillin  and  isoxsuprine. 
Liley  suggested  that  premature  labor  may 
be  due  to  a low  grade  amnionitis.  Although 
we  have  seen  no  overt  infections  either  be- 
fore or  after  we  have  used  the  Ampicillin, 
we  have  not  had  any  cases  of  premature 
labor  since  we  began  to  use  it.  We  will 
therefore  continue  to  use  it  empirically. 

Avoid  Error  of  False  Reading 

It  is  important  to  emphasize  that  the  di- 
rection of  change  in  the  curves  is  most  im- 
portant. We  rarely  use  a single  amniocen- 
tesis to  make  a decision.  We  take  into  con- 
sideration the  husband’s  zygosity,  the  pre- 
vious obstetrical  history  and  the  size  and 
change  of  the  pertinent  peak  of  the  amni- 
otic  fluid  curves.. This  latter  avoids  the  er- 
ror of  false  positive  readings.  High  zone 
curves  have  been  reported  in  Rh  negative 
fetuses.  The  question  arises  as  to  whether 
this  second  baby  is  Rh  positive  or  negative. 
Since  the  estriol  and  the  repeated  curves  in- 
dicated a severely  affected  fetus,  the  fact 
that  the  baby  is  still  Rh  negative  does  not 
mean  that  it  is  indeed  basically  Rh  nega- 
tive. In  all,  98  per  cent  of  its  hemoglobin 
was  adult  hemoglobin  and,  therefore, 
transfused  blood.  The  life  expectancy  of 
transfused  cells  should  be  (since  we  always 
use  fresh  cells)  120  days.  I think,  therefore, 
in  one  month  one  would  not  expect  to  see 
the  conversion  to  Rh  positivity.  This  case 
certainly  represents  the  acme  of  success  in 
intrauterine  transfusion.  Actually,  it  repre- 
sents to  me  the  possibility  that,  when  there 
is  a highly  successful  intrauterine  transfu- 
sion, the  fetus  can  perhaps  be  left  in  utero 
much  longer  than  was  previously  antici- 
pated. The  baby  could  perhaps  have  had  an- 
other 2 weeks  in  utero  to  provide  for  great- 
er maturity. 

Pediatric  Considerations  (Dr.  Paul  Wu) 

In  the  follow-up  of  infants  who  have  re- 
ceived intrauterine  blood  transfusion,  we  in 
pediatrics  have  to  reorient  our  thinking  as 
to  the  type  of  infant  with  which  we  are 
dealing.  They  differ  significantly  in  the  de- 


gree of  severity  from  that  which  we  are 
used  to  seeing.  Our  assessment  of  these  in- 
fants must  be  adjusted  accordingly.  We 
have  to  gather  data  in  order  to  learn  how 
to  assess  them.  The  first  thing  we  are  par- 
ticularly concerned  with  in  infants  who 
have  received  intrauterine  blood  transfu- 
sion is  the  percentage  and  the  type  of  hemo- 
globin that  these  infants  have  at  the  time  of 
delivery.  Before  the  era  of  intrauterine 
transfusion,  estimation  of  the  percentages 
of  adult  or  fetal  hemoglobin  was  the  excep- 
tion rather  than  the  rule.  After  an  intrau- 
terine blood  transfusion  this  is  imperative 
because  it  does  give  some  indication  of  the 
success  of  the  treatment  as  well  as  other 
pertinent  points  which  we  will  discuss 
shortly. 

In  relating  the  percentage  of  fetal  hemo- 
globin concentration  to  preterm,  term,  or 
postterm  infants,  the  gestational  age  rather 
than  the  birth  weight  should  be  employed. 
The  greater  validity  of  gestational  age  as 
an  index  is  to  be  expected  because  replace- 
ment of  hemoglobin  by  the  adult  hemo- 
globin is  essentially  a maturation  process 
that  is  not  of  necessity  connected  with  body 
growth.  This  is  illustrated  by  the  finding  of 
identical  hemoglobin-F  concentrations  in 
dizygotic  twins.  Also  we  find  contrasting 
cases  of  low  birthweight  infants  who  have  a 
certain  percentage  of  hemoglobin-F  and  dys- 
mature  infants  of  the  same  birthweight 
with  much  higher  concentrations  of  hemo- 
globin-A.  Although  most  workers  have 
found  significant  differences  in  the  hemo- 
globin-F concentrations  in  groups  of  pre- 
term, term,  and  post-term  infants,  there  is 
a wide  range  of  values  among  these  infants 
at  any  particular  gestational  age.  This  pre- 
vents prediction  of  gestational  age  by  us- 
ing hemoglobin-F  concentrations  in  in- 
dividual infants.  The  best  correlation  is 
obtained  when  the  ratio  of  hemoglobin-F 
concentration  to  birth  weight  in  kilo- 
grams is  charted  against  gestational  age.  A 
reasonably  good  linearity  and  minimal  scat- 
ter is  obtained  and  a 95  per  cent  confidence 
range  of  prediction  can  be  achieved. 

Hemoglobin  Level  Maintenance 

Our  data  on  the  ratio  of  the  hemoglobin- 
F in  cord  blood  showed  that  the  intrauterine 
blood  transfusion  had  been  entirely  suc- 
cessful in  the  majority  since  the  fetal: adult 
hemoglobin  ratio  was  extremely  low.  When 
the  percentage  of  hemoglobin-A  is  plotted 


42 


Illinois  Medical  Journal 


against  the  number  of  days  after  the  last 
intrauterine  transfusion,  we  see  that  if  the 
infant  is  born  within  48  hours,  the  percen- 
tage of  hemoglobin-A,  the  adult  type,  is 
low.  This  would  indicate  that  it  takes  an 
interval  of  at  least  24  to  48  hours  before  an 
adequate  level  of  hemoglobin-A  is  ab- 
sorbed. This  approach  also  shows  that  an 
adequate  level  can  be  maintained  for  a per- 
iod of  up  to  about  2 weeks.  After  2 weeks 
there  is  a tendency  for  the  hemoglobin  to 
fall  again.  This  suggests  that,  where  it  is 
necessary  to  repeat  intrauterine  blood 
transfusions,  one  should  aim  for  about  a 2 
week  interval  rather  than  waiting  longer. 
In  one  or  two  of  our  cases  we  have  tended 
to  procrastinate  because  of  the  success  of 
the  previous  transfusion;  in  these  we  have 
encountered  some  trouble  because  we  have 
waited  too  long.  We  saw  the  hemoglobin 
fall,  apparently  because  of  the  increase  in 
the  size  of  the  infant,  the  blood  volume, 
and  the  production  of  fetal  cells. 

Plotting  the  per  cent  of  hemoglobin-A 
against  the  number  of  intrauterine  blood 
transfusions,  we  find  that  as  far  as  the  hem- 
oglobin-A is  concerned  the  number  of  ex- 
changes does  not  have  a very  marked  efiEect. 
We  do  find  that,  in  those  infants  who  have 
received  3 or  more  intrauterine  blood  trans- 
fusions, the  hemoglobin-A  is  higher.  W^e 
also  occasionally  see  high  hemoglobin-A 
after  only  one  intrauterine  blood  transfu- 
sion, Therefore,  it  would  appear  that  some 
other  factor  might  be  responsible.  The  per- 
centages of  adult  hemoglobin  appear  to  de- 
pend more  on  the  total  volume  adminis- 
tered. If  we  can  administer  a volume  ex- 
ceeding about  150  ml.  into  the  infant,  then 
perhaps  we  can  achieve  a good  concentra- 
tion of  adult  hemoglobin  in  these  infants. 

Bilirubin 

The  next  factor  we  are  interested  in  is,  of 
course,  the  bilirubin.  Our  previous  exper- 
ience showed  that  a critical  level  in  cord 
blood  was  generally  associated  with  a rath- 
er seriously  affected  infant.  I was  somewhat 
puzzled  to  find  that  in  the  infants  who  had 
received  intrauterine  blood  transfusions 
this  was  no  longer  true.  Examining  the 
levels  of  serum  bilirubin  in  the  cord  blood 
plotted  against  the  total  volume  of  the 
blood  transfused,  w^e  have  seen  no  definite 
correlation  between  the  amount  transfused 
and  the  cord  blood  concentration  of  bili- 
rubin at  the  time  of  delivery.  In  general,  a 


better  correlation  appeared  to  exist  with 
total  hemoglobin.  When  we  plot  the  serum 
bilirubin  against  the  concentration  of 
hemoglobin  present  in  the  cord  blood,  we 
find  that  there  is  a somewhat  linear  rela- 
tionship. A word  of  caution  is  in  order 
here.  We  may  be  dealing  with  infants  who 
have  quite  a high  bilirubin  as  a result  of 
blood  received.  We  do  not  know,  for  in- 
stance, what  degree  of  hemolysis  can  occur 
in  the  peritoneal  cavity.  Perhaps  we  should 
aim  merely  at  limiting  transfusions  to  a 
particular  volume  sufficient  to  maintain  the 
infant  until  the  time  of  delivery  rather  than 
to  overload  with  a larger  amount.  This  is 
just  a suggestion  based  on  preliminary 
data. 

There  is  no  apparent  correlation  be- 
tween the  serum  bilirubin  and  the  percent- 
age of  hemoglobin-A.  We  have  found  that 
one  of  the  features  of  those  infants  who 
have  received  a successful  intrauterine 
blood  transfusion  is  that  their  blood  is 
generally  the  same  group  as  the  donor, 
and  is  Rh  negative  and  Coombs  negative. 
As  to  outcome,  the  group  showing  high  ab- 
sorption of  transfused  blood  seems  to  have 
done  much  better.  Incidentally,  the  per- 
centage of  hemoglobin  at  the  time  of  birth 
has  no  bearing  on  outcome.  In  many,  the 
hemoglobin  levels  were  well  in  the  hy- 
dropic range.  It  would  appear  that  what 
has  kept  these  babies  alive  was  the  donor 
blood.  W^e  find  that  there  was  a higher 
mortality  among  infants  showing  vestiges 
of  their  own  blood  type  (mixed).  Here 
again  in  most  of  these  infants  the  hemo- 
globin is  in  the  range  where  one  would 
expect  them  to  be  hydropic.  In  fact  several 
were  hydropic  infants.  Finally,  in  the  group 
that  had  their  own  blood  grouping  we  find 
that  the  mortality  is  somewhat  higher.  In 
all,  7 of  our  14  liveborn  infants  survived. 
This  does  indicate  quite  good  results  and 
are  comparable  with  those  that  have  been 
reported. 

Prevention  (Dr.  Emanual  A.  Friedman) 

Attempts  to  prevent  Rh  sensitization  date 
back  almost  to  the  discovery  of  the  relation- 
ship between  the  Rh  factor  and  erythro- 
blastosis fetalis  in  1940,  The  attempts  fall 
into  three  broad  areas:  (1)  preventing  ini- 
tial sensitization  of  the  mother  by  protect- 
ing the  placental  integrity,  avoiding  intrau- 
terine manipulation  and  trauma,  thus  os- 
tensibly to  prevent  the  offending  fetal  red 


for  July,  1968 


43 


cells  from  entering  the  maternal  circula- 
tion; (2)  blocking  the  sensitization  by  in- 
jecting antibody  to  neutralize  the  fetal 
cells  that  have  gained  entrance  to  the  ma- 
ternal circulation;  (3)  neutralizing  or  in- 
activating the  circulating  antibody  present 
in  maternal  circulation  before  significant 
amounts  cross  to  the  fetus.  Efforts  along 
the  last  avenue  included  the  unsuccessful 
use  of  Rh  hapten,  cortisol,  and  ethylene  di- 
sulfonate; and  more  recently  (and  some- 
what more  successfully)  by  various  ribonu- 
cleic acid  derivatives  (adenylic  acid,  uri- 
dylic  acid,  cytidylic  acid,  and  cytidine  hem- 
isulfate),  unnatural  sugars  (1 -glucose,  1- 
mannose,  d-gulose),  and  sugar-amines  (glu- 
cosamine and  galactosamine).  These  latter 
have  shown  some  promising  preliminary  in 
vitro  and  animal  results  in  inhibiting  the 
formation  of  complete  and  incomplete  Rh 
antibodies.  The  most  encouraging  and 
hopeful  application,  however,  appears  to  be 
in  the  area  of  blocking  sensitization  by  use 
of  high  titer  antibody. 

The  history  of  development  of  this 
method  is  quite  interesting,  two  independ- 
ent groups  having  arrived  at  the  same 
place  almost  simultaneously  by  two  differ- 
ent routes.  As  far  back  as  1943,  Levine 
noted  a negative  relationship  between 
ABO-incompatibility  and  Rh  sensitization. 
In  ABO-incompatible  situations  (between 
mother  and  baby),  a certain  degree  of  pro- 
tection seems  to  exist  for  the  infant.  This 
concept  formed  the  basis  for  the  investiga- 
tion designed  by  Finn  and  Clarke  in  Liver- 
pool. It  was  felt  that  naturally  occurring 
ABO  antibodies  somehow  affected  the 
foreign  red  cells  from  the  fetus  in  such  a 
way  as  to  prevent  the  Rh  antigen  from 
expressing  itself  to  the  extent  of  causing 
sensitization.  In  the  course  of  their  work, 
they  found  transplacental  fetal  cell  leak- 
age, using  the  Kleihauer-Betke  method  of 
staining  fetal  red  cells  (acid  elution),  and 
set  about  to  devise  some  means  of  eliminat- 
ing these  foreign  red  cells  from  the  moth- 
er’s circulation.  It  occurred  to  Finn  that 
artificially  injected  anti-Rh  antibody  might 
coat  the  Rh  positive  fetal  cells  so  as  to 
inactivate  their  antigenicity  and  also  to 
clear  them  from  the  mother’s  circulation 
rapidly  before  they  could  immunize.  The 
logical  step  then  was  to  administer  passive 
antibody  as  a means  of  preventing  hemoly- 
tic disease  of  the  newborn. 

At  the  same  time,  Freda  and  Gorman  in 


New  York  arrived  at  the  same  method,  on 
the  basis  of  other  theoretical  considera- 
tions. Theobald  Smith  first  recorded  the 
phenomenon  of  immunity  inhibition  in 
1909,  when  he  npted  that  diphtheria  toxin 
injected  with  an  excess  of  antitoxin  was 
no  longer  antigenic.  This  has  been  con- 
firmed many  times  over  since  then.  The 
specific  antibody  injected  passively,  either 
with  its  antigen  or  separately,  prevents  ac- 
tive immunization.  The  principle  briefly 
stated  is  that  passive  immunity  strongly 
suppresses  active  immunity.  Freda  and  Gor- 
man put  this  principle  to  use  in  1960  and 
initiated  a program  to  determine  whether 
initial  immunization  of  Rh  negative  moth- 
ers could  be  prevented  by  the  passive  ad- 
ministration of  Rh  antibody  immediately 
after  childbirth.  Simultaneously  and  inde- 
pendently, Finn  and  Clarke  began  their 
experimental  work  along  the  same  lines. 

The  materials  used  at  the  outset  were 
somewhat  different,  Freda  using  high  titer 
anti-D  gamma-globulin;  Finn  using  immune 
plasma.  The  single  risk  that  had  been 
feared  most,  namely  the  phenomenon  of 
enhancement,  rather  than  suppression  of 
immunity  by  passive  antibodies,  was  ob- 
tained by  the  Liverpool  group  using  im- 
mune plasma  containing  the  large  (19S) 
saline  gamma  M anti-Rh  antibody.  Subse- 
quent use  of  the  purer  gamma  G (7S) 
anti-Rh  antibody  gave  no  evidence  of  any 
degree  of  immunological  enhancement  in 
either  Rh  negative  male  volunteers  or  re- 
cently pregnant  mothers.  It  is  still  possible 
that  mothers  may  develop  isoimmunization 
to  antigens  on  the  injected  gamma-globulin 
molecules,  but  it  is  doubted  that  this  would 
have  clinical  significance.  The  anti-Rh 
gamma-globulin  is  prepared  in  the  same 
way  that  currently  available  gamma-globu- 
lin for  protection  say  against  measles  is 
made,  namely  by  low  temperature  alcohol- 
fractionation  procedures  starting  with  very 
high  titered  specific  anti-D  serum,  prefer- 
ably from  type  AB,  Rh  negative  donors 
where  it  is  possible  to  obtain  these.  This 
is  a most  satisfactory  preparation  because 
it  does  not  carry  risk  of  hepatitis.  The  titer 
of  material  used  is  around  1:260,000.  In- 
jection of  5 ml.  produces  artificial  titers  of 
antibody  up  to  1:128. 

Finn  found  that  when  Rh  positive  red 
cells  labeled  with  radioactive  chromium 
were  injected  into  Rh  negative  male  volun- 
teers, and  the  recipients  were  given  the 


44 


Illinois  Medical  Journal 


potent  anti-D  serum,  the  injected  cells  dis- 
appeared rapidly,  about  50  per  cent  in  two 
days.  When  5 ml.  of  the  high  titer  incom- 
plete anti-D  gamma-globulin  was  given  in- 
tramuscularly, Rh  positive  fetal  cells  could 
be  rapidly  removed  from  the  circulation. 
Starting  with  Rh  negative  male  volunteers 
who  were  challenged  with  injections  of  Rh 
positive  red  blood  cells,  Freda  and  Gor- 
man progressed  to  studies  in  the  postpar- 
tum patient,  beginning  in  1964  to  ad- 
minister the  Rh  immunoglobulin  prepara- 
tion to  all  postpartum  mothers  at  risk, 
namely  those  Rh  negative  mothers  de- 
livered of  Rh  positive  ABO-compatible  in- 
fants in  whom  there  was  no  evidence  of 
active  immunization  found  either  during 
that  pregnancy,  at  delivery,  or  within  the 
three  day  period  immediately  following  de- 
livery. This  is  somewhat  at  variance  with 
the  group  selected  by  Finn  and  Clarke, 
who  only  administered  Rh  immunoglobu- 
lin to  “high  risk”  patients  in  whom  they 
found  a significant  number  of  fetal  cells  in 
the  maternal  circulation  (by  the  Kleihauer 
method). 

Clinical  trials  to  date  have  been  reported 
on  329  patients  at  risk  who  were  com- 
pletely protected  by  the  immunoglobulin 
preparation  as  compared  with  337  control 
mothers,  46  of  whom  became  sensitized  sub- 
sequently (13.6  per  cent).  These  were  all 
first  pregnancy  results.  A small  number 


have  been  followed  through  a second  preg- 
nancy: 31  passively  immunized  mothers 

were  completely  protected  as  contrasted 
with  27  control  mothers,  among  whom  11 
became  sensitized  (40.7  per  cent)  and  sub- 
sequently delivered  infants  with  hemolytic 
disease. 

It  appears  that  at  least  six  months  must 
elapse  before  the  passive  antibody  com- 
pletely disappears.  As  long  as  any  passive 
antibody  persists  in  a given  individual,  it 
is  impossible  to  determine  whether  or  not 
active  antibody  production  has  taken  place. 
More  significantly,  the  best  check  on  the 
efficacy  of  protection  is  the  outcome  of  sub- 
sequent pregnancies  with  Rh  positive  fe- 
tuses. This  would  represent  a more  critical 
biological  test  of  immunization  than  post- 
partum antibody  screening  because  such 
subsequent  pregnancies  tend  to  provoke  a 
strong  secondary  immune  response.  More- 
over, prevention  of  clinical  hemolytic  di- 
sease is  the  real  proof  of  effectiveness.  It 
is  very  encouraging  to  see  the  accumulated 
data  being  gathered  from  various  centers 
to  indicate  that  Rh  immunoglobin  is  effec- 
tive in  preventing  clinical  hemolytic  di- 
sease of  the  newborn  and  has  the  ability 
to  suppress  anti-Rh  antibody  in  the  post- 
partum period.  If  this  trend  continues,  we 
may  be  witnessing  the  beginning  of  a 
marked  shift  in  emphasis  from  management 
of  erythroblastotic  babies  to  prevention  of 
maternal  immunization. 


TEST  FOR  LEAD 

Adequate  multiple  sampling  of  the  urine  is  the  only  method,  in 
practice,  that  will  certainly  provide  the  information  required  for  the  pur- 
pose of  depicting  the  extent  of  the  occupational  hazard  of  an  individual 
due  to  lead,  if  indeed  one  must  depend  upon  the  urine  for  this  purpose. 
On  the  other  hand,  the  blood  is  not  subject  to  any  very  considerable  di- 
urnal physiological  variation,  with  respect  to  its  lead  content,  so  that  the 
accurate  analysis  of  one  certainly  uncontaminated  specimen  of  blood  is 
more  useful  in  the  estimation  of  the  significance  of  the  occupational  ex- 
posure to  lead  than  is  any  other  procedure.  One  precise  analytical  result 
on  the  blood  of  an  individual  is  worth  several  analytical  results  (of  equal 
precision)  on  the  urine  of  the  same  individual  in  estimating  the  safety  or 
danger  of  his  regular  occupational  exposure  to  lead.  In  addition,  the  up- 
per limit  of  safety,  in  relation  to  the  concentration  of  lead  in  the  blood,  is 
defined  sharply  by  precise  analytical  procedure,  at  80  micrograms  per  100 
Gm.  of  whole  blood,  while  the  corresponding  limit  in  the  urine  must 
always  be  expressed  as  a range  of  values  approximating  0.15  to  0.24  mg. 
per  liter.  Question  Clinic.  Jl.  Occupational  Med.  (Apr.)  1968,  lOA,  201- 
202,  (Question:  Accuracy  of  Atomic  Absorption  Spectroscopy  in  Urine 
Analysis  for  Lead,  answered  by  Robert  A.  Kehoe.) 


for  July,  1968 


45 


Nephrology— Volumes  I and  II:  Jean 
Hamburger,  G.  Richet,  J.  Crosnier,  J.  L. 
Funck-Brentano,  B,  Antoine,  H.  Ducrot,  J. 
P.  Mery,  and  H.  deMontera.  With  the  col- 
laboration of:  P.  Royer.  Translated  by: 
Anthony  Walsh,  F.R.C.S.I.  W.  B.  Saunders 
Co.,  1968  Illustrated.  1312  pages.  $50.00  the 
set. 

This  two  volume  treatise  is  both  a text- 
book of  nephrology  and  a compilation  of 
the  views  and  experience  of  the  most  emi- 
nent group  of  nephrologists  in  France.  The 
work,  which  was  written  by  some  17  work- 
ers, headed  by  Professor  Jean  Hamburger, 
was  first  published  in  French  in  1966.  The 
1968  American  edition,  translated  by  the 
urologist  Anthony  Walsh  of  Dublin,  has 
been  revised  and  in  some  places  rewritten 
to  bring  it  up  to  date.  That  there  was  need 
for  such  changes  after  so  short  a time  is  a 
reflection  of  the  extraordinary  interest  and 
activity  in  the  subject  of  nephrology. 

The  subject  matter  covers  virtually  the 
whole  field  of  nephrology,  which  the  auth- 
ors define  as  the  study  of  the  kidney  in 
health  and  disease.  The  work,  which  con- 
sists of  58  chapters,  is  divided  into  12  parts, 
including  the  anatomy  and  physiology  of 
the  kidneys;  symptomatology  and  renal 
function  tests;  major  renal  syndromes; 
functional  renal  disorders;  organic  nephro- 
pathies; sundry  pathological  conditions  of 
the  kidney  (24  chapters);  malformations  of 
the  kidney  and  urinary  tract;  nephrolithia- 
sis and  nephrocalcinosis;  renal  tuberculo- 
sis; tumors  of  the  kidney;  renal  vessel  path- 
ology, and  major  therapeutic  procedures. 

With  such  a vast  range  of  subject  matter, 
it  is  not  surprising  that  some  aspects  are 
dealt  with  in  more  detail,  and  perhaps 
more  authoritatively,  than  others.  Through- 
out the  work,  emphasis  is  placed  on 
current  knowledge  of  renal  pathophysiol- 
ogy, which  of  course  is  the  area  from  which 


so  much  of  our  improved  understanding  of 
kidney  disease  has  come,  particularly  since 
the  advent  of  percutaneous  renal  biopsy, 
and  the  application  of  electron  microscopy 
and  immunofluorescent  techniques  to  bi- 
opsies. 

One  criticism  to  be  made  of  this  great 
work  is  that  in  areas  of  persisting  conten- 
tion, usually  only  one  view  of  the  problem 
is  presented.  To  some  extent,  this  defi- 
ciency is  mitigated  by  a good  bibliography 
after  each  chapter. 

The  two  books,  which  are  beautifully 
produced  in  the  manner  one  expects  of  the 
W.B.  Saunders  Company,  are  an  outstand- 
ing contribution  to  the  subject,  and  will  be 
referred  to  by  all  those  seriously  interested 
in  nephrology. 

Peter  B.  Herdson,  M.B.,Ch.B.,Ph.D. 
Radiological  Studies  of  the  Gravid 

Uterus.  Paul  A.  Bishop,  M.D.  Harper  and 

Row,  1965.  279  pages,  $14.50. 

Radiological  Studies  of  the  Gravid  Uterus 
is  unique  as  a radiology  text  in  that  it  deals 
specifically  with  fetal  growth  and  develop- 
ment and  pathology.  The  author  has  suc- 
cessfully prepared  a book  that  is  valuable  to 
both  radiologist  and  obstetrician  and  em- 
phasizes the  need  for  cooperation  of  the  two 
in  planning  the  radiologic  consultation. 
The  material  presented  is  primarily  gath- 
ered from  the  Department  of  Radiology, 
Pennsylvania  Hospital,  where  Dr.  Bishop 
was  formerly  Director. 

The  illustrations  are  of  a quality  that  re- 
quire little  supplementary  text  and  compre- 
hensive enough  that  few  radiology  depart- 
ments have  an  equivalent  accessible  source 
of  reference  cases.  The  chapter  on  erythro- 
blastosis and  fetal  hydrops  is  especially  inter- 
esting.  The  subject  of  pelvimetry  is 
excluded. 

The  book  is  recommended  to  both  ob- 
stetricians and  radiologists. 

William  N.  Brand,  M.D. 


46 


Illinois  Medical  Journal 


The  synthetic  pharmaceuticals  industry 
in  America  at  the  close  of  the  First  World 
War  was  in  its  early  years.  Pharmacists  still 
compounded  most  of  the  medicines  pre- 
scribed by  physicians.  Proprietary  drugs 
were  relatively  few  in  number  and  the  hey- 
day of  pharmaceutical  advertising  was 
about  to  begin.  The  detail  man,  calling  on 
physicians  in  large  cities  and  small  towns, 
was  in  a particularly  advantageous  position 
to  observe  medical  practice  at  a stage 
where  it  was  far  different  from  that  of 
today. 

In  the  spring  of  1920  this  writer  was  ap- 
pointed by  Herman  A.  Metz,  President  of 
the  H.  A.  Metz  Laboratories,  Inc.,  to  be 
the  firm’s  representative  in  the  Northern 
Midwest.  The  territory  extended  from  Al- 
ton to  Duluth,  Minn.,  and  from  Omaha 
to  Northern  Indiana,  with  Chicago  as  head- 
quarters. As  general  representative,  duties 
included  both  detail  and  sales  work.  This 
necessitated  visiting  all  of  the  medical 
schools  in  the  area,  the  principal  hospitals 
and  clinics,  and  the  health  officers,  as  well 
as  many  of  the  leading  medical  specialists. 

The  company  was  a well-established 
pharmaceutical  house  originally  importing 
German  drugs  but  at  this  time  beginning 
to  manufacture  in  the  United  States.  The 
drugs  produced  were  very  important  at 
the  time  and  included  the  Salvarsans  (ars- 
phenamines),  Novocaine  (procain),  Pyram- 
idon  (amidopyrin),  Holocaine  (an  eye 
anesthetic),  and  a variety  of  other  special 
products. 

It  was  my  duty,  not  only  to  introduce 
and  promote  products,  but  also  to  advise 
and  instruct  physicians  and  dentists  in  their 
proper  use. 

Inasmuch  as  I was  not  a doctor,  this  im- 
posed a considerable  responsibility,  but  I 
had  at  my  disposal  the  firm’s  specially 


trained  chemists  and  physicians  for  consul- 
tation. I was  also  free  to  obtain  assistance 
from  a small  group  of  doctors  in  the  area 
who  were  on  the  payroll  of  our  company, 
and  they  performed  a very  valuable  serv- 
ice. They  were  honest,  reliable,  and  well 
informed.  They  stood  high  in  their  profes- 
sions and  had  complete  freedom  of  opin- 
ion without  pressure  or  prejudice. 

From  the  detail  man’s  point  of  view,  it 
seemed  that  the  venereal  diseases  played  a 
very  large  part  in  the  office  practice  of  the 
physicians  at  that  time.  This  impression 
may  have  been  weighed  by  the  importance 
of  the  anti-luetic  drugs  we  produced. 

Practitioners  Instructed 

Many  physicians  who  wished  to  treat 
their  syphilitic  patients  with  Salvarsan  hesi- 
tated to  go  through  the  required  procedure 
of  converting  the  basic  material  to  a so- 
dium salt.  This  was  essential  since  other- 
wise the  drug  could  be  fatal.  The  procedure 
of  conversion  consisted  of  titrating  with  a 
solution  of  sodium  hydroxide.  To  avoid 
this  task  and  the  responsibility  imposed  in 
it,  these  doctors  preferred  to  send  their 
patients  to  one  of  the  medical  laboratories 
whose  technicians  were  trained  in  this  pro- 
cedure. In  a similar  fashion,  prior  to  the 
availability  of  cartridges  or  ampules,  doc- 
tors and  dentists  had  to  prepare  their  own 
solutions  of  Novocaine  and  epinephrine. 
It  was  among  my  duties  to  instruct  the 
practitioners  in  these  preparations  and  in 
the  techniques  of  their  administration. 
Familiarity  was  also  required  with  such 
techniques  as  the  Swift-Ellis  intraspinal  ad- 
ministration of  Neosalvarsan,  and  how  to 
cope  with  the  immediate  reactions  such  as 
shock  from  too  rapid  administration,  the 
Herxheimer  reaction,  arsenical  dermatitis, 
and  other  unfavorable  developments. 


for  July,  1968 


47 


Through  continual  contacts  with  the 
medical  profession,  a general,  broad  view 
of  the  drugs  in  use,  many  of  which  have 
since  been  discontinued,  was  obtained. 
Benzyl  benzoate  was  regarded  as  virtually 
a specific  in  asthmatic  spasms.  Silver  nu- 
cleinate  and  proteinate  colloids  were  very 
widely  employed  in  treating  the  mucous 
membranes  of  the  nose,  throat  and  eyes. 
Gonorrhea  was  almost  always  treated  with 
the  silver  salts.  Sodium  cacodylate,  an  ar- 
senical, was  frequently  used  in  the  early 
1920’s  for  treating  syphilis,  having  been 
advocated  by  no  less  prominent  a physician 
than  Dr.  John  B.  Murphy.  Lactobacilli, 
such  as  the  b.  Bulgaricus,  were  in  very 
wide  use  for  intestinal  disturbances.  Cer- 
tain organic  mercurials  originally  intro- 
duced as  anti-luetics  later  came  into  wide 
use  as  diuretics.  Antibiotics  did  not  begin 
to  dominate  the  field  until  the  early  and 
middle  1940’s. 

Novocaine  Introduced 

Pyramidon,  despite  its  very  extensive  em- 
ployment, all  but  disappeared  when  it  was 
occasionally  found  to  cause  agranulocytosis. 
Anesthetics  such  as  methyl-,  and 
ethylbromides,  benzyl  alcohol,  and  stovaine 
have  been  supplanted  by  other  agents. 
Novocaine,  which  was  introduced  in  1909 
on  the  other  hand,  has  persisted  with  even 
wider  use  in  infiltration,  regional  block 
and  spinal  anesthesia.  The  last  mentioned 
technique  owed  its  very  wide  popularity 
to  the  introduction  of  Pitkin’s  Spinocain 
and  the  Labat  technique  of  using  Novo- 
caine crystals.  The  term  “anesthesiology” 
came  into  common  usage  in  the  early 
1930’s  and  its  methods  have  expanded  far 
beyond  those  in  use  at  the  time.  One  sur- 
geon is  recalled  who  claimed  to  have  used 
Spinocaine  in  some  2500  operations,  but 
did  not  publish  his  satisfactory  experiences 


Joseph  P.  Renald 
was  the  first  labora- 
tory assistant  to  Dr. 
Casimir  Funk,  a 
leading  discoverer  of 
vitamins.  Mr.  Renald 
worked  many  years 
with  Dr.  Funk  and 
eventually  be- 
came an  independ- 
ent chemist.  He 
served  over  20  years 
as  a manufacturers 
representative  for 
medical  implements 
and  products. 


lest  his  name  become  associated  with  com- 
mercial exploitation  of  the  drug.  Avertin 
(tribromethanol)  was  brought  into  this 
country  from  Germany,  but  never  attained 
wide  usage. 

A general  attack  against  venereal  di- 
seases was  launched  in  the  early  years  of 
the  second  decade.  Syphilis  and  gonorrhea 
had  multiplied  at  a rapid  rate  as  an  after- 
math  of  World  War  I.  The  United  States 
Public  Health  Service,  through  its  Surgeon- 
General,  Dr.  Parran,  sponsored  an  eradi- 
cation campaign  by  the  Illinois  State  and 
Municipal  Health  Departments.  Dr.  Her- 
man Bundeson,  Chicago’s  Health  Commis- 
sioner, established  several  large  venereal 
disease  clinics  in  the  city  which  also 
spurred  the  activities  of  the  Illinois  Social 
Hygiene  League,  an  independent  organiza- 
tion to  combat  these  illnesses.  Prominent 
citizens  were  induced  to  underwrite  a 
greatly  advertised  V.D.  clinic  known  as  the 
Public  Health  Institute,  under  the  direc- 
tion of  Dr.  J.  G.  Berkowitz.  Because  adver- 
tising was  regarded  as  unethical,  organized 
medicine  declared  that  staff  doctors  of  this 
institution  were  to  be  dropped  from  the 
American  Medical  Association  unless  they 
withdrew  from  the  Institute. 

Dr.  Bundeson  had  ordained  that  prosti- 
tutes arrested  and  found  to  have  V.  D. 
were  to  be  incarcerated  in  a special  isolated 
ward  at  the  Municipal  Contagious  Disease 
Hospital  until  they  were  rendered  non- 
infective.  The  “ladies  of  the  night”  re- 
ceived their  medical  attention  from  Dr. 
Goldye  Hoffman.  A V.D.  clinic  was  also 
established  at  the  Iroquois  Memorial  Hos- 
pital, then  located  at  23  North  Market 
Street  with  Dr.  Hugo  Betz  in  charge.  Dr. 
Betz  also  maintained  a private  general 
practice  in  the  basement  of  a house  on 
Garfield  Boulevard. 

The  Public  Health  Institute  was  or- 
ganized for  the  care  of  low  income  patients 
and  the  fees,  including  diagnostic  tests, 
were  within  their  reach.  The  Institute  also 
served  as  an  experimental  station  for  an 
arsenical  preparation  (tryparsamide)  which 
had  been  especially  developed  for  neuro- 
syphilis. Some  ten  years  later  the  Institute 
merged  with  the  Illinois  Social  Hygiene 
League,  with  paying  patients  going  to  the 
Institute  and  the  non-paying  ones  to  the 
League  Clinic. 

Through  Dr.  Bundeson  I met  Dr.  Lee 
Alexander  Stone  who  bore  the  Health  De- 


48 


Illinois  Medical  Journal 


partment’s  title  of  "Chief  of  the  Public 
Hospitals.”  He,  in  turn,  introduced  me  to 
the  picturesque  personality.  Dr.  Ben  Reit- 
man,  who  was  already  known  as  the  whi- 
lom paramour  and  manager  of  the  an- 
archist Emma  Goldman.  He  was  at  that 
time  urologist  at  the  House  of  Correction 
and  invited  me  to  visit  the  clinic  at  the 
Bridewell.  We  met  at  5:30  a.m.  at  a nearby 
restaurant  and  from  there  proceeded  to 
his  institution.  The  demonstration  was 
somewhat  ghastly.  Neosalvarsan  was  put 
into  solution  in  small  fruit  jars  because 
the  prison  had  no  other  glassware.  Sterility 
and  purity  of  the  distilled  water  were  very 
sketchy.  It  is  not  surprising  that  there  were 
many  immediate  reactions. 

Dr.  Reitman  and  I became  very  close 
friends  and  from  him  I learned  much 
about  the  leftist  political  movements  of 
the  World  War  I years.  Also  through  him 
I met  Dr.  William  A.  Evans,  Health  Colum- 
nist of  the  Chicago  Tribune.  Dr.  Evans 
was  not  only  a reputed  public  health 
authority,  (he  had  been  Health  Commis- 
sioner of  Chicago  and  also  Professor  of 
Public  Health  at  Northwestern  Univer- 
sity Medical  School),  but  was  also  a well- 
informed  Civil  War  buff,  a shared  hobby. 
He  had  written  a medical  biography  of 
Mary  Todd  Lincoln.  Drs.  Evans  and  Reit- 
man were  very  close  friends  and  used  to 
take  long  swims  together  such  as  from  Bel- 
mont Harbor  to  the  foot  of  Navy  Pier  until 
the  authorities  put  a stop  to  these  aging 
enthusiasts. 

Vivisection  Discussions 

On  one  occasion  Dr.  Evans  invited  me 
to  accompany  him  to  a meeting  of  the 
Illinois  State  Legislature  Committee  at 
the  City  Hall  to  hear  arguments  for  and 
against  an  antivivisection  law  that  had  been 
introduced  in  Springfield.  As  we  entered 
the  chamber,  the  renowned  Professor  of 
Physiology  at  the  University  of  Chicago, 


The  166  Veterans  Administration  hos- 
pitals are  affiliated  with  76  of  the  nation's 
94  medical  schools  in  a partnership  that 
provides  better  medical  care  for  veterans 
and  helps  to  train  half  the  nation’s  new 
doctors  in  20  fields  of  medicine. 


the  colorful  Dr.  A.  J.  Carlson,  was  berat- 
ing the  antivivisectionists  who  had  charged 
that  all  persons  who  performed  experi- 
ments on  animals  were  unjustifiably  cruel. 
Carlson,  in  reply,  recalled  that  he  had 
been  President  Hoover’s  special  consultant 
on  the  project  of  feeding  the  starving 
children  in  Belgium  and  Russia  after  the 
War  and  that  he  considered  it  an  insult 
to  be  charged  with  cruelty.  Dr.  Evans,  sit- 
ting next  to  me,  fidgeted  and  muttered, 
“I  wish  Carlson  would  sit  down.”  The  rea- 
son became  apparent  when  several  invited 
veterinarians  presented  evidence  that  vivi- 
section benefited  animals  as  well  as  humans 
and  that  the  inhumanity  was  on  the  part 
of  those  who  would  see  the  animals  suf- 
fer from  diseases  of  which  they  could  be 
cured.  Dr.  Evans  had  been  instrumental 
in  organizing  this  flank  movement  against 
the  antivivisectionists.  The  bill  did  not 
pass  that  year. 

All  in  all,  early  experiences  from  the 
early  1920’s  through  the  late  1930’s,  a few 
of  which  have  been  mentioned  here,  were 
rich  and  rewarding.  I witnessed  the  intro- 
duction and  the  disappearance  of  many 
drugs  that  were  considered  important. 
Some  soon  became  limited  in  use,  others 
became  monuments.  Novocaine  is  the  ex- 
ception that  still  survives  as  the  most  wide- 
ly used  of  all  local  anesthetic  agents. 

In  my  work  I met  many  fine  members 
of  the  healing  professions.  Numerous  phy- 
sicians, surgeons  and  dentists  became  and 
still  are  warm  friends.  In  these  later  years, 
those  who  are  still  here  exchange  memories 
like  these  recorded  and  make  them  seem 
as  if  they  occurred  but  yesterday.  I was  a 
confidant  of  some  of  these  professional 
practitioners,  listened  to  the  stories  of  their 
experiences  which  were  otherwise  not  dis- 
closed. Some  were  humorous  and  some 
were  tragic,  but  they  gave  my  quasi-medical 
status  a perspective  I could  not  otherwise 
have  had  as  a layman. 


The  Veterans  Administration  plans  to 
provide  intensive  care  units  for  critically 
ill  patients  in  more  VA  hospitals.  This  in- 
cludes special  facilities  in  private  rooms 
for  cardiac  patients. 


for  July,  1968 


49 


Seven  Day  Utilization  Of  Our  Hospitals 

By  Frederick  Stenn,  M.D./Chicago 


The  hospital  structure  is  strained  by 
the  great  demands  imposed  on  it  not  only 
by  a teeming  population,  and  by  improved 
medical  services,  but  by  Medicare,  by  pre- 
ventive medicine  and  by  prosperity  gener- 
ally. The  critical  shortage  of  hospital  beds 
demands  a solution  beyond  the  use  of  re- 
strictive methods.  The  policing  of  admis- 
sions, curtailing  the  duration  of  stay  and 
accelerating  the  discharge  of  patients  has 
helped  some  but  not  enough.  A promising 
movement  initiated  some  ten  years  ago  lies 
in  the  improvement  of  bed  utilization  by 
the  extension  of  the  ancillary  or  integral 
services  through  Saturday  and  Sunday  of 
each  week. 

Every  member  of  the  medical  team  is 
painfully  aware  of  the  tempo  of  hospital 
service.  Bed  and  laboratory  utilization  fol- 
lows a feast  and  famine  pattern,  a peak  and 
valley  work-load:  a bottleneck  on  Sunday 
night,  a deluge  on  Monday,  a rush  on  Tues- 
day, a steady  flow  on  Wednesday  and 
Thursday,  a slackening  on  Friday,  a trickle 
on  Saturday  morning,  and  a dead-stop  on 
Saturday  afternoon  and  all  day  Sunday. 
This  fluctuation  is  seen  most  with  surgical 
patients,  less  with  medical  and  least  with 
psychiatric,  pediatric  and  obstetrical  pa- 
tients. This  inequality  in  the  daily  use  of 
beds  and  services  has  proven  to  be  ineffi- 
cient, wasteful,  and  uneconomical.  Why 
must  there  be  two  waiting  lists:  the  out- 
patient list  composed  of  those  waiting  one 
day  up  to  a week  to  be  admitted,  and  the 
inpatient  list  of  those  waiting  days  until 
Monday  when  the  laboratory,  awakened 
from  its  week-end  slumber,  begins  to  func- 
tion for  elective  studies.  Why  must  a pa- 
tient’s release  be  delayed  so  that  a blood 
sugar  or  a PAP  smear  might  be  done  on 
Monday  morning?  Is  watching  time  essen- 


tial to  the  conduct  of  the  modern  hospital? 
What  is  so  inviolable  about  Saturday  and 
Sunday?  Why  must  x-rays  of  the  gastro-in- 
testinal  tract  beginning  on  Monday  finish 
before  Friday?  Why  must  the  stroke  pa- 
tient requiring  physiotherapy  twice  daily  be 
obliged  to  omit  such  service  on  Sunday? 

The  ancillary  or  integral  services  and  fa- 
cilities—X-ray,  chemistry  laboratory,  diete- 
tic, pharmacy,  heart  station,  business, 
laundry,  housekeeping  and  engineering- 
are  valued,  in  most  instances,  in  many  mil- 
lions of  dollars;  yet  they  are  put  to  little 
use  for  one  and  a half  to  two  days  of  each 
week,  6 days  of  each  month,  and  78  days  of 
each  year.  This  is  bad  business,  and  worse 
medicine. 

Sickness  respects  no  calendar,  no  day  of 
the  week.  A man  with  a coronary  thrombo- 
sis deserves  as  good  care  on  Sunday  as  he 
gets  on  Tuesday  when  all  services  are  func- 
tioning. What  physician  does  not  have  an 
added  worry  for  the  patient  admitted  as  an 
emergency  on  Saturday  night  or  Sunday 
with  diabetic  coma,  bleeding  peptic  ulcer 
or  acute  abdominal  condition?  Why  must 
the  physician  who  on  Friday  submits  to  the 
microbiology  laboratory  sputum  from  his 
gravely  ill  pneumonia  patient  wait  for  a 
report  of  polymyxin-sensitive  pseudomonas 
culture  until  Monday  night  when  his  pa- 
tient has  died?  Laboratory  care  is  bound 
hand  and  foot  with  bed-side  care:  neglect 
the  one  and  we  fail  the  other. 

Hospital  Example  Cited 

The  Cooper  Hospital  of  Camden,  N.  J., 
with  a bed  capacity  of  700  and  under  the 
direction  of  Robert  Garrett,  Jr.,  has  set  a 
fine  example  in  the  resolution  of  the  bed 
shortage  problem.  In  January  1963  it  in- 
itiated a 6-day  work  week:  so  successful  was 


Frederick  Stenn,  M.D.,  is  a practicing  internist  with  offices  in  Chi- 
cago. He  is  a graduate  of  the  University  of  Chicago  Medical  School 
and  served  his  internship  at  Evanston  Hospital.  He  is  interested  in 
the  History  of  Medicine. 


50 


Illinois  Medical  Journal 


this  experience  that  in  January  1964  it  be- 
gan a 7-day  week  which  operates  effectively 
at  present.  All  integral  services  are  in  oper- 
ation every  day  of  the  week.  The  operating 
rooms  are  functioning  in  full  force,  15  of 
the  hospital  surgeons  operating  regularly 
on  Saturdays  and  Sundays.  The  employees 
work  40  hours  a week  and  have  staggered 
hours  Saturday  and  Sunday  once  monthly. 
The  change  has  required  the  addition  of 
10  new  employees  to  a complement  of  1,040 
employees.  Their  salary  has  increased  ten 
cents  hourly.  The  ratio  of  employees  to  pa- 
tients in  1961  (5-day  week)  was  2.22:  in 
1964  (7-day  week)  1.89.  The  average  census 
has  increased  by  6%  or  38  patients  daily, 
being  90%  in  1961,  91%  in  1962  and  96% 
in  1963.  In  1964  the  change  to  a 6-day  week 
resulted  in  reducing  the  average  stay  by  1/2 
day.  In  one  year  the  hospital  admitted  981 
more  patients,  the  equivalent  of  30  hospital 
beds.  Two  months  after  the  6-day  opera- 
tion was  put  into  effect  the  Cooper  Hospi- 
tal operated  in  the  black.  Its  income  in- 
creased $4,300.00  daily  above  that  of  1961, 
and  the  yearly  income  in  1963  exceeded 
that  of  1961  by  $500,000.  This  change  has 
eliminated  the  need  for  new  hospital  con- 
struction. The  staff  morale  has  improved 
and  a professional  pride  has  been  created. 
No  longer  was  it  necessary  to  add  extra  staff 
to  meet  peak  loads. 

The  change-over  was  at  first  met  with  the 
usual  resistance  offered  any  new  idea  but 
the  benefits  provided  by  an  even  census, 
the  sharing  in  providing  efficient  services  at 
all  times  of  the  week,  the  financial  incen- 
tives and  long  vacations  were  acclaimed  by 
the  hospital  employees  and  physicians 
alike. 

This  plan  of  week-end  hospital  service 
has  been  adopted  by  other  institutions  as 
well.  The  Veterans  Hospital  of  Coral  Ga- 
bles, Fla.  and  the  Tunica  County  Hospital 
of  Tunica,  Miss.,  have  been  operating  satis- 
factorily for  a number  of  years.  The  Al- 
bany Medical  Center  adopted  the  6-day 
week  in  1964  and  has  thereby  reduced  the 
hospital  stay  appreciably.  The  Jewish  Hos- 
pital of  Cincinnati  admitted  10  to  20  more 
patients  each  week  as  a result  of  the  change. 
The  Pontiac  General  Hospital  of  Pontiac, 
Mich.,  is  now  initiating  a 7-day  hospital 
program. 

The  advantages  of  the  7-day  week  as  ex- 
perienced by  these  hospitals  consist  of: 

1.  Prompt  diagnostic  and  therapeutic 


service  reducing  delay. 

2.  Efficient  use  of  hospital  beds  and 
equipment. 

3.  Briefer  hospital  stay. 

4.  Fewer  beds  needed  for  care  of  the 
same  number  of  patients  over  the 
year. 

5.  Lower  capital  investment  for  patient. 

6.  Spread  of  costs  over  a large  number 
of  patients. 

7.  Lower  cost  for  hospitalized  patients. 

8.  Reduced  human  suffering  because  of 
rapid  service. 

Objections  to  the  program  have  been 
made  by  physicians  who  fear  lowered  stan- 
dards of  care  and  service  because  of  the 
scarcity  of  adequately  trained  personnel. 
Practical  experience  however,  shows  this 
fear  as  invalid.  Some  directors  of  the  ancil- 
lary services  have  been  cautious  in  under- 
taking week-end  responsibilities,  but  assis- 
tants and  residents  taking  their  places  have 
done  a better  job  than  anticipated. 

Natural  Extension  of  Services 

The  7-day  hospital  service  is  a natural 
extension  of  our  present  continuous  nurs- 
ing and  emergency  departments.  Like  other 
community  services,  water,  sanitation,  gas, 
electricity,  fire,  police,  ambulance,  trans- 
portation and  food  supply,  the  hospital  has 
a necessary,  around  the  clock,  every  day 
of  the  week  function. 

Physicians  and  hospital  administrators 
can  now  take  a hard  look  at  our  time-worn 
hospital  tradition,  and  discover  the  5 14 
day  week  out  of  step  with  the  rapid  strides 
of  modern  hospital  needs. 

“And,  behold  there  was  a man  which  had 
his  hand  withered,  and  they  asked  Him 
saying,  ‘Is  it  lawful  to  heal  on  the  Sabbath 
days?’  that  they  might  accuse  Him;  and  He 
said  unto  them,  ‘What  man  shall  there  be 
among  you,  that  shall  have  one  sheep,  and 
if  it  fall  into  a pit  on  the  Sabbath  day,  will 
he  not  lay  hold  on  it,  and  lift  it  out?  How 
much  then  is  a man  better  than  a sheep? 
Wherefore  it  is  lawful  to  do  well  on  the 
Sabbath  days’.”  (New  Testament,  Matt. 
XII  10-12.  Luke  VI,  1-9.) 

References 

1.  Carros,  D.  H.:  The  Seven  Day  Hospital:  Study 
Shows  Benefits,  Hospital  Topics.  45:49,  Feb. 
1967. 

2.  Editorial:  Extension  of  Hospital  Services,  The 
Se^•en  Day  Week,  Currents  in  Hospital  Admin- 
istration, March-April  1965.  Vol.  9,  No.  2. 

(Continued  on  page  106) 


for  July,  1968 


51 


- i 


'■'if.'.  : ■ 


I"' 


"'■^  7'^, 


Limits  its  services  and  its  claims  to  credit  to  its  own  area  of  competence. 


Acknowledges  the  responsibility  of  making  its  services  available  to  all  the  public.  This  service 
must  be  maintained  at  the  same  high  level  regardless  of  remuneration  received. 


Msintsins  a progressive  code  of  ethics  to  protect  those  it  serves  and,  secondarily,  to  insure 
maximum  freedom  for  cooperation  between  its  members.  It  freely  exchanges,  within  its  ranks  and 
without  reserve  to  benefit  humanity,  its  knowledge. 


Establishes  standards  of  excellence  (for  those  who  seek  entrance  or  wish  to  continue  as  mem- 
bers of  the  profession)  based  on  knowledge,  character,  and  achievement  without  regard  to  race, 
color  or  creed. 


Carries  out  the  responsibility  of  interpreting  itself  to  the  public,  and  expresses  its  social  conscience 
by  cooperating  with  other  ethical  professions,  groups  and  persons. 


Offers  to  each  of  its  members  (by  tradition  in  the  United  States)  the  right  to  render  services  to 
whom  he  pleases,  at  the  place  and  time  he  chooses,  at  a price  he  wishes  to  charge,  providing  that 
all  of  these  are  consistent  with  the  ethics  of  the  profession,  the  law  of  the  land,  and  the  public 
interest  generally. 


Assumes  leadership  responsibility  in  the  local  community  to  provide  the  best  in  education  at  all 
levels,  effective  and  efficient  local  government,  the  provision  of  adequate  health  and  recreational 
services  and  to  practice  and  promote  the  highest  standards  of  spiritual  living  for  the  total  com- 
munity 


$0ts  an  example  of  moral  action  in  the  community  that  is  above  reproach. 


Establishes  an  environmental  pattern  of  every  day  living  which  can  be  emulated  by  all  in  his 
community. 


Individual  memberships  in  lAP  are  available 
for  those  who  are  already  members  in  good  standing 
of  their  state  professional  societies. 

Your  support  is  encouraged. 

Membership  Application  Form  on  page  105. 


52 


Illinois  Medical  Journal 


Surgical  Grand  Rounds  are  held  weekly^ 
on  Saturday  at  8:00  A.M.;  alternating  be- 
tween the  Staff  Room,  Chicago  Wesley 
Memorial  Hospital  and  Offield  Auditor- 
ium, Passavant  Memorial  Hospital.  Patient 
presentations  from  these  hospitals  and 
from  the  Veterans  Administration  Re- 
search Hospital  form  the  basis  of  the  discus- 
sions. This  case  report  was  part  of  the  Sur- 
gical Grand  Rounds  held  at  Passavant  Me- 
morial Hospital  on  October  21,  1967. 


Case  Presentation: 


Dr.  John  Beal:  The  first  patient  this 
morning  had  an  interesting  lung  problem. 
A patient  of  Dr.  Shields,  it  will  be  pre- 
sented by  Dr.  Watts. 

Dr.  David  Watts:  A 55  year  old  Negro 
man  was  admitted  to  the  Veterans  Admin- 
istration Research  Hospital  in  May,  1967. 
He  complained  of  severe  cough,  productive 
of  blood  and  of  yellow  sputum  amounting 
to  about  one  cupful  per  day.  He  also  had 
chills,  sweats  and  fever  as  high  as  104°F. 
Chest  pain  was  absent.  He  was  a heavy 
smoker,  two  packs  of  cigarettes  per  day, 
and  had  a chronic  cough  for  many  years. 
Two  months  before  his  admission  a chest 
x-ray  elsewhere  was  considered  normal. 
Physical  examination  was  umemarkable. 
White  blood  cell  count  was  11,000  with  a 
shift  to  the  left.  Urinalysis  was  normal. 
Sputum  cultures  yielded  gram  positive  dip- 
lococci  sensitive  to  penicillin.  Skin  tests 
were  negative  except  for  a positive  P.P.D. 
Bronchoscopy  revealed  hyperemic  mucosa 
without  evidence  of  tumor  or  foreign  body. 
Six  sputum  smears  were  negative  for  tu- 
mor cells  and  acid  fast  organisms.  Penicil- 
lin therapy  was  instituted  and  there  was 
prompt  resolution  of  his  fever  and  clearing 
of  his  clinical  symptomatology.  A rapid  de- 
crease in  size  of  the  lung  infiltrate  occur- 
red. Pulmonary  function  studies  were  com- 
patible with  mild  to  moderate  obstructive 
emphysema  and  a residual  opacity  per- 
sisted in  the  left  lower  lung  field.  The  pa- 
tient was  discharged  to  take  oral  penicillin. 
He  was  seen  as  an  outpatient  at  irregular 
intervals  with  persistence  of  the  lung  lesion. 


Abscess  of  Lung 


In  September  he  was  admitted  for  the 
second  time  with  a gunshot  wound  of  his 
right  great  toe.  He  reported  a persistent 
cough  with  minimal  sputum  production. 
Physical  examination  at  this  time  was  es- 
sentially negative.  Hemogram  and  urina- 
lysis were  normal,  and  sputum  culture 
grew  out  only  normal  flora.  Sputum  cyto- 
logy was  negative  for  tumor  cell.  Acid  fast 
organisms  were  not  found.  The  electrocar- 
diographic report  was  that  a right  bundle 
branch  block,  unchanged  on  repeated  trac- 
ing, was  present.  Bronchoscopy  revealed  hy- 
peremia of  the  left  bronchial  tree  without 
obstruction  or  tumor.  Pulmonary  function 
studies  demonstrated  that  his  maximal 
breathing  capacity  was  61  liters  or  53  per 
cent  of  the  predicted  value.  Vital  capacity 
was  53  per  cent  and  the  residual  volume 
was  66  per  cent  of  normal,  or  2,895  ml. 

Dr.  Hirsch  Handmaker:  The  first  chest 
films  taken  in  May,  1967  show  a left  lower 
lobe  density  best  seen  in  lateral  projection 
(Fig.  1).  The  infiltrate  is  homogeneous. 


Fig.  1.:  Lateral  chest  film  demonstrated  cav> 
ity  in  May,  1967. 


54 


Illinois  Medical  Journal 


not  peripheral,  and  has  a central  core  of 
excavation  or  cavity.  It  appears  to  lie  just 
below  the  fissure  but  does  not  cross  it.  Fol- 
lowing treatment  the  mass  appears  smaller 
on  subsequent  films,  and  the  cavitation  is 
less  obvious.  The  October  1967  films  dem- 
onstrate persistence  of  the  density  without 
definite  cavitation  (Fig.  2).  Barium  swal- 


Fig.  2.:  Following  treatment,  the  mass  was 
smaller  but  still  present  in  October,  1967. 

low  at  that  time  revealed  neither  esopha- 
gea  deviation  nor  extrinsic  pressure  from 
mediastinal  nodes.  Laminograms  con- 
firmed the  poorly  circumscribed  mass  with 
a cavity  within  it.  The  fissure  did  appear 
traversed,  and  the  periphery  was  shaggy. 
Central  excavation  favors  benign  abscess 
as  the  etiology,  as  does  the  course  radio- 
graphically. This  was  our  preoperative  im- 
pression. Its  improper  location  statistically 
(75  per  cent  of  abscesses  will  be  right-sided 
in  location)  and  the  irregular  margins 
make  the  exclusion  of  malignancy  impos- 
sible, however. 

Dr.  Thomas  Shields : When  this  pa- 
tient was  seen  originally  at  the  V.A.  the 
discussion  centered  around  whether  or  not 
this  was  truly  an  inflammatory  process  or 
whether  it  was  a neoplastic  process  with  an 
inflammatory  component.  We  were  more 
inclined  on  the  Surgical  Service  to  consider 
this  to  be  most  likely  a tumor  originally 
because  of  its  location  in  the  anterobasar 
portion  of  the  left  lower  lobe.  However, 
the  initial  response  to  antibiotic  therapy 
was  good,  and  this  gave  the  medical  peo- 
ple enough  confidence  so  that  they  felt  as- 
sured in  discharging  him  and  following 
him  as  an  outpatient.  Unfortunately  he 
was  somewhat  negligent  in  his  return  to 
the  clinic  and  it  was  only  because  of  the 

for  July,  1968 


gunshot  wound  that  he  did  return.  Be- 
cause of  the  persistence  of  the  mass,  in  fact 
in  the  opinion  of  some  it  had  increased  in 
size,  resection  was  planned.  Bronchoscopy 
was  repeated  and  was  essentially  normal 
and  no  contraindications  to  resection  were 
present.  The  operative  procedure  went 
quite  well.  The  mass  was  in  the  lower  lobe 
and  was  adjacent  to  the  fissure  but  did  not 
cross  it,  though  there  were  inflammatory 
adhesions  across  it  to  the  lingula.  How- 
ever, because  of  the  patient’s  course  and 
his  relatively  poor  pulmonary  function,  we 
elected  to  do  the  lobe  and  wedge  out  the 
area  of  involvement.  If  a frozen  section  of 
the  mass  did  show  it  to  be  tumor  addition- 
al removal  would  have  been  considered. 
Dr.  Sherrick  has  the  gross  specimen  that  we 
removed. 

Dr.  Joseph  Sherrick : The  specimen 
consisted  of  the  lower  lobe  of  the  left  lung. 
The  pleural  surface  showed  a few  fibrous 
adhesions.  Consistency  was  increased,  and 
on  section  there  was  a 3 cm.  cavity  connect- 
ing with  a bronchus  and  surrounded  by 
firm  anthracotic  lung  tissue.  The  sections 
(Fig.  3)  show  the  lining  of  the  cavity. 


Fig.  3.:  Section  tbrougb  the  wall  of  the  lung 
abscess  demonstrates  the  presence  of  stratified 
squamous  epithelium. 


which  is  composed  partly  of  respiratory 
epithelium  and  partly  of  stratified  squa- 
mous epithelium.  This  is  an  example  of 
squamous  metaplasia  in  response  to  long- 
continued  inflammation.  The  surrounding 
lung  showed  scarring  with  increased  fib- 
rous connective  tissue  and  lymphoid  folli- 
cles. 

Dr.  Thomas  Shields:  This  patient’s 
postoperative  course  was  uneventful  and 
he  had  no  problem  whatsoever  as  far  as  the 
pulmonary  procedure  went.  During  his 
hospital  stay  the  metalic  fragment  was  re- 
moved from  his  foot. 

Lung  abscesses  in  the  past  were  extreme- 

55 


ly  lethal  problems.  Well  over  50  per  cent 
of  the  patients  succumbed  to  the  infection 
before  discovery  of  antibiotics.  The  thor- 
acic surgeon  was  literally  called  upon  to 
rescue  the  patient  from  a sinking  ship  with 
closed  drainage  of  the  chest  and  pneumo- 
nostomy  to  drain  the  lung  abscess.  Fortu- 
nately for  us  this  surgical  indication  is 
practically  never  seen  anymore,  and  the 
treatment  of  abscesses  per  se  is  medical. 
About  80  per  cent  of  the  patients  will  re- 
spond quite  successfully  to  adequate  medi- 
cal management.  Only  the  remaining  20 
per  cent  or  so  will  require  surgical  inter- 
vention which,  as  the  rule,  is  a resection, 
segmentectomy,  lobectomy,  or  pneumonec- 
tomy as  indicated  by  the  topographic  ex- 
tent of  the  disease.  This  type  of  surgery 
has  two  serious  potential  postoperative 
complications  seen  with  a higher  frequency 
than  in  other  thoracic  surgical  patients. 
One  is  bronchopleural  fistula  and  the 
other  is  empyema.  With  antibiotics,  pos- 
tural drainage,  aerosol  therapy  these  have 
become  lessened  in  frequency. 

The  important  thing  in  considering  a 
lung  abscess  is  to  determine  its  underlying 
etiology.  The  most  important,  of  course,  is 
to  rule  out  the  presence  of  carcinoma.  Well 
over  50  per  cent  of  patients  with  lung  ab- 
scesses over  the  age  of  50  have  carcinoma 
as  the  underlying  cause.  This  is  why  it  is 
paramount  that  a specific  set  of  diagnostic 
procedures  be  carried  out,  bronchoscopy, 
cytologic  examinations,  and  as  indicated, 
bronchography  in  evaluating  such  patients. 
The  other  common  cause  of  lung  abscess  is 
due  to  aspiration  of  a foreign  body.  The 
specific  locations  of  aspiration  abscess  are 
due  to  the  bronchial  topography,  and  they 
are  most  often  on  the  right  in  the  superior 
segment  of  the  lower  lobe  or  in  the  axil- 
lary sub-segment  of  the  upper  lobe.  You 
do  not  see  aspiration  abscesses  in  the  mid- 
dle lobe.  We  do  see  a number  of  abscesses 
here  but  the  etiology  is  different.  It  is  just 
common  sense  that  when  a patient  is  un- 
conscious and  in  the  prone  position  if  he 
regurgitates  or  vomits  from  one  cause  or 
another  the  material  is  going  to  run  out  of 
his  mouth.  It  is  not  going  to  be  aspirated 
down  into  his  tracheal  bronchial  tree  in 
this  position  in  contrast  to  an  unconscious 
patient  lying  on  his  back  or  his  side.  So 
whenever  you  have  had  more  than  enough 
to  drink,  be  sure  you  lie  on  your  belly! 

The  other  abscesses  that  one  must  con- 


sider are  the  specific  ones  of  tuberculosis, 
histoplasmosis,  coccidiomycosis,  and  others 
of  the  fungal  origin.  Hydatid  cysts  of  par- 
asitic origin  may  become  infected.  The  me- 
chanical cysts  such  as  acquired  cysts  of  bul- 
lae and  blebs  may  become  infected.  Bron- 
chogenic cysts  may  become  infected  and 
present  as  an  abscess.  Sequestered  lungs 
likewise  may  become  infected.  As  a result 
there  is  a large  number  of  underlying  path- 
ologic conditions,  but  by  and  large  most 
lung  abscesses  are  either  the  result  of 
tumor  or  aspiration.  We  have  had  one 
other  patient  recently  of  a typical  aspira- 
tion lung  abscess.  Dr.  Handmaker  might 
like  to  show  the  films.  This  patient  is  re- 
ceiving intensive  antibody  care  and  I hope 
this  is  an  acute  enough  process  that  with  a 
period  of  time  he  will  respond.  To  judge 
the  response  of  a patient  under  medical 
care  the  patient  clinically  should  become 
afebrile,  the  white  count  should  revert  to 
normal,  sputum  production  should  become 
lessened,  the  abscess  empty  out,  the  walls 
become  thinner  and  gradually  the  abscess 
cavity  itself  should  disappear. 

Dr.  Hirsch  Handmaker:  This  patient’s 
diagnosis  roentgenographically  is  more  cer- 
tainly that  of  lung  abscess  (Fig.  4).  It  is  a 


Fig.  4.;  Large  cavity  with  a smooth,  well  cir- 
cumscribed border  contains  an  air-fluid  level. 

well  circumscribed  mass  with  a very  regu- 
lar central  cavity,  smooth  edge,  and  con- 
tains an  air-fluid  level.  The  mass  is  peri- 
pheral and  in  the  right  lower  lobe.  These 
findings  are  very  typical  and  make  him 
ideal  for  comparison  with  the  previous 
patient,  obviously  a more  difficult  diagnos- 
tic problem.  When  cavitation  appears  ec- 
(Continued  on  page  104) 


56 


Illinois  Medical  Journal 


A Case  Of  Post-Pericardiotomy  Syndrome 
Pathogenical  Consideration 

By  Emanuel  J.  Cohen,  M.D.,  and  Joseph  R.  Nora,  M.D. /Chicago 


The  Clinical  picture  of  the  post-pericar- 
diotomy syndrome  as  it  was  decribed  by 
Ito,  Engle  and  Goldberg  and  of  the 

similar  illness,  the  post-myocardial  syn- 
drome described  by  Dressier  and  co-workers 
is  well  known. 

The  post-pericardiotomy  syndrome  had 
originally  been  called  post-commissurotomy 
syndrome  and  was  first  described  in  1953.^ 

In  some  cases  the  clinical  entity  is  not  so 
complete  as  in  the  original  description:  this 
is  especially  true  in  the  post-myocardial  in- 
farction syndrome  in  which  the  main  com- 
plaint may  be  anginal  pain,  as  we  had  ob- 
served in  some  cases.  Also  well  known  is  the 
left  shoulder  (arthralgia)  syndrome  follow- 
ing myocardial  infarction.  The  pathogene- 
sis of  these  syndromes  is  unclear  and  pos- 
sible knowledge  of  all  the  various  clinical 
features  in  addition  to  the  classical  picture 
is  important  to  better  understand  the  path- 
ogenesis of  these  syndromes. 

Report  of  a Case 

A 34  year  old  white  female  was  admitted 
to  Columbus  Hospital  on  March  17,  1965 
because  of  weakness  and  pain  in  the  chest. 
The  pain  is  precordial  and  is  radiating  to 
the  left  shoulder,  left  arm  to  the  wrist,  es- 
pecially after  exertion,  but  ocassionally  oc- 
curs during  the  night  and  is  accompanied 
with  numbness  and  tingling  sensations.  It 
lasted  generally  about  five  minutes  and  it  is 
a severe  pain,  sometimes  as  a pressure. 
These  complaints  started  in  June,  1963  two 
months  after  open  cardiac  surgery  (Dr.  Kir- 
lin— Mayo  Clinic,  April,  1963).  She  had  a 
previous  closed  commissurotomy  in  1958. 


Other  complaints  were  shortness  of  breath, 
palpitations  and  edema  of  the  ankles.  The 
patient  is  a known  case  of  mitral  stenosis 
since  1951. 

In  July  and  August,  1963  she  was  re- 
hospitalized in  Mayo  Clinic  because  of 
pneumonitis  and  pleural  effusion  and  was 
told  that  these  complaints  were  related  to 
her  cardiac  surgery. 

She  was  next  hospitalized  in  October 
1963  and  given  defibrillation  shock  fol- 
lowed by  improvement.  The  patient’s  con- 
dition was  good  until  June,  1964  when  she 
again  re-required  defibrillation,  to  be  re- 
peated in  October  and  December  1964. 

Since  December,  1964  pronestyl  (being 
allergic  to  quinidine),  digitalis,  anti-coagu- 
lants, hydrodiuril  and  penicillin  were 
given.  The  patient  has  been  receiving  pen- 
icillin orally  since  1951. 

She  has  a history  of  cardiac  failure  in 
1952  (dyspnea  of  exertion,  edema  and  asci- 
tis) when  digitalis  and  diuretics  were  given. 
There  is  no  history  of  rheumatic  fever. 

Past  History 

Patient  had  appendectomy  and  removal 
of  right  ovary  in  1946,  and  cholescystectomy 
in  1959,  but  she  continued  to  complain  of 
pain  in  the  right  upper  quadrant.  Coccix 
bone  was  removed  in  1952  after  an  accident. 
She  has  had  two  episodes  of  pneumonia, 
chronic  kidney  infection  and  peptic  ulcer 
in  1960. 

Physical  Examination 

On  admission  patient  was  normally  de- 
veloped, and  in  no  acute  distress,  but  with 


Emanual  J.  Cohen,  M.D.,  (left)  is  a staff  phy- 
sician in  the  Pulmonary  Service,  Veterans  Ad- 
ministration Hospital,  Hines.  He  received  his 
M.D.  from  the  University  of  Bucharest,  Roman- 
ia and  has  served  on  the  staff  at  Columbus 
Hospital,  Chicago.  Joseph  R.  Nora,  M.D. 
(right)  is  Medical  Director  of  Columbus,  Cun- 
eo  and  Cabrini  Hospitals,  Chicago.  He  is  a 
graduate  of  Loyola  University  Stritch  School 
of  Medicine  and  interned  at  Cook  County.  He 
served  residencies  at  Peter  Bent  Brigham,  West 
Side  V.A.,  and  Chicago  State  TB  Sanitarium. 


i 


for  July,  1968 


57 


slight  respiratory  difficulty  and  apprehen- 
sion. Temperature  was  98.2°,  pulse  84  and 
irregular,  blood  pressure  100/80.  There 
was  no  cough  and  no  engorgement  of  the 
neck  veins.  Lungs  were  clear.  Heart:  PMI 
felt  slightly  beyond  the  left  midclaviculor 
line  at  5th  intercostal  space.  Rhythm  was 
irregular.  First  sound  was  loud.  Grade  3-4 
systolic  murmur,  almost  thruout  the  whole 
systole.  Low  pitched  diastolic  murmur  just 
inside  the  apex.  Heart  rate  88.  Pulmonary 
area:  loud  second  sound. 

Abdomen  was  soft  and  not  distended, 
but  the  liver  could  be  palpated  3 cm.  be- 
low the  right  costal  margin  and  was  tender. 
The  spleen  was  not  palpable. 

Extremities:  No  deformities  or  clubbing 
of  the  fingers.  There  was  slight  edema  of 
the  ankles. 

Laboratory  data  revealed  the  following: 
HB  78%,  (11.7g.),  red  blood  cells  4,190,- 
000.  White  blood  count  per  cubic  milli- 
meter 7,700,  with  normal  differential;  ery- 
throcyte sedimentation  rate  38  mn.  VDRL 
non-reactive.  Blood  urea  nitrogen  10  mg. 
per  cent. 

Electrolytes:  Na  151,  potassium  4.0,  chlo- 
ride 103.4,  CO2  27.6  in  Meq. 

Serum  amylase  was  105U.  and  120U. 
urinary  amylase  200U.  Urinalysis  for  pro- 
tein, sugar  and  acetone  were  negative; 
WBC  8-10. 

T-3  uptake  22.5%  (within  hypothyroid 
range).  The  electrocardiogram  showed  at- 
rial fibrillation,  digitalis  effect  and  left  ven- 
tricular hypertrophy. 

Chest  X-ray:  showed  slight  cardiac  en- 
largement and  passive  congestion. 

Stomach  X-ray:  Minimal  deformity  of 
the  bulb  due  to  old  scarring.  No  other 
abnormality  of  the  stomach  and  duodenum 
was  demonstrated. 

Pulmonary  function  tests:  VC  1.77  L.  5% 
of  normal;  MBC  (Maximal  Breathing  Ca- 
pacity) 52  L/Min.,  63%  of  normal.  Con- 
clusions: Mild  reduction  of  MBC  with 
moderate  reduction  of  VC,  explained  in 
basis  of  cardiac  disease  (Dr.  Amaral  and 
Dr.  Choudhury). 

Phonocardiogram:  There  was  evidence  of 
a prominent  systolic  murmur  and  a very 
prominent  early  diastolic  murmur,  both  at 
the  apex.  (Dr.  Gerald  Nora). 

Hospital  Course 

During  the  hospitalization  the  patient 
had  episodes  of  tachycardia  and  precordial 


pain  with  numbness  in  the  left  arm.  She 
also  complained  of  pain  in  the  right  hypo- 
chrondrium  and  epigastric  area  with  nau- 
sea. The  patient  received  the  following 
therapy:  bed  rest,  anticoagulants,  digita- 
lis, diuretics,  antacids,  anglesics,  tranquiliz- 
ers, vitamin  Bj  and  Bg  and  low-salt  diet. 

The  patient  was  discharged  from  the 
hospital  after  19  days,  much  improved 
with  the  diagnosis  of  Atrial  fibrillation.  Mi- 
tral stenosis  and  insufficiency,  early  de- 
compensation and  Postpericardiotomy  syn- 
drome. On  out-patient  follow-up  she  re- 
turned on  July  9,  1965  to  state  a contin- 
ued improvement.  Lungs  were  clear,  heart 
rhythm  irregular,  rate  86,  tender  liver,  no 
edema.  She  was  able  to  resume  all  works 
of  a housewife. 

Discussion 

The  pathogenesis  of  the  post-pericardio- 
tomy  and  post-myocardial  infarction  syn- 
drome is  still  unclear  and  debatable;  of 
interest  is  the  suggestion  of  Dressier,  that 
the  myocardial  necrosis  may  lead  to  anti- 
genetic  changes,  which  elicits  in  predispos- 
ing individuals,  an  autoimmune  response. 

Van  der  Geld  found  antiheart  antibodies 
in  these  syndromes,  but  this  author  also 
found  antiheart  antibodies  after  cardiac 
surgery  in  sera  of  patients  without  signs  of 
post-pericardiotomy  syndrome.® 

The  fact  remains  an  important  finding, 
but  the  significance  of  auto-antibodies  in 
these  syndromes  or  auto-immune  diseases 
is  unknown,  because  the  question  is  if  these 
auto-antibodies  are  only  the  consequence 
of  the  pathological  process  of  it,  in  addi- 
tion, they  could  at  a later  time  have  a caus- 
ative role.  In  our  opinion  the  present 
knowledge  in  this  problem  permits  us  to 
consider  the  auto-antibodies  to  be  the  con- 
sequence of  the  cardiac  lesions;  and  clinical- 
ly they  have  the  same  significance  as  other 
findings,  secondary  to  the  myocardial  ne- 
crosis, for  example,  the  increased  transami- 
nases. (Current  opinion  is  that  the  anti- 
bodies in  past  cardiotomy  syndrome  are  not 
tissue  damaging;  that  is  that  these  antibod- 
ies do  not  react  with  tissue  antigen,  in  vivo.) 
It  remains  to  the  future  to  prove  if  they  are 
also  casual  agents  or  not.  Other  relation- 
ships between  auto-antibodies  and  auto- 
imune  diseases  are  discussed  recently  in  the 
medical  literature. 

In  our  hypothesis  the  casual  agent  of 
(Continued  on  page  101) 


58 


Illinois  Medical  Journal 


Coronary  Artery  Occlusion  with  Myocardial 
Infarction  in  a Twelve  Year  Old  Boy  — Two 
Episodes  with  a Fatal  Outcome 

By  James  D.  Gross,  M.D.  and  William  C.  Schiffbauer,  M.D./Streator 


The  possibility  of  coronary  artery  occlu- 
sion in  childhood  and  adolescence  is  not 
well  appreciated  clinically.  The  youth  in 
this  case  experienced  two  coronary  occlu- 
sions, the  first  passing  unrecognized  clini- 
cally and  the  second  resulting  in  death. 

Report  of  a Case 

Clinical  History.  — This  twelve  year  old 
white  male  was  in  apparent  good  health 
and  led  a relatively  normal  life  until  the 
time  of  his  sudden  unexpected  death  while 
watching  television.  A few  days  prior  to 
death  he  had  developed  a mild  upper  res- 
piratory tract  infection,  consulted  a phy- 
sician and  was  treated.  No  evidence  of 
more  serious  disease  was  elicited  at  that 
time.  The  patient  had  been  a quite  active 
player  one  year  previously  in  Little  League 
baseball.  Members  of  the  patient’s  family 
had  no  history  of  cardiac  disease  or  heredi- 
tary disease.  No  recorded  blood  pressure 
readings  were  found  after  review  of  all 
available  records. 

Gross  Autopsy.  — The  body  weighed  137 
lbs.  and  was  59  inches  long.  The  body  was 
very  obese  with  the  fat  distributed  in  a fe- 
male pattern.  The  testes  and  penis  were 
small.  A few  hairs  were  present  in  a femin- 
ine distribution  above  the  symphysis  pubis. 
The  neck  was  quite  short  and  the  head  sat 
practically  upon  the  chest,  making  dissec- 
tion very  difficult.  No  x-rays  of  the  cervical 
spine  were  obtained.  The  cranial  cavity, 
brain  and  pituitary  were  examined  and 


were  without  abnormality.  The  neck  or- 
gans were  without  abnormality,  save  for 
some  mild  enlargement  of  the  lymph  nodes 
bilaterally.  The  axillary  lymph  nodes  were 
also  slightly  enlarged. 

The  heart  weighed  410  grams.  The  ven- 
tricular myocardial  walls  measured:  left 
12  mm.,  right  2 mm.  The  foramen  ovale 
was  closed  as  was  the  ductus  arteriosus.  The 
valves  were  without  abnormality.  The  cor- 
onary arteries  presented  several  abnormal- 
ities. The  circumflex  branch  of  the  left 
coronary  artery  was  a vessel  1.5  mm.  in  di- 
ameter and  was  without  abnormality.  The 
anterior  descending  branch  of  the  left  cor- 
onary artery  measured  1.5  mm.  in  diameter. 
The  lumen  of  the  anterior  descending 
branch  of  the  left  coronary  artery  1 cm. 
distal  to  the  bifurcation  ended  abruptly.  In 
the  area  ordinarily  occupied  by  the  lumen 
of  this  vessel  was  a 1.5  mm.  in  diameter,  5 
mm.  long,  very  firm,  calcified,  gray-tan, 
cylindrical  plaque.  The  lumen  of  the  vessel 
could  not  be  traced  through  this  plaque. 
Distal  to  the  nodule  the  anterior  descending 
branch  of  the  coronary  artery  regained  its 
lumen.  No  other  plaques  were  found  in  the 
left  coronary  artery. 

The  right  coronary  artery  provided  the 
outstanding  pathology  in  this  case.  Three 
orifices  were  present  in  the  right  aortic 
sinus  of  Valsalva.  The  two  smaller  orifices 
led  into  very  short,  0.5  mm.  in  diameter 
vessels  which  extended  for  15  mm.  into  the 
adjacent  epicardial  fat  and  then  ended.  No 
plaques  were  found  in  these  small  vessels. 


James  D.  Gross,  M.D.,  (right),  Director  of  Laboratories  at  St.  Mary’s 
Hospital,  Streator,  received  his  M.D.  from  Vanderbilt  Medical  School. 
He  served  a rotating  internship  at  the  U.S.  Naval  Hospital,  St.  Albans, 
Long  Island,  N.Y.,  and  a residency  in  Anatomic  and  Clinical  Patho- 
logy at  the  Bethesda,  Md.,  Naval  Hospital.  Dr.  Wm.  Schiffbauer  re- 
ceived his  M.D.  from  Northwestern  University  Medical  School.  He 
served  an  internship  at  Evanston  Hospital  Assn,  as  well  as  a partial 
residency  in  surgery. 


for  July,  1968 


59 


The  major  orifice  led  into  the  major  p>or- 
tion  of  the  right  coronary  system.  The  right 
coronary  artery  was  much  the  larger  of  the 
coronary  arteries  in  this  patient,  measuring 
up  to  3 mm.  in  diameter.  The  right  coron- 
ary artery  contained  firm,  yellow  plaques 
that  encroached  upon  the  lumen  slightly 
for  a distance  of  15  mm.  from  the  orifice. 
Distal  to  this  point  no  plaques  were  found. 
Beginning  immediately  at  the  orifice  and 
extending  for  7 cm.  a huge  blood  clot  com- 
pletely occluded  the  lumen  of  this  vessel. 
The  blood  clot  was  adherent  to  the  plaques 
in  the  wall  of  the  vessel.  The  posterior  in- 
terventricular septum  and  the  posterior 
portion  of  the  left  ventricular  myocardium 
contained  a 5 cm.  in  diameter  region  of 
marked  softening.  A central  green-yellow 
area  with  scalloped  borders  was  surrounded 
by  an  area  of  recent  hemorrhage.  This  tis- 
sue was  much  softer  and  more  friable  than 
the  surrounding  red-brown  myocardium. 
The  apex  of  the  heart  contained  a 2 cm.  in 
diameter  area  in  which  the  wall  measured 
only  3 mm.  in  thickness,  composed  entirely 
of  dense,  firm,  white  tissue.  There  was  also 
a 5 X 5 X 1 cm.,  dense,  firm,  white  scar  in 
the  anterior  portion  of  the  interventricular 
septum. 

Lungs  and  Abdominal  Organs 

The  lungs  together  weighed  510  grams 
and  contained  a slightly  increased  amount 
of  clear  colorless  fluid.  Bilaterally  there  was 
marked  focal  dilatation  of  the  bronchi.  In 
several  scattered  areas  close  to  the  pleura, 
bronchi  3.5  mm.  in  diameter  were  en- 
countered. The  abdominal  organs  were  in 
the  usual  anatomical  position,  save  for  pro- 
trusion of  the  liver  4 cm.  inferior  to  the 
right  costal  margin  in  the  mid-clavicular 
line.  The  liver  weighed  1350  grams  and 
was  red-brown,  firm,  homogeneous  and 
without  abnormality.  The  gallbladder  was 
normal.  No  stones  were  present.  The  spleen 
weighed  280  grams  and  was  composed  of 
rather  homogeneous,  blue-red  tissue.  The 
lymphoid  follicles  were  quite  prominent. 
The  pancreas  and  adrenals  were  without 
abnormality.  The  kidneys  together  weighed 
290  grams.  Several  small  cysts  measuring 
from  1 to  4 mm.  in  diameter,  lined  by 
glistening,  transparent  tissue  were  present 
in  both  kidneys.  These  cysts  did  not  occupy 
a significant  volume  of  these  organs.  The 
renal  pelves,  ureters  and  bladder  were  nor- 
mal. The  testes  were  those  of  a prepuberal 


male.  The  gastrointestional  tract  was  with- 
out abnormality.  The  mesenteric  lymph 
nodes  were  moderately  enlarged. 

Microscopic  Autopsy.  — Sections  of  the 
right  coronary  artery  in  the  grossly  some- 
what thickened  proximal  15  mm.  segment 
revealed  marked  intimal  thickening  due  to 
cellular  proliferation  and  to  production  of 
an  increased  amount  of  fibrous  connective 
tissue,  some  of  which  had  become  hyalin- 
ized.  Many  cholesterol  clefts  were  present 
in  the  intima  and  small  calcium  deposits 
were  seen  in  the  intima  and  media.  The  in- 
ternal surface  of  the  intima  was  rough  and 
irregular  and  a large  thrombus  was  at- 
tached to  this  area.  The  thrombus  com- 
pletely filled  the  narrowed  lumen.  Sections 
of  the  left  coronary  artery  in  the  area  of  the 
cylindrical  plaque  revealed  marked  thick- 
ening of  the  intima,  with  obliteration  of 
the  lumen  due  to  cellular  proliferation  and 
to  production  of  a very  large  amount  of 
fibrous  connective  tissue,  much  of  which 
had  become  hyalinized.  Many  cholesterol 
clefts  were  present  in  the  intima  and  many 
large  calcium  deposits  were  seen  in  the 
intima  and  media.  In  some  scattered  areas 
dilated  capillaries  were  seen  in  the  intima. 
No  other  changes  were  seen  in  the  previ- 
ously described  portions  of  the  coronary 
arteries  and  the  remaining  portions  of  the 
coronary  arteries  showed  no  abnormality. 

Sections  of  the  thin  portion  of  the  left 
ventricular  wall  near  the  apex  revealed 
destruction  of  almost  all  muscle  fibers.  The 
muscle  fibers  were  replaced  by  dense,  eosin- 
ophilic, relatively  acellular  fibrous  connec- 
tive tissue.  No  acute  or  chronic  inflamma- 
tory cells  were  present  and  no  recently  ex- 
travasated  red  blood  cells  or  hemosiderin- 
containing  macrophages  were  seen.  Sec- 
tions of  the  anterior  portion  of  the  inter- 
ventricular septum  revealed  widespread 
destruction  of  the  muscle  fibers  and  re- 
placement by  relatively  acellular  dense, 
eosinophilic  fibrous  connective  tissue.  No 
acute  or  chronic  inflammatory  cells  were 
present  and  no  recently  extravasated  red 
blood  cells  or  hemosiderin-containing  ma- 
crophages were  seen. 

Sections  from  the  posterior  portion  of 
the  interventricular  septum  in  the  area  of 
the  gross  softening,  supplied  by  the  right 
coronary  artery,  revealed  massive  recent 
destruction  of  myocardial  fibers.  Fragmen- 
tation of  muscle  fibers,  brilliantly  eosino- 


60 


Illinois  Medical  Journal 


philic  staining  reaction  of  some  muscle 
fibers,  loss  of  cross  striations,  and  karyor- 
rhexis,  pykosis  and  karyolysis  of  muscle 
fiber  nuclei  were  prominent  changes.  The 
central  portion  of  the  lesion  contained  a 
heavy  infiltrate  of  neutrophilic  polymor- 
phonuclear leukocytes.  Surrounding  this 
central  area,  the  peripheral  portions  of  the 
lesion  showed  less  prominent  necrosis  of 
muscle  fibers,  and  recently  extravasated  red 
blood  cells  were  present  in  large  numbers 
in  the  edematous  interstitial  connective  tis- 
sue. White  blood  cells  were  not  present  in 
the  interstitial  tissue  in  these  peripheral 
portions  of  the  lesion. 

Sections  of  the  lungs  revealed  congestion 
of  the  alveolar  wall  blood  vessels.  A small 
amount  of  fibrin  was  present  in  a few  alveo- 
lar spaces.  No  other  pulmonary  lesion  was 
found  after  examination  of  several  sections. 
Sections  of  the  liver  revealed  atrophy  of  the 
central  parenchymal  cells  and  dilatation  of 
the  central  sinusoids,  with  congestion  of 
these  sinusoids  by  red  blood  cells.  A few 
fat  vacuoles  were  present  within  the  paren- 
chymal cell  cytoplasm.  Sections  through  the 
spleen  revealed  some  congestion  of  the  red 
pulp  but  no  other  abnormality.  Sections  of 
the  adrenal  glands  revealed  no  abnormal- 
ity. Sections  of  the  appendix  revealed 
lymphoid  hyperplasia  but  no  other  lesion. 
Sections  of  the  kidneys  revealed  scattered, 
very  dilated  tubules  and  infiltration  of  the 
interstitial  tissue  by  a few  mature  lympho- 
cytes. Sections  of  the  testes  revealed  no 
spermatogenesis.  Increased  fibrous  connec- 
tive tissue  was  present  in  the  interstitium. 
Sections  of  the  brain,  brain  stem  and  pitui- 
tary gland  were  not  abnormal. 

Discussion 

This  case  is  presented  because  of  the 
young  age  of  the  patient.  A previous  non- 
fatal  left  coronary  artery  thrombosis  and 
myocardial  infarct  had  occurred  probably 
prior  to  the  age  of  eleven  and  had  been  un- 
detected. The  boy  had  continued  his  usual 
activities  without  apparent  modification, 
only  to  suffer  a second  right  coronary  artery 
thrombosis  and  myocardial  infarct,  result- 
ing in  death.  Unfortunately,  blood  pressure 
readings  of  this  patient  were  not  available. 
Studies  of  blood  cholesterol  on  this  patient 
and  his  family  were  not  performed. 

Talbot^  reported  the  case  of  a seven  year 


old  white  male  with  progeria  who  devel- 
oped atheromatous  coronary  disease  and 
who  sustained  a myocardial  infarction.  Jokl 
and  Greenstein’s^  ten  year  old  patient  is 
the  youngest  reported  case  of  death  due  to 
coronary  atherosclerosis  in  childhood  in  a 
patient  without  progeria.  It  is  believed  that 
this  case  represents  the  youngest  reported 
patient  to  have  suffered  two  chronologically 
distinct  myocardial  infarcts  caused  by 
thrombosis  of  atherosclerotic  coronary  ar- 
teries. 

Summary 

This  is  a case  of  a twelve  year  old  white 
male  who  was  quite  active  and  led  a rela- 
tively normal  life  until  the  time  of  his 
death.  A few  days  prior  to  death,  the  pa- 
tient developed  a mild  upper  respiratory 
tract  infection.  He  consulted  a physician 
and  was  treated  for  this  condition.  While 
watching  television  at  home  the  patient 
suddenly  expired. 

Autopsy  revealed  marked  coronary  ather- 
osclerosis of  a degree  quite  unusual  for  a 
child  of  this  age.  Thrombosis  of  the  anter- 
ior descending  branch  of  the  left  coronary 
artery  had  occurred  some  time  in  the  past, 
with  resultant  myocardial  infarction  of  the 
anterior  interventricular  septum  and  an- 
terior left  ventricular  wall.  Myocardial  hy- 
pertrophy and  fibrosis  followed  the  devel- 
opment of  the  atherosclerosis,  thrombosis 
and  myocardial  infarction.  The  myocardial 
infarction  resulted  in  marked  thinning  and 
fibrosis  of  the  apex  of  the  left  ventricle, 
giving  rise  to  the  aneurysm  of  the  left  ven- 
tricular chamber  in  that  region.  These 
changes  were  followed  by  chronic  passive 
congestion  of  the  liver  and  spleen.  The  pa- 
tient then  suddenly  died  of  a very  recent 
thrombosis  of  the  right  coronary  artery  re- 
sulting in  myocardial  infarction  of  the  pos- 
terior interventricular  septum  and  poster- 
ior left  ventricular  wall. 

References 

1.  Talbot,  N.  B.,  et  al:  Progeria;  Clinical,  Met- 
abolic and  Pathologic  Studies  on  Patient. 
American  Journal  of  Diseases  of  Children, 
69:267,  1945. 

2.  Jokl,  E.  and  Greenstein,  J.:  Fatal  Coronary- 
Sclerosis  in  a Bov  of  Ten  Years,  Lancet  2:659 
(Nov.  18)  1944. 

3.  Stryker,  "Walter  A.:  Coronary  Occlusive  Disease 
in  infants  and  Children,  American  Journal  of 
Diseases  of  Children,  March,  1946. 


for  July,  1968 


61 


Fusion  Of  The  Labia  Minora 

By  Marc  I.  Rowe,  M.D./Chicago 


In  the  past  year  we  have  treated  four 
young  girls  with  fusion  of  the  labia  minora. 
None  of  these  patients  had  the  correct  diag- 
nosis made  before  referral  to  the  hospital. 
The  first  girl  was  a six-year-old  referred 
from  the  pediatric  service  for  x-ray  and 
endocrine  evaluation  of  intersex.  A seven- 
year-old  was  brought  to  the  hospital  by 
two  grief-stricken  parents  who  had  just 
been  told  by  their  physician  that  their 
daughter  was  born  without  a vagina.  The 
third  patient,  twenty-two  months  old,  was 
sent  to  the  surgical  service  by  a pediatrician 
for  surgical  correction  of  a minute  vaginal 
opening.  The  final  patient  was  four  years 
old  and  had  a referring  diagnosis  of  “con- 
genital anomaly  of  the  genitalia.”  All  of 
these  girls  had  typical  fusion  of  the  la- 
bia minora  that  was  simply  and  quickly 
treated.  This  relatively  common  and  in- 
nocuous lesion  is  apparently  not  well  re- 
cognized or  managed,  resulting  in  needless 
apprehension  in  the  patient  and  her  family 
and  unnecessary  referrals. 

Etiology 

Campbell,  in  1940,^  suggested  that  fu- 
sion of  the  labia  minora  was  a congenital 
anomaly.  He  felt  that  during  the  third  and 
fourth  month  of  fetal  life,  embryologic  mid- 
line fusion  of  the  labioscrotal  folds  oc- 
curred similar  to  the  merging  of  the  two 
scrotal  folds  in  the  male.  Currently  it  is 
generally  accepted^'^-'^  ^'S  that  labial  fusion 
is  an  acquired  condition  resulting  from  an 
episode  of  vulvovaginitis.  Several  facts  seem 
to  substantiate  this.  (1)  The  labial  folds 
develop  from  the  edges  of  the  genital  tu- 
bercles and  are  not  fused  in  any  stage  of 
fetal  development.^’®  (2)  Fusion  of  the 
labia  minora  is  seen  in  infants  and  chil- 
dren but  not  neonates.  There  is  only  one 
reported  case  of  fusion  in  a newborn.^  (3) 
There  is  often  a documented  history  of 
genitalia  previously  observed  to  be  normal. 
Fifty-seven  of  Nowlin,  Adams,  and  Nalle’s® 
110  patients  with  labial  fusion  had  normal 


Marc  I.  Rowe,  M.D.,  is  Assistant  Professor 
of  Pediatric  Surgery,  the  Department  of  Sur- 
gery, The  University  of  Chicago  and  Wyler 
Children’s  Hospital.  He  is  a graduate  of  Tufts 
Univ.  School  of  Medicine. 


vaginal  examinations  at  birth.  (4)  A pre- 
ceding history  of  vulvovaginitis  frequently 
can  be  elicited.  Forty-seven  per  cent  of 
Vakar’s'^  patients  had  such  a history.  (5) 
The  lesion  has  recurred  in  as  many  as  20 
per  cent®  of  the  patients  after  surgical 
separation.  (6)  Separation  of  the  labial  fu- 
sion follows  locaF'^  or  systemic®  estrogen 
therapy  without  mechanical  efforts  to  sepa- 
rate. (7)  Spontaneous  separation  occurs 
just  before  the  menarche  when  estrogen 
levels  rise.  (8)  Congenital  anomalies  are 
not  common  in  these  patients.® 

Pathogenesis 

The  newborn’s  external  genitalia  are 
stimulated  by  maternal  estrogen.  After  a 
few  months  the  estrogen  level  drops  and 
continues  at  a relatively  low  level  until 
the  premenarche.  Until  the  increase  in  es- 
trogen concentration  which  then  occurs 
the  bacterial  flora  of  the  vagina  is  quite 
different  from  the  adult,  and  the  pH  of 
the  vagina  is  alkaline.  Vulvovaginitis  is  be- 
lieved to  result  from  an  exaggeration  of 
the  physiologic  hypoestrogenism  of  the 
child.  A low  grade  inflammation,  similar 
to  senile  vaginitis,  develops  and  the  sub- 
sequent erosions  and  inflammation  of  the 
closely  approximated  labia  minora  lead  to 
adhesions  and  fusion. 

Clinical  Characteristics 

The  lesion  is  most  commonly  seen  in 
girls  between  the  ages  of  two  and  six  years. 
A history  of  preceding  vulvovaginitis 
characterized  by  a thin,  watery,  yellowish 
discharge,  reddened  vulva,  pain  and  pruri- 
tus sometimes  will  be  obtained.  The  par- 
ents’ recollection  or  the  patient’s  record 
may  indicate  that  the  genitalia  previously 
had  been  normal.  In  about  20  per  cent  of 
the  cases®  urinary  symptoms  will  be  noted. 
Deviations  of  the  urinary  stream,  straining 
dysuria,  pyuria,  and  low  abdominal  pain 
will  then  be  reported. 

The  physical  findings  are  typical.  Gen- 
tle retraction  of  the  labia  majora  reveals 
a single  opening  between  the  pubis  and 
the  anus.  The  vaginal  orifice,  clitoris,  and 
urethral  meatus  are  not  visible.  The  labia 


62 


Illinois  Medical  Journal 


minora  are  sealed  together  by  a thin,  red 
median  line,  often  semi-transparent.  The 
single  aperture  is  commonly  in  the  subcli- 
toral  area  and  can  be  quite  small.  A probe 
passed  through  this  opening  and  directed 
downward  and  outward  will  demonstrate 
the  thinness  of  the  line  of  fusion,  and  fre- 
quently produce  separation.  Once  the  fu- 
sion has  been  broken,  normal  urinary  and 
vaginal  orifices  are  visible. 

Complications 

This  condition  usually  causes  little 
trouble,  and  the  main  concern  is  over  the 
psychic  trauma  sustained  by  the  child  and 
her  parents.  Urine  collecting  in  the  gut- 
ter, behind  the  fusion,  may  reflux  into 
the  vagina  causing  a severe  vaginitis,  or 
seep  onto  the  perineum  and  produce  a 
refractory  ammonia  dermatitis.  Urinary 
tract  infections  have  frequently  been 
blamed  on  the  relative  obstruction  to  the 
urethral  meatus  produced  by  the  fusion.^ 
No  urinary  tract  anomalies  were  found  in 
these  patients  by  urologic  investigation  and 
their  infections  were  invariably  cured  by 
labial  separation  and  systemic  antibiotics. 

Treatment 

Daily  applications  of  estrogen  cream  to 
the  vulva  usually  results  in  nontraumatic 
separation  of  the  labia  in  several  days.  Sev- 
eral authors^'^'®  found  surgical  separation, 
either  by  blunt  dissection  or  incision  rapid 
and  simple.  With  heavy  adhesions,  or  when 
a urologic  evaluation  is  to  be  done,  anes- 
thesia is  employed.  The  recurrence  rate 
with  surgical  separation,  however,  has  been 
as  high  as  20  per  cent.®  Teton  and  Tread- 
well® believed  surgical  separation  or  local 
estrogen  applications  produce  psychic  and 
physical  trauma  to  the  young  girl  that  may 
cause  difficulty  in  her  later  sexual  adjust- 
ments. They  recommended  oral  estrogen 
for  ten  to  fourteen  days.  The  labial  ad- 
hesions disappeared  in  both  their  patients 
but  slight  enlargement  of  the  breast,  dark- 


The Veterans  Administration  can  now 
provide  nursing  care  in  practically  every 
town  in  the  country.  By  using  contract 
nursing  homes  for  care  of  convalescents  and 
the  aged,  VA  has  freed  4,000  beds  in  its 
166  hospitals  for  use  by  the  more  acutely 
ill  while  nursing  care  patients  can  stay 
closer  to  home. 


ening  of  the  areola,  and  growth  of  pubic 
hair  occurred. 

We  recommend  the  following  therapeu- 
tic plan.  (1)  If  the  fusion  is  thin  it  will 
frequently  begin  to  separate  during  the 
initial  examination.  With  gentle  but  firm 
spreading  of  the  labia,  complete  separation 
can  be  completed  quickly  and  relatively 
painlessly.  The  fusion  can  also  be  broken 
down  by  manipulation  of  a probe  or 
curved  clamp  placed  in  the  defect  in  the 
adhesions.  (2)  Following  separation,  estro- 
gen cream  should  be  applied  by  the  mother 
for  three  or  four  days  to  prevent  recur- 
rence. (3)  If  the  adhesions  are  heavy  and 
do  not  separate  easily  estrogen  cream  is 
applied  for  four  or  five  days.  (4)  If  the 
labia  fail  to  separate  with  local  estrogen 
therapy  the  adhesions  are  divided  with  a 
scalpel  under  anesthesia.  Bleeding  is  mini- 
mal and  no  sutures  are  needed  to  repair 
the  cut  edges.  If  the  patient  requires  anes- 
thesia for  cystocopy  or  other  reasons, 
separation  can  be  done  at  this  time.  Estro- 
gen cream  should  be  applied  in  the  post- 
operative period. 

Summary 

Fusion  of  the  labia  minora  is  an  acquired 
condition  resulting  from  the  nonspecific 
vulvovaginitis  of  childhood.  Local  applica- 
tion of  estrogen  cream  or  surgical  separa- 
tion are  simple  and  successful  methods  of 
treatment. 

References 

1.  Bowles,  H.  E.,  and  Childs,  L.  S.:  Synechias  of 
Vulva  in  Small  Children,  Am.  Journ.  Dis. 
Child.,  66:259,  1943. 

2.  Campbell,  M.F.:  Vulvar  Fusion;  Its  Urogyne- 
cologic  Interest,  J.A.M.A.,  I15:5i3,  1940. 

3.  Craig,  D.S.:  Fusion  of  the  Labia  Minora  in 
Infancy,  The  Practitioner,  196-424,  1966. 

4.  Huffman,  J.  W.:  Disorders  of  the  External 
Genitals  and  Vagina,  Pediat.  Clinics  N.  Am., 
5:36,  Feb.  1958. 

5.  Nowlin,  P.,  Adams,  J.  R.,  and  Nalle,  B.  C., 
Jr.:  Vulvar  Fusion,  Jour,  of  Urology,  62:75, 
1949. 

6.  Teton,  J.  B.,  and  Treadwell,  N.  C.:  The  Man- 
agement of  Nonspecific  Vulvitis  in  Children, 
Am.  Jour,  of  Obst.  Gyn.,  72:674-676,  1956. 


World  War  II  veterans  who  have  not 
already  used  their  eligibility  for  G.  I.  loans 
and  whose  individual  eligibility  has  not 
expired  are  reminded  that  the  final  cut-off 
date  for  their  participation  in  the  G.  I. 
loan  program  has  been  extended  until 
June  25,  1970. 


for  July,  1968 


63 


Clinical  Experience  with  a New  Topical 
Corticosteroid,  Betamethasone  17-Valerate 


By  Roy  A.  Hecht,  M.D.,  F.A.A.A.,  F.A.C.A./Kankakee 


Betamethasone  17-valerate— a new  ester 
of  betamethasone  developed  through  in- 
tensive research  in  England  and  at  Scher- 
ing  Corporation,  has  recently  become 
available  in  this  country  as  Valisone 
Cream  0.1%. 

During  its  investigational  phase,  clinical 
studies  of  betamethasone  17-valerate  cream 
0.1%  and  0.05%  and  ointment  0.1%  and 
0.05%  were  made  by  this  writer.  This  brief 
report  describes  clinical  experience  with 
this  new  topical  corticosteroid  in  all  four 
formulations. 

In  double-blind  paired-comparison  trials, 
betamethasone  17-valerate  has  been  found 
as  effective  as  or  more  effective  than  fluo- 
cinolone  acetonide.  Mitchell  et  al.i  and 
Coburn^  reported  that  betamethasone  17- 
valerate  cream  0.1%  was  equally  effective 
as  fluocinolone  acetonide  cream  0.025% 
and  0.01%,  respectively,  in  50  and  25  pa- 
tients respectively.  Ross^  compared  the  fol- 
lowing preparations  in  196  trials: 

betamethasone  17-valerate  cream  0.1% 
and  ointment  0.1%,  fluocinolone  aceto- 
nide cream  0.1%  and  ointment  0.01%, 
two  cream  bases, 
two  ointment  bases. 

Statistical  analysis  of  the  results  showed  no 
significant  difference  among  the  active 
drugs  though  all  four  were  superior  to  the 
bases  without  active  ingredients. 

Comparison  With  Other  Ointments 

A group  of  seven  investigators^  in  as 
many  clinical  centers  in  England  collabor- 
ated in  a clinical  study  involving  345  pa- 
tients with  psoriasis  and  462  with  eczema. 
They  compared  betamethasone  17-valerate 
ointment  0.1%  with  five  other  topical  cor- 
ticosteroids, all  applied  with  and  without 


occlusion,  in  a double-blind  paired-compar- 
ison trial.  The  other  ointments  were 
fluocinolone  acetonide  0.025%,  triamcino- 
lone acetonide  0.1%,  flurandrenolone 
0.05%,  betamethasone  phosphate  0.1%,  and 
hydrocortisone  1.0%.  In  patients  with  psor- 
iasis, betamethasone  17-valerate  was  judged 
more  effective  than  the  corticosteroid  being 
compared  with  it  in  40%  to  75%,  less  ef- 
fective in  6%  to  15%,  and  equally  effective 
in  19%  to  45%.  In  patients  with  eczema, 
betamethasone  17-valerate  was  judged  more 
effective  than  the  corticosteroid  being  com- 
pared with  it  in  27%  to  60%,  less  effective 
in  13%  to  18%,  and  equally  effective  in 
27%  to  56%.  Statistical  analysis  of  the 
overall  results  showed  betamethasone  17- 
valerate  to  be  more  effective  than  all  the 
other  compounds. 

Zimmerman^  made  a double-blind  pair- 
ed-comparison trial  of  17-valerate  ointment 
0.05%  and  fluocinolone  acetonide  oint- 
ment 0.025%  in  54  patients  with  bilateral, 
symmetrical  lesions.  The  results  were  as 
follows. 

Betamethasone  17-valerate 

superior  37  (69%) 

Fluocinolone  acetonide 

superior  1 ( 2%) 

Both  equally  effective  16  (29%) 

Thus,  betamethasone  17-valerate  was  as  ef- 
fective as  or  more  effective  than  fluocino- 
lone acetonide  in  53  of  54  patients  (98%). 

Report  of  Study 

This  investigator  conducted  a clinical 
trial  of  betamethasone  17-valerate  in  97  pa- 
tients with  various  allergic  dermatoses. 
The  diseases  treated  and  the  formulations 
administered  are  presented  in  Table  1. 

Since  betamethasone  17-valerate  will  be 


Roy  A.  Hecht,  M.D.,  F.A.A.A.,  F.A.C.A.,  is  engaged  in  the  practice 
of  allergy.  He  received  his  medical  training  at  the  Chicago  Medical 
School  and  served  his  internship  and  residency  at  the  Hospital  of  St. 
Anthony  De  Padua,  Chicago.  Dr.  Hecht  is  consultant  in  allergy,  St. 
Mary’s  and  Kankakee  State  Hospitals. 


64 


Illinois  Medical  Journal 


Table  I 

TYPES  OF  DERMATOSES  TREATED  WITH 
BETAMETHASONE  17-VALERATE,  BY 
FORMULATION 

Cream  Ointment  Total 


No.  of 

0.1%  0.05%  0.1%  0.05%  Patients 


Atopic  eczema 
(acute) 

1 

8 

6 

12 

27 

(chronic) 

- 

5 

- 

6 

11 

Eczematoid 

dermatitis 

2 

4 

2 

1 

9 

Atopic 

dermatitis 

1 

5 

3 

4 

13 

Dermatitis 

venenata 

2 

6 

5 

5 

18 

Detergent 

dermatitis 

2 

1 

2 

3 

8 

Other  contact 
dermatitis 

1 

2 

3 

Seborrheic 

dermatitis 

2 

1 

3 

Pruritus 

. 

2 

- 

. 

2 

.4  topic 

neurodermatitis 

1 

1 

Axillary 

erythrasma 

1 

1 

Psoriasis 

- 

1 

- 

- 

1 

Totals 

9 

32 

23 

33 

97 

used  adjunctively  with  other  drugs,  particu- 
larly by  physicians  treating  allergic  derma- 
toses, an  evaluation  of  this  concomitant 
use  is  timely.  Only  33  patients  in  this  study 
were  treated  with  betamethasone  17-valer- 
ate alone.  All  the  others  received  concomit- 
ant treatment  with  ACTH,  or  with  other 
topical  or  systemic  corticosteroids,  or  with 
antihistamines  or  other  agents.  About  40% 
of  the  patients  had  a chronic  or  recurrent 
disease  that  either  had  persisted  or  recurred 
periodically  for  a year  or  more.  No  occlu- 
sive dressings  were  used  with  any  of  the  pa- 
tients. Betamethasone  17-valerate  was  us- 
ually applied  twice  a day.  About  two-thirds 
of  the  patients  were  treated  for  only  one  or 
two  weeks.  Only  15  patients  required  treat- 
ment for  more  than  three  weeks. 


Results 

Responses  were  judged  as  follows:  Ex- 
cellent: Relief  or  pruritus,  burning,  and 
stinging  within  24  hours;  relief  or  eryth- 
ema, weeping,  oozing,  and  edema  in  2 to  3 
days;  subsequent  control  of  flare-ups.  Good: 
Delayed  or  less  than  complete  response  of 
subjective  and  objective  symptoms.  Fair: 
Little  or  no  response.  Poor:  No  improve- 
ment or  worse. 

The  results  of  97  patients  were  evaluated 
as  follows: 


Excellent 

Good 

Fair 

Poor 


61 

33 

3 

0 


(63%) 
(34%) 
( 3%) 


The  results  by  formulation  were  as  fol- 


lows: 

Formulation  of 
betamethasone 
1 7-valer'ate 

Exc. 

Good 

Fair 

cream  0.1% 

7 

2 

0 

cream  0.05% 

14 

18 

0 

ointment  0.1% 

18 

5 

0 

ointment  0.05% 

22 

8 

3 

61 

33 

3 

Discussion 

In  terms  of  percentage  of  excellent  re- 
sults, the  0.1%  formulations  were  some- 
what more  effective  than  the  0.05%  formu- 
lations (80%  compared  with  40  to  60%), 
as  would  be  expected.  There  were  no  treat- 
ment failures.  No  adverse  effects  were  ob- 
served. Although  an  allergic  population 
was  being  treated,  no  hypersensitivity  re- 
actions to  the  drug  occurred.  The  medica- 
tion was  well  received  and  well  tolerated. 
There  was  no  clinical  evidence  of  systemic 
absorption,  though  no  laboratory  measure- 
ments were  performed.  Thus,  betametha- 
sone 17-valerate  proved  to  be  a useful  new 
agent  for  inclusion  in  the  regimen  of  ther- 
apy for  allergic  dermatoses. 

Summary 

This  investigator  used  a new  ester  of  be- 
tamethasone-betamethasone 1 7-valerate— 
in  four  topical  formulations  to  treat  97  pa- 
tients with  allergic  dermatoses.  The  num- 
bers of  patients  who  received  each  formu- 
lation were  as  follows:  0.1%  cream  9, 
0.05%  cream  32,  0.1%  ointment  23,  0.05% 
ointment  33.  Most  of  the  patients  received 
the  medication  twice  a day,  and  over  80% 
were  treated  for  only  three  weeks  or  less. 
Therapeutic  results  were:  61  excellent,  33 
good,  3 fair,  and  0 poor.  The  0.1%  formu- 
lations were  somewhat  more  effective  than 
the  0.05%,  as  would  be  expected.  No  ad- 
verse effects,  including  hypersensitivity  re- 
actions, were  seen.  There  was  no  clinical 
evidence  of  systemic  absorption.  The  medi- 
cation was  uniformly  well  accepted  and 
well  tolerated.  Betamethasone  17-valerate 
(Valisone)  is  an  effective  new  agent  for  ad- 
junctive treatment  of  allergic  dermatoses. 

References 

1.  Mitchell,  D.  M.,  et  ah:  Betamethasone  17-val- 
erate. A clinical  trial  of  a new  topical  steroid, 
J.  Irish  Med.  55:44-45  (Aug.)  1964. 

(Continued  on  page  108) 


for  July,  1968 


65 


Community  Immunity 
How,  When  And  How  Much? 

By  Herbert  S.  Lipschultz^  M.D.  Ward  Duel^  M.P.H. 
AND  Seymour  Diamond,  M.D. 


The  Skokie  Board  of  Health  in  past 
years  and  again  in  1967,  was  presented 
with  the  request  from  the  local  community 
and  the  recommendation  of  the  United 
States  Public  Health  Service  to  “eradicate” 
measles.  Since  there  had  been  differences 
of  opinion  concerning  the  community  need 
for  a “Measles  Day”*  approach  to  mass  im- 
munization, a committee  was  appointed  to 
further  study  the  problem. 

The  Village  of  Skokie  is  somewhat  un- 
usual. It  has  a high  percentage  of  profes- 
sional people  in  the  community— physicians 
and  lawyers  with  Chicago  offices,  profes- 
sors from  nearby  Northwestern  University, 
and  owners  and  managers  of  successful  bus- 
inesses. It  is  a young  community  with  a 
median  age  of  30.6  years.  In  the  last  twelve 
years,  the  number  of  homes  increased  over 
300%;  the  median  value  of  homes  is  $27,- 
300.  School  health  records  indicate  that  the 
overwhelming  majority  of  the  children  are 
cared  for  privately  and  immunizations  are 
current. 

The  Decision 

From  the  above,  the  committee  felt  that 
a very  large  percentage  of  the  children 
would  be  under  private  care  and  might 
well  already  have  been  immunized.  It  was, 
therefore,  recommended  that  a careful  sur- 
vey was  in  order  to  first  determine  the 
need  for  a mass  immunization  program. 

Other  recommendations  included  a sim- 
ple technique  for  accomplishing  a mass  sur- 
vey (rather  than  the  usual  “sampling”  pro- 
cedure) with  almost  negligible  cost.  The 
uses  of  the  existing  organizational  struc- 
tures of  the  public  and  parochial  schools, 
churches,  synagogues,  pre-school  nurseries 
and  in  addition,  the  “woman  power”  of 
the  Parent  Teacher  Association  and  the 
Association  of  University  Women.  The  ex- 
traordinary cooperation  of  available  per- 


*  The  United  States  Public  Health  Service 
uses  the  word  “eradication”  to  denote  that  level 
of  immunity  in  a community  which  prevents 
the  occurrence  of  secondary  cases  within  the 
incubation  period  of  that  disease. 


sonnel  of  the  PTA  and  AUW  more  than 
made  up  for  what  might  otherwise  have 
been  an  excessively  costly  and  overambi- 
tious  project. 

The  response  of  the  public  in  the  provi- 
sion of  services  was  tremendous.  An  infor- 
mal tabulation  indicated  that  over  1,000 
people  participated  and  the  total  cost  to 
the  community  for  the  entire  survey  was 

0.6  of  one  cent  per  respondent!  Over  11,- 
000  children,  ages  one  through  twelve 
(2/3  of  the  total  estimated  population  in 
this  age  group)  responded. 

The  Procedure 

1.  The  full  time  professional  staff  of  the 
Skokie  Health  Department  obtained  litera- 
ture and  consultative  aid  from  the  State 
Health  Department  and  the  U.S.  Public 
Health  Service. 

2.  This  material  as  well  as  an  informa- 
tion flyer  and  a questionnaire  printed  lo- 
cally was  distributed  to  the  public,  paro- 
chial and  nursery  schools. 

3.  The  packets  of  literature  and  the 
questionnaire  (a  tear-off  slip  of  paper) 
were  distributed  by  teachers,  nursery  school 
directors,  ministers,  rabbis  and  priests  in 
their  respective  schools  to  the  children. 

Special  efforts  were  directed  to  the  pre- 
school population  through  a telephone  sur- 
vey and  newspaper  reproduction  of  the 
questionnaire.  Over  thirty  radio  and  num- 
erous church  announcements  advised  par- 
ents of  pre-school  children  where  forms 
could  be  obtained. 

Setting  Up  the  Survey 

In  order  to  prevent  prejudiced  decisions 
by  post  facto  decision-making,  the  follow- 
ing statistical  measles  program  guidelines 
were  established  in  consultation  with  Dr. 
Walter  Buell,  UPHS  Consultant  to  the 
IDPH  for  the  measles  eradication  program: 

80-85%  immune— assume  community  is 
approaching  herd  immunity,  and/ 
or  eradication  levels  and  conduct 
mail  effort  to  susceptibles 


66 


Illinois  Medical  Jouriml 


75%  immune— assume  community  need 
not  be  concerned  about  an  epi- 
demic, and  direct  immunization  to 
groups  identified  in  the  study 
70-75%  immune— plan  effort  for  a Sun- 
day mass  immunization,  (Physicians 
on  the  Skokie  Board  of  Health 
volunteered  to  contribute  their  serv- 
ices if  such  a program  proved  ne- 
cessary) 

Results 

Sixty-seven  different  groups  were  tabu- 
lated according  to  their  susceptibility  and 
immunity  within  the  gioup.  Among  these 
were  five  public  school  districts  (divided 
into  14  buildings),  five  parochial  schools, 
and  eight  nursery  schools. 


The  tabulated  results  show  that  Skokie 
is  a remarkably  ^veil-protected  community 
in  that  the  general  susceptibility  of  the 
combined  gi'oup  is  only  4%;  only  2.7%  of 
the  school  age  children  are  susceptible; 
and  only  7%  of  the  pre-school  children 
are  susceptible.  ’Where  the  survey  revealed 
differences  between  one  of  the  identified 
groups  of  children  and  the  total  studied 
population,  special  studies  tvere  made.  In 
one  district  both  the  school  and  pre-school 
susceptibles  clustered  around  an  area  of 
older  homes.  Some  of  these  homes  are 
being  torn  down,  and  apartment  buildings 
are  being  built.  None  of  these  susceptibles 
lived  in  the  apartment  buildings.  Further 
investigation  revealed  that  the  results  from 


TABULATION  OF  SURVEY  RESULTS  BY 
AGE  GROUPS  AND  SOURCE  OF  STATISTICS 


1 thi'u  12 

years 

1 thru  5 

years 

6 thru  12 

years 

No.  No. 

% 

No.  No. 

% 

No.  No. 

% 

Rep.  Sus. 

Sus. 

Rep.  Sus. 

Sus. 

Rep.  Sus. 

Sus. 

Public 

Schools 

8647 

285 

3% 

2175 

141 

6% 

6472 

144 

2% 

Parochial 

Schools 

1975 

124 

6% 

389 

47 

12% 

1586 

77 

5% 

Nursery 

Schools 

382 

3 

1% 

277 

3 

1% 

105 

0 

0% 

Miscellaneous 

- 

Telephone 

127 

2 

2% 

127 

2 

2% 

— 

— 

— 

Newspaper 

28 

3 

10% 

17 

2 

12% 

11 

1 

9% 

GRAND 

TOTAL  11,159 

417 

3.7% 

2,985 

195 

6.5% 

8,174 

222 

2.7% 

Herbert  S.  Lipschultz,  M.D.  (left),  is  on  the  attending  staff  of  Edgewater  Hospital 
and  Bethesda  Hospital,  Skokie,  as  well  as  being  in  the  private  practice  of  internal 
medicine.  He  received  his  M.D.  from  the  Chicago  Medical  School  and  interned  at  White 
Cross  Hospital,  Columbus,  Ohio,  where  he  also  took  his  residency  in  internal  medicine. 
Ward  C.  Duel,  M.P.H.,  (center)  is  Director  of  the  McHenry  County  Department  of 
Health.  He  served  as  Director  of  the  Skokie  Department  of  Health  previousiv.  His 
M.P.H.  is  from  the  University  of  California  at  Berkeley.  Seymour  Diamond,  M.D. 
(right),  is  a general  practitioner  and  an  Associate  in  Neurologv'  and  Psychiatry  at  the 
Chicago  Medical  School,  from  which  institution  he  holds  the  M.D,  He  served  an  in- 
ternship at  the  University  of  Arkansas  Hospital  and  at  White  Cross  Hospital,  Columbus, 
Ohio.  He  presently  serves  on  staff  at  three  Chicago  hospitals. 


67 


for  July,  1968 


one  school  were  skewed  by  a few  large 
families,  each  of  whom  contributed  a large 
number  of  susceptible  children.  Twelve 
percent  of  the  pre-school  children  of  fami- 
lies sending  their  children  to  parochial 
schools  are  susceptible  to  measles.  This 
compares  to  less  than  7%  of  the  similarly 
aged  children  found  in  the  rest  of  the  com- 
munity. As  a whole,  27%  of  the  susceptible 
children  have  parochial  ties,  even  though 
they  constitute  only  15%  of  the  children 
in  the  community.  Only  1%  of  the  pre- 
school age  children  in  families  which  send 
their  children  to  nursery  schools  are  sus- 
ceptible. 

The  high  level  of  immunity  of  the  nur- 
sery school  children  and  their  younger  sib- 
lings is  reflected  by  the  health  depart- 
ment’s strong  program  in  this  area,  which 
requires  immunization  before  enrollment. 
Apparently  the  effect  of  this  program  has 
also  reached  the  younger  siblings  of  the 
nursery  school  students.  This  is  confirmed 
by  comparison  with  the  miscellaneously 
reported  children  (those  contacted  by  tele- 
phone and  newspaper  surveys)  and  the 
younger  siblings  of  public  and  parochial 
students,  all  of  whom  have  a significantly 
higher  level  of  susceptibility.  This  survey 
can  serve  as  a solid  basis  for  program  plan- 
ning because  of  the  remarkable  internal 
consistency  of  the  statistics,  the  large  num- 
bers tabulated,  and  the  percent  of  the  study 
population  reached. 

Examination  of  the  Skokie  measles  sur- 
vey statistics  reveals  that  the  community 
immunity  is  very  high,  and  substantiates 
the  fact  that  herd  immunity  has  been 
achieved.  This  is  also  demonstrated  by  the 


fact  that  in  the  1966-67  reporting  season, 
only  one  primary  case  of  locally-occurring 
measles  was  reported  to  the  health  depart- 
ment. No  secondary  cases  were  reported. 
Although  no  seriously  susceptible  groups 
were  found  by  the  survey,  some  lesser  pro- 
tected groups  were  identified. 

Conclusions  and  Recommendations 

1.  The  Skokie  community  surveyed  had 
more  than  surpassed  “eradication”  level  of 
measles  immunization  through  the  normal 
channels  of  private  medical  practice. 

2.  The  lists  of  susceptibles  would  be 
used  for  transmitting  additional  informa- 
tion to  the  parents  concerning  desirability 
of  measles  immunization  and  vaccine  made 
available  for  this  purpose. 

3.  This  mechanism  of  using  large  num- 
bers of  organized  volunteers  may  be  strong- 
ly recommended  for  use  in  community 
screening  projects  as  well  as  determining 
the  need  for  such  community  sponsored 
programs. 

Summary 

A mass  survey  approach  to  the  determi- 
nation of  community  need  was  used  in 
Skokie,  Illinois  in  relation  to  measles  sus- 
ceptibility. Over  11,000  responses  were  ob- 
tained demonstrating  an  overall  immunity 
of  approximately  96%  in  ages  1 thru  12. 
The  use  and  cooperation  of  the  organized 
Woman  Power  of  the  community,  as  well 
as  the  public  and  parochial  school  systems, 
made  an  otherwise  overwhelming  task  both 
possible  and  simple.  The  technique  is  cer- 
tainly usable  for  many  and  varied  pur- 
poses. 


FILMS  AVAILABLE 


Two  films,  each  in  two  parts,  running 
30  to  38  minutes  each  in  16  mm.,  sound, 
B/W,  are  available  to  teach  radiologists  in- 
terpretation of  mammography— an  import- 
ant diagnostic  aid  in  the  control  and  de- 
tection of  breast  cancer.  Each  film  is  re- 
stricted to  showing  by  individuals  listed  in 
the  Directory  of  the  American  College  of 
Radiology.  Radiologists  not  listed  should 
direct  an  inquiry  to;  Program  Representa- 
tive for  Mammography,  Cancer  Control 


Program,  National  Center  for  Chronic  Dis- 
ease Control,  USPHS,  DHEW,  Washing- 
ton, D.  C.  20201.  “Mammography  Diagno- 
sis: Normal,  Non-Malignant  Breast,”  and 
“Mammography  Diagnosis:  Malignant 

Breast  Disease,”  were  produced  by  the  Na- 
tional Medical  Audiovisual  Center  for  the 
National  Center  for  Chronic  Disease  Con- 
trol. It  is  available  only  on  short-term  loan 
from  the  Audiovisual  Center,  Chamblee, 
Ga.  30005. 


68 


Illinois  Medical  Journal 


TUBERCULOSIS  - TODAY 

Tuberculosis  is  still  a disease  that  people 
“catch”  from  one  another.  In  the  United 
States  and  a number  of  other  countries, 
tuberculosis  death  rates  have  been  reduced 
as  much  as  98  per  cent  since  1900.  How- 
ever, it  still  is  the  leading  cause  of  death 
among  infectious  diseases  caused  by  a single 
class  of  germ.  The  "World  Health  Organi- 
zation estimates  that  more  than  half  the 
world’s  population  has  been  infected  by 
the  tubercle  bacillus,  including  500  million 
children.  Three  million  persons  died  last 
year  and  15  million  more  were  suffering 
from  the  disease. 

The  tuberculosis  problem  concerns  all  of 
us.  We  must  recognize  our  responsibilities 
and  lose  our  complacency. 

"With  the  introduction  of  effective  chemo- 
therapy in  the  1940’s  came  optimism  that 
tuberculosis  would  be  rapidly  eliminated. 
This  resulted  in  marked  reduction  in  the 
number  of  beds  for  tuberculous  patients 
and  reduced  numbers  of  tuberculosis  resi- 
dencies and  grants,  despite  a definite  need 
for  more  physicians  with  knowledge  about 
the  treatment  and  supervision  of  tubercu- 
lous patients.  In  fact,  many  cities  are  un- 
able to  secure  qualified  physicians  for  their 
chest  clinics  to  replace  those  retiring.  A 
recent  survey  of  practicing  physicians  in 
Massachusetts,  for  example,  revealed  that 
lack  of  knowledge  and  misinformation  on 
the  current  concepts  of  tuberculosis  existed 
among  a number  of  physicians  interviewed. 

Present  improved  diagnostic  and  thera- 
peutic modalities  give  the  physician  a bet- 


ter armentarium  with  which  to  control  and 
ultimately  eradicate  tuberculosis. 

"^Vhat  shall  we  tell  the  public?  For  the 
past  10-20  years,  we  have  prematurely  ad- 
vised that  tuberculosis  has  been  controlled 
and  is  being  eradicated.  Now  they  must 
be  told  the  truth— every  day— not  only  at 
Christmas  Seal  time— tuberculosis  is  still  a 
real  problem,  locally,  nationally  and  in- 
ternationally. 

It  is  essential  that  all  old  cases,  treated 
and  untreated,  be  followed  indefinitely. 
This  includes  all  contacts.  Unfortunately, 
in  many  cities  there  are  not  sufficient  health 
workers  to  follow  even  the  active  cases.  It 
may  be  necessary  to  use  lay  personnel  for 
proper  follow-up  of  all  active  and  “inac- 
tive” cases.  All  new  or  relapsing  cases  must 
be  reported.  If  one  inquires  into  case  re- 
ports, there  may  be  found  inadequate,  of- 
ten inaccurate,  or  even  unreported  cases. 
In  the  past,  we  estimated  the  number  of 
active  tuberculous  patients  based  upon 
deaths  from  tuberculosis.  Today,  this  is 
no  longer  valid,  making  us  more  dependent 
upon  initial  and  follow-up  reports  or  post- 
mortem findings. 

In  Lake  County,  111.,  we  do  have  suffi- 
cient facilities,  in  the  Tuberculosis  Sana- 
torium, Tuberculosis  Association  and  the 
County  Health  Department  to  carry  on  ade- 
quate “case  finding”  and  “follow-up”  ac- 
tivities. 

The  private  practitioners  of  medicine 
can  call  upon  these  facilities  to  aid  in  their 
management  of  contacts,  tuberculin  con- 


fer July,  1968 


69 


verters,  inactive  and  active  cases  of  tuber- 
culosis. 

Medicine  has  made  and  is  making  great 
strides.  Let  us  continue  tuberculosis  pro- 
grams, including  the  tuberculin  converters 
as  well  as  clinically  active  cases  and  carry 
out  the  most  effective  methods  of  manage- 


ment, treatment  and  prevention.  Only  with 
such  a regimen  can  we  control  and  ulti- 
mately eradicate  tuberculosis.  A continued 
active  program,  not  words,  will  mean  suc- 
cess. 

Charles  K.  Fetter,  M.D. 


Observations  of  a Run  for  Your  Lifer  or 
the  Loneliness  of  the  Short  Distance  Runner 


Much  has  been  written  recently  on  the 
great  value  of  running  in  the  prevention 
of  cardio-vascular  disorders,  especially  cor- 
onary heart  disease. Dr.  Thomas  Cure- 
ton  has  done  a vast  amount  of  work  in 
studying  the  physiology  of  exercise.^  As 
a result  of  these  publications  many  doctors 
advise  some  of  their  patients  to  start  an 
exercise  program  which  usually  involves 
some  running.  Doctors  who  are  physically 
able  are  also  engaged  in  running  at  gyms 
and  the  Y M C A;  however,  it  is  still 
quite  rare  to  see  adults  engage  in  running 
for  exercise.  One  questions  whether  the 
patients  are  following  their  physician’s 
advice. 

I would  like  to  advocate  a type  of  run- 
ning which  I have  carried  out  for  several 
years.  I have  found  that  running  to  and 
from  hospitals  after  parking  at  the  far 
end  of  a hospital  parking  lot  or  at  a dis- 
tance from  a house  call  can  result  in  well 
over  a half  mile  of  running  each  day.  This 
not  only  gives  exercise  to  the  lungs,  heart, 
and  leg  muscles,  but  it  is  a great  time 
saver  for  the  perennially  late  physician. 
It  should  be  recognized  that  this  type  of 
jogging  would  be  in  conjunction  with  a 
well  organized  program  of  exercise. 


One  drawback  is  that  the  doctor  risks 
being  accused  of  running  for  the  almighty 
dollar  by  his  less  energetic  colleagues,  who 
may  be  unaware  of  the  physician’s  true 
motive. 

I have  yet  to  observe  another  doctor  run 
in  or  out  of  a hospital  during  my  pleas- 
ant jogs.  One  still  commonly  observes 
many  overweight  physicians  and  nurses 
slowly  trudging  in  and  out  of  hospitals 
oblivious  to  the  joys  of  running. 

It  is  suggested  that  physicians  set  a 
shining  example  for  all  nurses  and  patients 
to  see.  Run,  leap,  lope,  trot  over  those 
hospital  parking  lots.  Preserve  your  youth 
by  becoming  a run  for  your  lifer.  Once 
you  get  accustomed  to  it,  you’ll  find  it 
difficult  to  go  back  to  your  sedentary  ways. 

Harvey  Kravits,  M.D. 


References 

1.  Harris,  W.  E.  et  al.  Jogging.  An  Adult  Exercise 
Program.  Jama  201:759-761  (Sept.  4)  1967. 

2.  Currens,  J.  H.  and  White,  P.  D.  Half  a Cen- 
tury of  Running.  New  Ene.  J.  Med.  265:988-993 
(Nov.  16)  1961 

3.  Fox,  S.  M.,  Ill  and  Haskill,  W.  L.  Physical 
Activity  and  Health  Maintainance,  J.  Rehab. 
32:89-92  March-April  1966. 

4.  Cureton,  T.  K.  Physical  Fitness  and  Dynamic 
Health.  Dial  Press.  New  York,  1965. 


We  Study  the  Octopus 


Cephalopods,  members  of  the  group  to  which  squid  belong,  have  con- 
tributed to  our  basic  knowledge  of  neurophysiology.  The  common  octopus 
possesses  a highly  evolved  brain,  capable  of  certain  types  of  learning.  The 
octopus  is  simple  enough  to  lend  itself  to  a large  variety  of  experiments 
involving  the  effects  of  different  situations,  or  drugs,  or  brain  ablations 
(cutting  off  of  parts)  on  the  learning  process.  Yet  its  brain  is  complex 
enough  to  serve  as  a model  for  brains  in  general,  our  own  included.  Per- 
haps it  is  an  exaggeration  to  say  that  octopuses  have  emotions  as  well; 
they  do  exhibit,  however,  some  dramatic  responses  which  have  the  appear- 
ances of  rage  and  fear.  These  phenomena,  and  the  other  aspects  of  octo- 
pus behavior,  are  being  extensively  studied  at  many  institutions.  It  would 
be  surprising  if  this  work  did  not  significantly  affect  the  medical  study  of 
the  human  brain  and  the  treatment  of  its  disorders.  Michael  Gruber.  The 
Healing  Sea.  Sea  Frontiers,  1968. 


70 


Illinois  Medical  Journal 


^‘TOTAL  CARE’’ 

Highlights  of  Convention 

Summary  of  Actions  of  1968 
House  of  Delegates 


128th  Annual  Convention 
inois  State  Medical  Society 


f ; ■ 

S - : 5 ■ ■■ 

i ■,:>:* 

} r,  » ^ ^ 

i - 

1968-1969  OFFICERS  AND 
BOARD  OF  TRUSTEES 


Officers 
President 
President-Elect 
1st  Vice-President 
2nd  Vice-President 
Secretary-Treasurer 


Philip  G.  Thomsen,  13826  Lincoln  Ave.,  Dolton  60419 
Edward  W.  Cannady,  4601  State  St.,  E.  St.  Louis  62205 
Casper  Epsteen,  25  E.  Washington  St.,  Chicago  60602 
Carl  E.  Clark,  225  Edward  St.,  Sycamore  60178 
Jacob  E.  Reisch,  1129  S.  2nd  St.,  Springfield  62704 


House  of  Delegates 

Speaker  of  the  House  Maurice  M.  Hoeltgen,  1836  West  87th  St.,  Chicago  60620 
Vice-Speaker  Paul  W.  Sunderland,  214  N.  Sangamon  St.,  Gibson  City  60936 


Trustees 


1st  District 

1971 

2nd  District 

1971 

3rd  District 

1971 

1971 

1970 

1970 

1969 

1969 

4th  District 

1970 

5th  District 

1970 

6th  District 

1969 

7th  District 

1970 

8th  District 

1970 

9th  District 

1969 

10th  District 

1969 

11th  District 

1971 

Joseph  L.  Bordenave,  1665  South  St.,  Geneva  60134 
Wm.  A.  McNichols  Jr.,  101  W.  1st  St.,  Dixon  61021 
Wm.  M.  Lees,  7000  N.  Kenton  Ave.,  Lincolnwood  60646 
Frank  J.  Jirka,  1507  Keystone  Ave.,  River  Forest  60305 
Wm.  E.  Adams,  55  E.  Erie  St.,  Chicago  60611 
James  B.  Hartney,  410  Lake  St.,  Oak  Park  60302 
Warren  W.  Young,  10816  Parnell  Ave.,  Chicago  60628 
J.  Ernest  Breed,  55  E.  Washington,  Chicago  60602 
Paul  P.  Youngberg,  1520  Seventh  St.,  Moline  61265 
Darrell  H.  Trumpe,  St.  John’s  Sanatorium,  Springfield  62707 
Mather  Pfeiffenberger,  State  8c  Walls  Sts.,  Alton  62002 
Arthur  F.  Goodyear,  142  E.  Prairie  Ave.,  Decatur  62523 
Wm.  H.  Schowengerdt,  301  E.  University  Ave.,  Champaign  61820 
Charles  K.  Wells,  117  N.  10th  St.,  Mt.  Vernon  62864 
Willard  C.  Scrivner,  4601  State  St.,  E.  St.  Louis  62205 
Joseph  R.  O’Donnell,  444  Park,  Glen  Ellyn  60137 


Trustee-at-Large 


Newton  DuPuy,  1101  Maine  St.,  Quincy  62301 


Chairman  of  the  Board  Frank  J.  Jirka,  1507  Keystone  Ave.,  River  Forest  60305 


72 


Illinois  Medical  Journal 


CONVENTION 

Attendance  Totals 

In  attendance  at  the  convention  were: 

Physicians 

Guests 

Woman’s  Auxiliary 

Technical  Exhibitors 

Scientific  Exhibitors 

TOTAL 

Representatives  of  SAM  A Urge 
ISMS  Interest  in  Students 

Representatives  of  the  SAMA  chapters  at 
the  five  Chicago  medical  schools  were  at  the 
sessions.  Remarks  for  the  five  schools  were 
presented  by  Joseph  Valaitis,  Jr.,  president 
of  the  chapter  at  Loyola  University  Stritch 
School  of  Medicine.  Mr.  Valaitis  encour- 
aged physicians  to  take  an  active  role  in 
organized  medicine  and  to  set  the  pace  for 
the  physicians  of  tomorrow.  He  asked  sup- 
port of  SAMA  activities  by  all  physicians. 

A recent  survey  of  pre-med  students  indi- 
cated that  a significant  number  of  them  were 
not  aware  of  the  objectives  of  medical  organ- 
izations. It  is  at  this  level  that  medical  socie- 
ties face  a great  challenge  in  stimulating 
concerted  action  among  future  doctors. 

IMPAC  Successes  Reported 

Dr.  Philip  Thomsen  reported  that  Illi- 
nois is  the  leading  state  of  the  United  States 
in  the  support  of  AMPAC.  Over  45%  of  all 
physicians  in  Illinois  maintain  membership. 
Dr.  Thomsen  further  reported  that  it  is  only 
through  this  type  of  support  that  medicine 
will  be  able  to  effectively  introduce  favor- 
able legislation  and  defeat  bad  legislation 
on  both  the  state  and  national  level.  In  this 
election  year,  he  further  pointed  out,  these 
funds  will  allow  for  support  of  candidates 
favorable  to  medicine’s  cause.  The  number 
of  seats  in  the  house  with  only  a 5%  differ- 
ential in  the  1966  election  is  so  significant 
as  to  warrant  special  attention  by  physicians 
through  PAG  groups. 

President  Addresses  House  of  Delegates 

Newton  DuPuy,  at  the  conclusion  of  his 
year  as  ISMS  president  addressed  the  house 
and  thanked  the  physicians  for  their  excel- 
lent support  during  the  year.  He  recounted 
his  many  travels  around  the  state  and  to  sis- 
ter states,  which  took  him  over  30,000  miles 
on  a total  of  93  days  away  from  home  and 


HIGHLIGHTS 

lamented  the  fact  that  he  hadn’t  done  more. 
He  encouraged  the  members  of  ISMS  to 
continue  their  interest  in  the  course  of  medi- 
cine and  organized  medicine  and  indicated 
he  was  available  to  serve  further  in  any 
capacity  he  could. 

i Special  Committee  on 

Self-Examination  Encouraged 

Insufficient  evidence  to  reach  a decision 
regarding  voluntary  participation  in  self- 
examination  made  necessary  a reference 
committee  request  for  a Board  committee 
to  hear  evidence  regarding  this  concept  for 
report  at  next  year’s  convention. 

Mexican  Fiesta  President’s  Party 

The  annual  president’s  party  was  held  in 
the  grand  ballroom  and  took  on  the  motif 
of  Mexico  with  a Mexica  Fiesta.  Dancing  to 
the  mariachi  band  and  the  mexican  dance 
band  were  many  ISMS  members  and  their 
guests.  A buffet  was  served. 

Aesculapius  Award  to 
Drs.  Schumer  & Sperling 

The  Mead  Johnson  Aesculapius  Award 
was  made  to  Dr.  William  Schumer  and  Dr. 
Richard  Sperling  for  their  exhibit  on  Shock 
and  Its  Effect  on  the  Cell.  For  originality  Dr. 
Edward  K.  Isaacson  from  the  University  of 
Illinois  Medical  Center  received  the  gold 
award,  while  the  gold  award  for  an  educa- 
tional exhibit  went  to  Dr.  Edward  M.  Gold- 
berg and  Dr.  Ralph  N.  Bransky  of  Michael 
Reese  Hospital. 

Dr.  Frank  Jirka  New  Board  Chairman 

At  the  Wednesday  post-convention  meet- 
ing of  the  Board  of  Trustees,  Dr.  Frank  J. 
Jirka,  Jr.,  was  unanimously  selected  to  be 
Chairman  of  the  Board.  Dr.  Jirka,  a urolo- 
gist, is  a trustee  from  the  3rd  district  and 
lives  in  River  Forest.  He  succeeds  Dr.  Arthur 
Goodyear. 

AMAA  Illinois  Chapter  President 
Thanks  ISMS 

Mrs.  Helen  Smith,  president  of  the  Illi- 
nois Chapter  of  the  American  Medical  As- 
sistants Association,  addressed  the  House 
and  thanked  the  State  Society  for  the  inter- 
est and  effort  expended  in  behalf  of  the 
medical  assistants.  She  felt  there  was  a defi- 
nitely good  rapport  between  the  associa- 
tions and  that  the  programs  of  ISMS  geared 


1,640 

516 

350 

2,506 


for  July,  1968 


73 


Miss  Elizabeth  Lynch  (left)  ISMS  Staff  greets  the 
first  registrant  to  the  128th  Annual  Convention,  Dr. 
Robert  R.  Hartman,  Delegate  from  Jacksonville 
and  Chairman  of  the  ISMS  Maternal  Welfare  Com- 
mittee. The  convention  had  an  attendance  of  over 
2,500  physicians,  guests,  auxilians  and  exhibitors. 

to  the  needs  of  the  assistants  were  a definite 
asset  in  furthering  the  aims  and  educational 
objectives  of  IMAA. 

$127,758  Presented  to  Five 
Medical  Schools 

President  Newton  DuPuy  presented  a 
check  in  the  amount  of  $127,758  to  Dr. 
William  Grove,  Dean  of  the  University  of 
Illinois  College  of  Medicine,  to  be  appor- 
tioned among  Chicago’s  medical  schools  for 
use  in  building  the  programs  of  education 
at  the  institutions.  Dr.  Grove  indicated  that 
these  funds  are  invaluable  as  they  allow  the 
inception  of  new  programs  before  budgeted 
funds  are  available,  allow  the  completion  of 
research  on  special  projects  and  studies,  or 
allow  the  employment  of  specialists  to 
broaden  the  perspectives  and  horizons  of 
the  students.  The  funds  are  especially  wel- 
come as  there  are  no  special  requirements 
as  to  their  disposition  other  than  that  they 
be  used  to  further  education. 

Senator  Murphy  Addresses 
Public  Affairs  Dinner 

Presenting  the  annual  Camp  Memorial 
Lecture  at  the  Public  Affairs  Dinner  was 
Senator  George  Murphy  (R.-Calif.).  An 
entertaining  speaker.  Senator  Murphy  re- 
viewed fiscal  policy,  civil  disorders,  prob- 
lems of  youth,  foreign  aid  and  Southeast 
Asia.  He  called  for  persistence  in  achieving 
our  goals,  victory  in  Viet  Nam  and  a return 
to  law  and  order.  His  impromptu  talk,  en- 
titled “1968  — A Year  of  Challenge  and 
Opportunity,”  was  warmly  received  by  the 
hundreds  of  guests. 


All  candidates  for  major  state  offices  were 
invited  to  join  Illinois  physicians  at  this 
special  affair.  Among  those  attending  were 
Senator  E.  M.  Dirksen  (R.-Illinois),  Senate 
Minority  leader,  and  Richard  Ogilvie,  can- 
didate for  the  Republican  nomination  for 
governor.  Mayor  Wes  Olson  of  Quincy, 
candidate  for  State  Auditor,  also  attended. 

Philip  Thomsen  Installed  As 
ISMS  President 

At  the  third  session  of  the  House,  Philip 
Thomsen,  Dolton,  was  installed  as  president 
of  ISMS.  In  his  inaugural  address  Dr.  Thom- 
sen cited  the  challenges  which  appear  before 
him  in  this  next  year,  but  challenges  not 
only  to  him  but  to  each  and  every  physician 
and  to  ISMS.  Among  these  are  the  need  for 
more  physicians,  revision  of  guidelines  for 
medical  school  admission,  and  an  effort  on 
the  part  of  physicians  to  speak  out  on  socio- 
economic matters  of  vital  concern  to  medi- 
cine. He  stated  that  medicine  itself  is  today 
a patient,  on  an  emergency  list.  He  called 
for  concerted,  increased  effort  on  the  part 
of  ISMS  and  all  physicians  to  answer  the  cry. 


Philip  Thomsen,  (left)  receives  the  President’s 
Medallion  from  Newton  DuPuy  at  Dr.  Thomsen’s 
installation  at  the  third  session  of  the  House  of 
Delegates.  Dr.  DuPuy  now  becomes  trustee-at- 
large  of  the  society. 

Special  Report  Draws  Praise 
Dr.  George  Lull,  Executive  Administrator, 
presented  a special  23-minute  slide  presen- 
tation report  to  the  House.  The  report 
showed  all  the  varied  activities  of  ISMS, 
and  showed  how  each  function  of  the  vari- 
ous councils  and  divisions  are  accomplished. 
This  special  report  was  lauded  as  a most 
effective  portrayal  of  ISMS  activities  and 
services.  The  report  will  be  made  available 
to  county  and  district  medical  societies  in 
the  future. 


74 


Illinois  Medical  Journal 


Third  Annual  Hamilton  Teaching  Award 
To  Dr.  Arthur  R.  Colwell 

Dr.  Arthur  R.  Colwell,  Professor  and 
Chairman  of  the  Department  of  Medicine, 
Northwestern  University,  Emeritus  in  1965, 
received  the  Edwin  S.  Hamilton  Teaching 
Award  for  outstanding  medical  teaching. 
The  honor  is  given  annually  by  the  Inter- 
state Postgraduate  Medical  Association  of 
North  America  in  honor  of  Dr.  Hamilton, 
past  president  of  ISMS.  Born  in  Chicago, 
Dr.  Colwell  is  a graduate  of  Rush  Medical 
School  and  taught  at  Northwestern  from 
1933  to  1965. 


George  F.  Lull,  M.D.,  immediate  past  president 
of  the  Interstate  Postgraduate  Medical  Associa- 
tion, presents  the  Edwin  S.  Hamilton  Teaching 
Award  to  Arthur  R.  Colwell,  M.D.  The  annual 
plaque  and  cash  prize  is  awarded  to  an  outstand- 
ing educator  in  honor  of  the  past  president  of 
ISMS. 

New  Executive  Administrator  Named 
The  Board  of  Trustees,  meeting  during 
the  convention,  named  Roger  N.  White 
executive  administrator  of  ISMS.  The  an- 
nouncement was  made  at  the  second  session 
of  the  House.  Mr.  White,  a native  of  Penn- 
sylvania, has  served  ISMS  for  8 years  as  the 
Director  of  Legislation  and  Public  Affairs 
and  Assistant  Executive  Administrator.  He 
succeeds  Dr.  George  F.  Lull. 

Special  Sesquicentennial  Luncheon 
With  Fifty-Year  Club 

A total  of  36  physicians  were  inducted 
into  the  Fifty-Year  Club.  This  club,  the 
first  of  its  kind  in  the  United  States,  was 
originated  by  ISMS  in  1937.  It  honors  phy- 
sicians who  have  achieved  the  milestone  of 
50  years  since  graduation  and  numbers  over 
500  members.  The  luncheon,  in  conjunc- 
tion with  the  Archives  Committee,  com- 
memorated the  sesquicentennial  of  Illinois. 


The  luncheon  speaker,  W.  D.  Snively,  MD, 
Vice  President  of  the  Mead  Johnson  Com- 
pany, spoke  with  his  talk  entitled  “We  War 
Perplext  by  a Disease  Cald  Milksick.”  As  a 
result  of  this  program  ISMS  was  awarded 
a special  citation  by  the  Illinois  Sesquicen- 
tennial Commission  for  outstanding  con- 
tributions to  the  commemoration  of  the  an- 
niversary. 

Journalism  Fellowship  Winners 
Attend  Convention 

Mrs.  Sue  Dinges  of  the  Illinois  State  Reg- 
ister, Springfield  and  Mr.  James  Rick  of  the 
Danville  Commercial  News,  were  in  attend- 
ance at  the  convention.  They  were  the  re- 
cipients of  the  Second  Annual  Journalism 
Fellowships  of  the  ISMS.  The  fellowships 
are  unique  among  state  medical  societies 
and  encourage  young  science  writers  in 
achieving  their  goal  of  top  notch  reporting. 
Both  recipients  filed  stories  daily  about  the 
activities  of  the  convention. 

New  Members  of  Board  of  Trustees 

Elected  1st  Vice  President  of  ISMS  was 
Dr.  Casper  Epsteen  of  Chicago.  The  new 
2nd  Vice  President  is  Dr.  Carl  E.  Clark  of 
Sycamore,  who  retired  as  trustee  from  the  1st 
district.  Succeeding  Dr.  Clark  is  Dr.  Joseph 
L.  Bordenave  of  Geneva,  Elected  as  trustee 
from  the  2nd  district  was  Dr.  William  A. 
McNichols,  Jr.,  Dixon.  Dr.  Joseph  R. 
O’Donnell,  Glen  Ellyn  was  re-elected  from 
the  11th  district.  Drs.  Lees  and  Jirka  were 
re-elected  from  the  3rd  district. 

Physicians  Urged  To  Use  Only  Illinois 
Laboratories 

The  use  of  medical  diagnostic  laboratories 
supervised  by  a duly  qualified  physician, 
licensed  in  or  by  the  state  of  Illinois  was 
encouraged  by  the  House  approval  of  the 
Laboratory  Evaluation  Sub-committee  re- 
port. The  hazards  of  mailing  specimens 
over  long  distances  and  the  need  for  ade- 
quate Illinois  inspection  are  of  utmost  im- 
portance. 

Mandatory  Tuberculin  Testing  Approved 

Approval  of  the  Report  of  the  Tuber- 
culosis Committee  by  the  House  encouraged 
all  physicians  to  make  a TTT  part  of  the 
school  health  record  of  every  child  in  Illi- 
nois. The  committee  recommended,  that 
“As  in  Michigan  and  Indiana,  Illinois 
should  make  the  tuberculin  test  mandatory 
in  all  pre-school  examinations.” 


for  July,  1968 


75 


Ad  HOC  Committee  on  IDPA 
Compensation  Called  For 

An  ad  hoc  committee  or  an  appropriate 
existing  ISMS  committee  was  encouraged 
by  the  House  in  a resolution  calling  for  de- 
termination of  an  alternate  method  of  com- 
pensation acceptable  to  those  physicians  not 
wishing  to  accept  assignments  but  who  are 
willing  to  accept  the  responsibilities  of  the 
health  care  of  public  aid  recipients. 


Health  Careers  Council  Support  Continued 

For  the  year  1969,  the  House  approved 
the  apportionment  of  $2  per  full  dues-pay- 
ing  member  for  HCCI.  The  funds  will  be 
taken  from  the  Benevolence  Fund. 


Hospital  Facilities  Grouping  To 
Be  Investigated 

The  House  resolved  to  cooperate  with  the 
Illinois  Hospital  Association  and  the  Illinois 
Department  of  Public  Health  in  seeking 
legislation  amending  the  hospital  licensure 
act  to  permit  hospitals  and  their  staffs  to 
combine  facilities  where  it  is  both  feasible 
and  desirable  for  the  improved  handling  of 
the  emergency  patient. 

Support  Legislation  On  Blood  And 
Tissue  Transfer 

Although  legislation  is  already  proposed 
in  the  Illinois  Assembly,  the  House  con- 
curred with  a recommendation  that  legisla- 
tion be  encouraged  to  make  the  transfer, 
transfusing  and  use  of  blood,  blood  derivi- 
tives,  plasma,  tissues  and  organs  a service 
and  not  a sale. 


Dancing  to  the  music  of  the  Mariachi  Band  at  the  President’s  Party,  the  Mexican  Fiesta,  were  these 
past-presidents  of  ISMS.  From  left.  Dr.  and  Mrs.  Arkell  Vaughn,  Dr.  and  Mrs.  Leo  P.  A.  Sweeney,  Dr. 
and  Mrs.  Harlan  English  and  Dr.  and  Mrs.  Burtis  E.  Montgomery.  The  party  was  preceded  by  the 
Camp  Memorial  Lecture  given  by  Sen.  George  Murphy  at  the  President’s  Dinner. 


76 


Illinois  Medical  Journal 


ABSTRACTS  OF  ACTIONS  OF  THE 
HOUSE  OF  DELEGATES 
MAY,  1968 

OFFICERS  AND  ADMINISTRATION 


Under  this  area  in  Headquarters  lies  the 
supervision  of  several  important  commit- 
tees, all  of  which  appear  as  “Board  Com- 
mittees” on  the  general  outline.  The  re- 
ports of  the  President,  Chairman  of  the 
Board,  Secretary-Treasurer  embody  much 
of  the  important  material  to  come  before 
the  Board  in  the  interim  between  meetings 
of  the  House. 

The  Policy  Committee,  chaired  by  Wil- 
liam E.  Adams,  presented  several  new  policy 
statements  to  be  incorporated  in  the  Policy 
Manual  when  it  is  reprinted  in  the  Refer- 
ence Issue  of  the  IMJ  in  the  fall. 

Audits  and  Surveys  (In  hospitals  and 
nursing  homes,  etc.) 

Audits  and  surveys  which  impinge  on 
personal  privacy,  patient  care  and  local 
hospital  trustee  and  medical  decisions  as 
to  management,  should  not  be  condoned. 

Hospital  Committees  (Dealing  with  phy- 
sician-patient relationship) 

All  committees  dealing  with  the  review 
of  physician-patient  relationship  in  hos- 
pitals and  nursing  homes,  are  urged  not 
to  release  findings  to  any  third  parties  ex- 
cept by  subpoena  or  court  order.  Any  re- 
ports issued  by  the  committees  involved 
should  be  submitted  to  the  chief  of  staff 
for  his  disposition. 

These  two  statements  %vere  the  two  which 
impressed  the  reference  committee  more 
than  any  of  the  others  which  were  presented 
(a  total  of  six  which  will  appear  in  the  new 
manual).  No  change  was  made  this  year 
in  the  existing  statements. 

The  Committee  to  Study  Committees  was 
asked  to  continue  its  review  of  the  responsi- 
bilities and  purposes  assigned  to  each  active 
committee,  and  to  keep  the  various  Councils 
defined  and  active. 

One  of  the  most  far  reaching  actions  taken 
by  the  House  was  to  approve  the  request  of 
the  COMMITTEE  TO  CONSIDER  OS- 
TEOPATHIC PROBLEMS,  which  perhaps 
will  clear  the  atmosphere  and  make  some 
progress  possible  in  an  area  long  clouded  by 


deep-seated  differences  between  the  two 
professions.  The  Reference  Committee 
recommended  (and  the  House  concurred) 
that  the  following  statement  be  approved: 
“Voluntary  professional  associations  with 
a Doctor  of  Osteopathy  are  not  deemed 
unethical  if  the  Doctor  of  Osteopathy 
bases  his  practice  on  the  same  scientific 
principles  as  those  adhered  to  by  mem- 
bers of  the  American  Medical  Association, 
and  if  he  is  licensed  to  practice  medicine 
and  surgery  in  all  of  its  branches  in  Illi- 
nois.” 

The  resoluton  to  limit  the  number  of 
terms  a delegate  from  the  ISMS  to  the  AMA 
House  could  serve,  was  defeated.  The  Ref- 
erence Committee  stated  that  “in  as  much 
as  the  delegates  must  be  re-elected  every 
two  years,  adequate  means  for  replacing 
delegates  already  exists”.  Also,  such  limita- 
tion might  well  deprive  Illinois  of  the 
Speaker  or  Vice  Speakership  of  the  AMA 
House,  since  both  these  officers  must  be 
members  of  the  House,  elected  by  one  of  the 
component  state  societies. 

The  House  did  ask  that  the  AMA  dele- 
gation, in  its  yearly  report  to  the  House, 
“specifically  speak  to  the  point  of  ways  to 
increase  the  effectiveness  of  the  delegation 
with  special  reference  to  preparation  of 
future  members  of  our  AMA  Delegation”. 


Receiving  an  award  from  the  liiinois  Sesquicen- 
tennial  Commission  for  its  efforts  in  behalf  of  the 
commemoration  is  ISMS  President  Newton  DuPuy. 
The  award  was  presented  by  Mr.  Newman,  Direc- 
tor of  the  Illinois  Sesquicentennial  Commission. 


for  July,  1968 


77 


FINANCES  AND  BUDGETS 


The  Society  has  implemented  the  recom- 
mendation in  the  1966  Opinion  Research 
report  that  data  processing  be  instituted  in 
various  areas  o£  society  activity.  During  the 
year  1968  seventy  county  medical  societies 
used  the  direct  membership  dues  billing  and 
collection  service.  To  date,  the  Society  has 
bought  computer  time  as  needed. 

The  committee  stressed  the  ruling  of  the 
House  that  was  made  several  years  ago— 
that  any  new  program  of  major  nature 
must  be  accompanied  by  a suggested  method 
of  providing  the  necessary  finances  for  the 
project. 

The  revolving  fund  set  up  by  the  lAA 
and  the  ISMS  for  the  education  of  rural 
students  interested  in  medicine  and  willing 
to  practice  in  a small  Illinois  community 
operates  with  a capital  of  $230,000.  Dr.  Jack 
Gibbs  and  his  committee  conduct  the  in- 
vestigations, make  the  loans,  and  report  on 
the  project  in  detail. 

Funds  are  always  needed  by  the  Educa- 
tional and  Scientific  Foundation  to  conduct 
programs  of  various  nature.  A “one  time” 
donation  of  $45,750  was  made  to  the  Foun- 
dation by  the  Illinois  Medical  Journal,  and 
has  been  earmarked  for  planned  improve- 
ments in  the  IMJ. 

ECONOMICS  AND 

The  Committee  on  Aging  has  developed 
in  cooperation  with  the  Blue  Shield  Plan  of 
Illinois  Medical  Service,  a Pre-retirement 
Planning  Series  of  13  half-hour  shows  to 
appear  on  WTTW,  Channel  11,  Chicago. 

The  tapes  will  be  available  for  other  tele- 
vision stations  in  Illinois  and  perhaps 
throughout  the  country.  The  reference 
committee  felt  this  a positive  approach  to 
the  problem  popularly  referred  to  as  the 
“retirement  revolution”. 

Economics  and  Insurance  information 
was  reviewed  carefully.  The  new  profes- 
sional liability  insurance  program  was 
studied  as  were  other  policies  available  to 
members.  The  features  which  make  the 
professional  liability  program  of  extreme 
interest  include: 

1.  Coverage  available  to  all  ISMS  mem- 
bers with  no  restriction  on  age  or 
specialty. 

2.  Policies  are  non-cancellable  without 
just  cause. 


The  House  specifically  requested  that  the 
full  $20  allocated  from  each  physician’s 
dues  be  returned  to  the  AMA-ERF.  Medical 
Education  needs  unrestricted  funds  more 
today  than  at  any  other  time,  and  the  co- 
operation of  the  five  deans  with  the  State 
Society  has  been  a growing  and  an  impor- 
tant phase  of  educational  planning  in  Illi- 
nois. 

Also,  the  need  of  the  Health  Careers 
Council  of  Illinois  was  recognized.  The 
House  recommended  that  the  Board  allocate 
$2  per  dues  paying  member  to  this  group 
again  in  1969.  In  order  to  keep  the  dues 
structure  at  the  same  level,  the  Board  of 
Trustees  agreed  that  the  $7  scheduled  for 
the  Benevolence  Fund  should  be  cut  to  $5, 
and  the  balance  of  $2  should  be  given  to 
HCCI  in  1969. 

This  holds  the  DUES  STRUCTURE  AT 
THE  SAME  LEVEL  in  1969,  with  the  dis- 
tribution as  follows: 


Dues for  1969 

$105.00 

Breakdown: 

AMA-ERF 

$20.00 

HCCI 

2.00 

Benevolence 

5.00 

Reserves 

8.00 

Operating  Fund 

70.00 

INSURANCE 

3.  Claims  cannot  be  settled  by  the  in- 
suring company  without  the  physi- 
cian’s consent. 

4.  The  company  and  ISMS  will  coop- 
erate in  an  educational  program  to 
show  physicians  how  they  can  lessen 
the  chances  of  a malpractice  suit  being 
filed  against  them. 

The  reference  committee  specifically 
urged  the  Society  to  make  every  promotional 
effort  to  provide  an  informational  program 
to  the  membership. 

The  Relative  Value  Study  should  be  re- 
vised and/or  reprinted  if  money  is  available. 
By  action  of  the  House,  this  recommenda- 
tion was  referred  to  the  Board  for  consid- 
eration. 

In  the  area  of  Illinois  Department  of 
Public  Aid  activity,  the  House  concurred  in 
the  reference  committee  recommendation 
that  county  medical  societies  be  urged  to 
appoint  review  committees  (or  assign  this 
duty  to  an  already  established  committee) 


78 


Illinois  Medical  Journal 


to  act  as  liaison  between  the  Illinois  Depart- 
ment of  Public  Aid  and  local  physicians. 
This  would  undoubtedly  enhance  com- 
munications between  IDPA  and  the  local 
membership.  In  fact,  the  reference  commit- 
tee and  the  House  felt  that  the  problem  of 
communications  was  one  of  the  most  im- 
portant areas  for  providing  a constructive 
and  smoothly  operating  IDPA  program. 

ISMS  was  asked  to  institute  periodic  in- 
structional meetings  (work-shops)  for  the 
county  medical  society  review  committees 
to  keep  them  abreast  of  problems  and 
changes  in  payment  policies. 

The  “double  standard  of  usual  and  cust- 
omary fees  paid  by  Medicare  fiscal  inter- 
mediaries and  the  usual  and  customary  fees 
paid  by  the  IDPA”  came  up  for  action.  The 
House  recommended  that  this  double 
standard  be  discontinued  even  if  it  “requires 
the  implementation  of  legislation  to  ac- 
complish this  end”  . . . 

In  the  area  of  usual  and  customary  fees, 
the  reference  committee  and  the  House  ap- 
proved this  method  of  approach  as  satis- 
factor}'  and  as  a possible  solution  to  the 
problem  of  compensation  for  medical  serv- 
ices to  public  aid  recipients. 

Unfortunately,  exceptions  have  occurred 
in  which  IDPA  has  indiscriminately  reduced 
payments  without  explanation.  The  House 
felt  this  probably  due  to  inadequate  com- 
munications and  poor  liaison,  and  suggested 
that  when  fee  problems  are  adjudicated: 

1.  Appeal  should  be  made  to  the  IDPA 


Springfield  office. 

2.  If  physician  and  the  IDPA  cannot 
agree,  the  physician  has  the  right  of 
appeal  to  the  advisory  committee  of 
his  county  medical  society. 

3.  The  final  appeal  is  to  the  ISMS  Usual 
and  Customary  Fee  Committee. 

The  reference  committee  called  the  at- 
tention of  the  House  to  the  fact  that  the 
Division  of  Vocational  Rehabilitation  con- 
tinues to  follow  a fee  ceiling  plan  inconsist- 
ent with  the  policy  of  the  Society. 

The  House  approved  the  recommenda- 
tion that  the  Usual  and  Customary  Fee 
Committee  renew  its  efforts  to  persuade  the 
DVR  to  adopt  a medical  payments  program 
based  on  usual,  customary  and  reasonable 
fees,  in  the  interest  of  uniformity  and  con- 
sistency, and  third  party  participation 
should  be  so  based. 

Many  of  the  Society’s  most  important  pro- 
grams fall  within  the  purview  of  this  com- 
mittee’s activities.  Close  cooperation  with 
the  various  county,  state  and  federal  agen- 
cies, rulings  in  the  area  of  patient  care, 
communications  with  the  membership,  and 
a constant  alert  are  prerequisites  for  con- 
tinued success. 

It  was  suggested  that  the  sub-committee 
on  cardiovascular  diseases  be  disbanded. 

Praise  for  the  Drug  Manual  and  the  ef- 
forts expended  in  maintaining  it  were  ex- 
pressed. The  Committee  has  reviewed  963 
written  requests  for  drugs  not  listed  in  the 
manual  and  more  than  99%  of  the  requests 
were  approved. 


PUBLICATIONS  AND  SCIENTIFIC  SERVICE 


In  the  area  of  scientific  service  many  of 
the  committees  submitted  progress  reports 
upon  which  no  specific  action  of  the  House 
was  necessary.  Except  for  several  items  con- 
sidered by  the  Reference  Committee  on 
Finances  and  Budgets  the  report  of  the  IMJ 
was  included  in  this  area.  The  Journal  for- 
mat, contents,  program  given  in  New  York 
for  the  members  of  the  advertising  media, 
all  received  praise,  not  only  from  the  mem- 
bers of  the  Board,  but  from  outside  sources. 
The  “ISMS  STORY— Slide-Sound  Presenta- 
tion” given  to  the  House  at  its  opening  ses- 
sion on  Sunday,  was  originally  prepared  for 
the  advertisers  at  the  New  York  reception. 

The  support  for  the  AMA-ERF  contribu- 


tion was  approved;  the  educational  program 
for  preceptorships  supported;  a medically 
oriented  summer  job  program  for  freshmen 
medical  students  met  with  unanimous  ac- 
ceptance and  will  be  instituted  as  soon  as 
possible. 

The  vital  and  pressing  importance  of 
medical  education  and  the  Campbell  report 
came  in  for  discussion,  and  members  of  the 
Committee  on  Medical  Education  were 
asked  to  continue  cooperation  with  the 
deans,  encourage  the  establishment  of  an 
additional  medical  school  in  Illinois;  work 
to  increase  the  number  of  students  in  the 
field  of  medicine,  and  continue  to  empha- 
size the  field  of  general  practice. 


for  July,  1968 


79 


LEGISLATION  AND  PUBLIC  AFFAIRS 


The  brevity  of  the  report  of  the  Refer- 
ence Committee  hardly  reflects  the  extensive 
activity  of  Dr.  Siegel’s  Council  on  Legisla- 
tion and  Dr.  Grevas’  Committee  on  Public 
Affairs. 

The  reference  committee  recommended 
and  the  House  concurred  in  the  request  of 
the  Council  on  Legislation  that  the  ISMS 
oppose  a service  occupation  tax  on  drugs, 
whether  dispensed  by  a physician  or  a phar- 
macist. The  House  recommended  coopera- 
tion to  develop  a study  of  hospital  costs, 
and  requested  continued  vigilance  in  the 
support  of  good  public  health  legislation 
and  the  defeat  of  bills  detrimental  to  medi- 
cine. 

The  use  of  impartial  medical  testimony 
in  malpractice  cases  is  now  authorized  under 
the  law.  The  House  felt  that  additional 
study  of  this  procedure  should  be  made  by 
the  Judicial  Council,  and  if,  at  any  time  a 
panel  for  malpractice  cases  is  deemed  de- 


sirable, then  this  area  of  activity  should  be 
placed  under  a separate  committee  with  a 
separate  panel  other  than  that  used  in  per- 
sonal injury  cases  at  the  present  time. 

The  outstanding  work  of  the  Committee 
on  Narcotics  was  called  to  the  attention  of 
the  House.  While  no  action  was  taken,  the 
importance  of  a reasonable  approach  to  the 
problem  of  drug  abuse,  the  use  of  narcotics, 
the  full  day  sessions  conducted  by  the  com- 
mittee, have  given  the  ISMS  the  lead  in 
this  area  on  a national  basis.  Continued  sup- 
port of  this  activity  was  recommended. 

The  resolutions  referred  to  this  commit- 
tee covered  a wide  field  of  legislative  ac- 
tivity and  subjects.  The  one  controversial 
subject  debated  by  the  House  for  over  two 
hours  was  the  resolution  asking  that  the 
Abortion  Laws  of  the  State  of  Illinois  be 
revised.  The  resolution  was  not  approved 
and  a substitute  resolution  was  tabled. 


PUBLIC  RELATIONS  AND  MISCELLANEOUS  BUSINESS 


The  various  committees  reporting  for  re- 
view by  this  reference  committee  included 
several  which  were  made  as  reports  of  prog- 
ress—the  Advisory  Committee  to  Paramedi- 
cal Groups,  the  Advisory  Committee  to  the 
Health  Careers  Council  of  Illinois,  the  Illi- 
nois Medical  Assistants,  were  all  compli- 
mented upon  their  continued  work  and  co- 
operation with  other  vitally  concerned  and 
interested  groups. 

The  Sub-committee  on  Nursing  received 
a minority  report  which  resulted  in  the 
House  approving  the  appointment  of  an 
Ad  Hoc  Committee  on  Nursing  to  examine 
the  complex  problem  and  report  at  the  next 
meeting. 

The  development  of  the  “President’s 
Tour’’  approach  to  communication  between 
the  headquarters  office  and  the  county  so- 
ciety was  praised  highly.  This  utilization  of 
the  time  and  efforts  of  the  officers  of  the 
Society  has  resulted  in  a better  understand- 
ing of  various  problems  wherever  these  tours 
have  been  held. 


Many  and  varied  activities  exist  within 
the  Public  Relations  Committee— Journal- 
ism Awards  which  have  received  outstand- 
ing appreciation  by  the  television,  radio 
and  press;  the  Journalism  Fellowship  which 
permits  two  young  science  writers  to  attend 
our  annual  convention;  Dr.  SIMS  and  the 
appearances  he  makes— on  the  air,  in  the 
press,  and  at  the  state  fair;  Community 
Health  Week,  which  has  become  a national 
affair;  physicians’  placement  service  which 
has  aided  physicians  in  finding  compatable 
areas  in  which  to  practice,  and  areas  to  find 
medical  personnel  willing  to  fill  the  local 
need.  Medicine  and  Religion  will  institute 
an  annual  award  similar  in  nature  to  the 
Journalism  Award  which  has  proven  to  be 
so  popular. 

The  House  approved  a resolution  urging 
that  protection  be  given  medical  treatment 
facilities,  all  patients  and  hospital  person- 
nel in  any  civil  disorder.  A resolution  asking 
that  the  AMA  consider  establishing  “a 
spokesman  of  continuing  tenure’’  was  re- 
ferred to  the  Board  for  further  study. 


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Illinois  Medical  Journal 


CONSTITUTION  AND  BYLAWS 


The  changes  made  in  the  Bylaws  this 
year  were  minor,  and  were  introduced  to 
clarify  the  Council  setup  developed  by  the 
major  changes  made  by  the  1967  House  of 
Delegates.  The  efficiency  of  this  method 
of  committee  appointment  and  function  is 
proving  itself  in  time  saved  for  the  Board, 


Enjoying  themselves  at  the  President’s  Dinner 
were  Dr.  and  Mrs.  Maurice  Hoeitgen,  Speaker  of 
the  House,  and  Dr.  and  Mrs.  Paul  Sunderland, 
Vice-Speaker. 


and  in  the  ability  of  the  Chairman  of  the 
Board,  through  the  Committee  on  Commit- 
tees, to  combine  and  keep  current,  society 
committees  and  their  functions.  A period 
of  several  years  may  be  necessary  for  some 
areas  to  recognize  and  utilize  the  advan- 
tages provided. 


Sen.  George  Murphy  (R.-Calif.)  Shares  some  views 
with  Dr.  Theodore  Grevas,  Rock  Island,  Chairman 
of  the  ISMS  Public  Affairs  Committee. 


ACTIONS  ON  RESOLUTIONS 
1968  HOUSE  OF  DELEGATES 


Number 

Introduced  by 

Title 

Action 

68M-1 

Kane  County 

Accounting  to  House  for  use  of 
AMA-ERF  Funds 

NOT  adopted 

68M-2 

Kane  County 

Legislation  re  Human  Tissue  as  a 
medical  service 

Considered  w/#  30- 
NO  action 

68M-3 

DuPage  County 

Preceptorship  Program  for 
Junior-Seniors 

Adopted 

68M-4 

DuPage  County 

Summer  Job  Programs  for 
Freshman  Medical  Students 

Adopted 

68M-5 

Jackson  County 

Legislation  re  consolidation  of 
emergency  room  services 

Substitute  resolution 
adopted 

68M-6 

Madison  County 

Legislation  re  Physical  exams  for 
pre-school  children 

NOT  adopted 

68M-7 

Kane  County 

Term  of  Office  of  AMA  delegate 

NOT  adopted 

68M-8 

Vermilion  County 

Legislation  re  Practice  without  a 
License 

NOT  adopted 

for  July,  1968 


81 


68M-9 

DuiPage  County 

Funds  for  Medical  Education  and 
ISMS  Foundation 

Subs,  resoiutioil 
adopted 

68M-10 

DuPage  County 

Support  for  per-student  subsidy  and 
Legislation  to  supply 

Adopted  as  amended 

68M-1 1 

Robt.  R.  Hartman 

Memorial  to  John  Rendock,  MD 

Adopted 

68M-12 

Philip  G.  Thomsen 

Fiscal  Year  of  Woman’s  Auxiliary 

Adopted;  to  AMA 

68M-13 

Saline-Pope-Hardin 

Prescription  forms  for  use  in  IDPA 
cases 

NOT  adopted 

68M-14 

Will-Grundy  County 

Study  of  Illinois  Mental  Health 
Dept. 

NOT  adopted 

68M-15 

Will-Grundy  County  Corporate  Practice  of  Medicine 

No.  1 

Adopted  as  amended; 
to  Board  of  Trus- 
tees 

68M-16 

Will-Grundy  County 

Corporate  Practice  of  Medicine 
No.  2 

NOT  adopted 

68M-17 

Will-Grundy  County 

Corporate  Practice  of  Medicine 
No.  3 

NOT  adopted 

68M-18 

Edward  A.  Razim 

JCAH  Ruling  on  Use  of  Externs, 
Clarification  of 

Adopted  as  amended; 
to  AMA 

68M-19 

James  P.  Campbell 

Protection  of  Medical  Personnel  in 
times  of  Civil  Disorder 

Adopted 

68M-20 

Morgan  Myer  for 
Committee  on  Med- 
ical Education 

Use  of  Externs  in  Hospitals 

NOT  adopted 

68M-21 

Coles-Cumberland 

Usual  and  Customary  Fees  for  IDPA 
cases 

NOT  adopted 

68M-22 

Aux  Plaines  Branch 
Delegates— CMS 

Financial  Support  for  HCCI 

w/resolution  # 28 
Subs,  resol.  approved 

68M-23 

Jackson  County 

Use  of  panel  system  of  IMT  in 
malpractice  suits 

NOT  adopted 

68M-24 

Winnebago  County 

Legal  protection  for  medical  profes- 
sion working  in  mass  immuniza- 
tion programs 

NOT  adopted 

68M-25 

Winnebago  County 

Requirement  under  Medicare  that 
MD  visit  extended  care  every  30 
days 

NOT  adopted 

68M-26 

Winnebago  County 

Mandatory  monthly  nursing  home 
visits  under  JCAH  ruling 

Adopted;  to  AMA 

68M-27 

Winnebago  County 

IDPA  levels  of  reimbursement  and 
Adjudication 

NOT  adopted 

68M-28 

Bond  County 

$2  per  member  for  HCC  from  AMA- 
ERF  and  assigned  again  in  1968 

w/Res.  #22  and  subs, 
adopted 

68M-29 

Lake  County 

Spokesman  for  AMA 

Referred  to  Board  of 
Trustees;  Adopted 

68M-30 

DeKalb  County 

Blood  and  Blood  Derivities 

Considered 

w/Res.  #2.  Approved 

68M-31 

Robt.  Hartman 

Statutes  re:  Abortion 

NOT  adopted 

68M-32 

Clark  County 

IDPA  method  of  compensation 

Substitute  resolution 
adopted 

68M-33 

Rock  Island 

Public  Affairs  at  AMA  level 

Adopted;  to  AMA 

68M-34 

82 

Del.  from  SS-CMS 

Neutrality  during  Civil 
Disturbances 

NOT  adopted 

Illinois  Medical  Journal 

if  you  are  not  already  a member  of  IMPAC  please  tear  off  the  coupon  and  send 
it  in  with  your  check 


ILLINOIS  MEDICAL  POLITICAL  ACTION  COMMIHEE 

360  NORTH  MICHIGAN  • CHICAGO,  ILLINOIS  • 60601 


MEMBERSHIP  APPLICATION 

(PLEASE  PRINT  OR  TYPE) 

NAME 

VOTING  ADDRESS 

CITY 

COMBINED  MEMBERSHIPS  (IMPAC  AND  AMPAC) 

□ SUSTAINING  ($199)  □ REGULAR  ($25) 

□ PLEASE  ENROLL  MY  WIFE  AS  A REGULAR  MEMBER  ($20) 

Principal  Hospital  Affiliation  

U.S.  Congressional  District  No Precinct  or  Ward 


for  July,  1968 


83 


SOCIO  ECONOMIC 

news 


A service  of  the  Public  Relations  and  Economics  Division 


Ambulance  Service 
Cutbacks  Arouse 
ISMS  Concern 


ISMS  Keogh  Plan  A 
Leader  in  Stock 
Fund  Growth 


Reconciliation  Sought 
in  Medicare, 

I DP  A Fees 


Funeral  directors  in  downstate  Illinois  are  phasing  out 
of  ambulance  service  because  of  the  prohibitive  costs  of 
sophisticated  equipment  and  attendant-training.  While  po- 
lice and  firemen  largely  conduct  such  service  in  Chicago, 
morticians  have  been  handling  80  per  cent  of  it  downstate. 
Several  solutions  are  possible,  including  subsidization  of  fu- 
neral directors  or  the  formation  of  ambulance  services  by 
hospitals,  state  agencies  or  private  agencies,  says  Dr.  Max 
Klinghoffer,  chairman  of  the  ISMS  Committee  on  Disaster 
Medical  Care.  He  adds  that  a combination  of  solutions  may 
prove  necessary,  including  use  of  civil-defense  personnel 
and  new  methods  of  transportation.  For  example,  English- 
style  vans  would  be  economical,  and  helicopters  would  be 
flexible,  particularly  in  the  face  of  traffic  tieups.  The  ISMS 
House  of  Delegates,  at  its  May  meeting,  urged  “an  all-out 
effort”  to  keep  ambulance  service  abreast  of  modern  needs. 

The  stock  fund  of  the  ISMS  tax-qualified  retirement 
(Keogh)  program  was  a leader  in  its  field  last  year  with  a 
27  per  cent  growth.  Medical  Economics  reports.  Of  the  17 
other  funds  sponsored  by  national,  state  and  local  medical 
associations,  only  one  (Colorado’s)  chalked  up  a larger 
growth.  Average  gain  in  all  the  Keogh  funds  was  21.1  per 
cent.  The  ISMS  program’s  Stein  Roe  & Farnham  Stock 
Fund  outstripped  all  but  two  of  the  other  funds  from  1964 
through  1967,  with  a 58.9  per  cent  growth.  Furthermore  the 
fund  is  no-load,  enhancing  the  relative  net  gains,  admin- 
istrator Paul  H.  Robinson,  Jr.,  noted.  Earnings  on  the 
group  annuity  portion  of  ISMS’  Keogh  program  ran  4.94 
per  cent  last  year  on  total  investments,  and  are  exceeding 
5 per  cent  this  year,  he  added.  ISMS  expects  to  double  its 
Keogh  enrollment  by  December  31  because  of  the  new  tax 
incentives  provided  by  Congress. 

Delegates  to  the  ISMS  annual  meeting  called  for  elimina- 
tion of  the  “double  standard”  in  the  usual  and  customary 
fees  paid  by  Medicare  fiscal  intermediaries  and  the  Illinois 
Department  of  Public  Aid.  This  step  should  be  taken  even 
if  it  requires  legislation,  the  recommendation  stated.  Draf- 
ters of  the  recommendation  feel  that  Medicare  fee  pay- 
ments are  more  considerate  and  consistent  than  those  paid 
by  IDPA. 


84 


Illinois  Medical  Journal 


Delegates  Ask  Im- 
provements in  Liaison 
With  IDPA 


Research  Pinpoints 
Relation  of  Alcohol 
to  Accidents 


SAMA  Project  in 
Ghettos  May  Extend 
to  Illinois 


Colorado  Abortion 
Facts  May  Interest 
Illinoisans 


Delegates  also  approved  recommendations  calling  for  bet- 
ter liaison  between  county  medical  societies  and  IDPA,  and 
between  the  state  and  county  offices  of  IDPA.  They  urged 
county  medical  societies  to  form  review  committees  to  act 
as  liaison  between  the  state  agency  and  local  physicians. 
Questioning  the  “efficiency  and  effectiveness”  of  communi- 
cations between  the  IDPA’s  state  and  county  offices,  the 
ISMS  suggests  that  “constructive  efforts  be  made  to  im- 
prove those  areas  in  which  communications  are  deficient.” 

Drivers  with  0.10  per  cent  of  alcohol  in  their  blood  are 
more  than  six  times  as  likely  to  cause  accidents  as  non- 
drinkers, while  those  with  0.15  levels  are  25  times  as  likely. 
Drivers  with  0.04  levels  are  no  more  accident-prone  than 
non-di'inkers.  These  are  the  findings  of  Dr.  Robert  F.  Bor- 
kenstein,  chairman  of  Indiana  University’s  Department  of 
Police  Administration,  and  R.  F.  Crowther,  as  reported  in 
the  Journal  of  American  Insurance.  The  ISMS  last  year 
helped  put  through  a state  law  reducing  from  0.15  to  0.10 
per  cent  the  level  at  ■which  a driver  is  presumed  to  be 
under  the  influence  of  liquor;  42  states  still  have  the  0.15 
yardstick.  The  insurance  magazine  noted  that  a person’s 
weight  influences  his  blood-alcohol  level.  A person  -^veigh- 
ing  140  pounds  reaches  the  0.10  level  after  four  highballs 
containing  100-proof  liquor;  a 200-pound  man  does  not 
reach  this  percentage  until  the  sixth  highball. 

The  Student  American  Medical  Association  hopes  to 
extend  to  Illinois  the  pilot  health-information  project  it  is 
launching  in  poorer  neighborhoods  of  Kansas  City,  Kan. 
“We  have  every  hope  of  extending  it  to  Chicago,  East  St. 
Louis  and  other  Illinois  cities,”  said  Russell  F.  Staudacher, 
SAMA  executive  director  emeritus.  But  such  action,  he 
noted,  is  “contingent  on  support  from  voluntary  health 
agencies  and  other  groups  in  the  private  sector  of  the  econ- 
omy.” A S39,000  grant  from  the  AMA  enables  the  Kansas 
City  project  to  operate  on  a year-around  basis.  Medical  stu- 
dents will  establish  contacts  with  residents  of  indigent 
neighborhoods  and  tell  them  what  medical  facilities  are 
available.  A basic  goal  is  to  help  the  students  learn  and 
evaluate  the  health-care  problems  of  the  poor.  Results  of 
the  project  will  be  weighed  at  SAMA’s  1969  convention  in 
Chicago. 

About  the  time  that  delegates  to  the  ISMS  annual  meet- 
ing rejected  proposals  for  broadening  the  Illinois  abortion 
law,  Colorado  tallied  some  results  of  its  own  liberalized 
statute.  Psychiatric  reasons  accounted  for  123  of  the  227 
therapeutic  abortions  reported  in  the  first  11  months  since 
the  Centennial  State’s  law  took  effect.  Medical  Tribune 
said  other  reasons  included  medical  risk,  28;  rape,  21; 
rubella,  13,  and  suicide,  2.  No  statement  was  given  in  40 
cases.  Sixty-five  of  the  patients  were  from  outside  the  state. 


for  July,  1968 


85 


IDPA  Director  Swank 
Gets  Public  Service 
Award 


Harold  O.  Swank,  IDPA  director,  has  been  presented 
with  the  Distinguished  Public  Service  Award  by  the  Cen- 
tral Illinois  chapter,  American  Society  for  Public  Adminis- 
tration. 


Chiropracter  Plea  to 
IDPA  Opposed  by 
Advisory  Group 


The  Illinois  Chiropractic  Society  has  asked  IDPA  to  in- 
clude chiropractic  in  the  services  provided  public-assistance 
recipients,  on  the  ground  that  its  practitioners  are  licensed 
under  the  Illinois  Medical  Practice  Act,  The  question  now, 
according  to  IDPA,  is  whether  or  not  such  service  is  “es- 
sential medical  care.”  The  ISMS  Medical  Advisory  Com- 
mittee to  IDPA  asserts  it  is  not. 

By  DON  B.  FREEMAN 


Clinics  for  Crippled  Children 


Twenty  one  clinics  for  Illinois’  physical- 
ly handicapped  children  have  been  sche- 
duled for  August  by  the  University  of  Illi- 
nois, Division  of  Services  for  Crippled  Chil- 
dren. The  Division  will  conduct  fourteen 
general  clinics  providing  diagnostic  ortho- 
pedic, pediatric,  speech  and  hearing  exami- 
nation along  with  medical  social,  and  nurs- 
ing service.  There  will  be  six  special  clinics 
for  children  with  cardiac  conditions  and 
rheumatic  fever,  and  one  for  children  with 
cerebral  palsy.  Clinicians  are  selected  from 
among  private  physicians  who  are  certified 
Board  members.  Any  private  physician  may 
refer  to  bring  to  a convenient  clinic  any 
child  or  children  for  whom  he  may  want 
examination  or  consultative  services. 
August  1 Lake  County  Cardiac— Victory 
Memorial  Hospital 

August  7 Carlinville— Carlinville  Area 
Hospital 

August  7 Alton  Rheumatic  Fever  & Car- 
diac—Alton  Memorial  Hospital 
August  7 Hinsdale— Hinsdale  Sanitarium 
August  8 Springfield  General— St.  John’s 
Hospital 

August  9 Chicago  Heights  Cardiac— St. 
James  Hospital 

August  9 Evanston— St.  Francis  Hospital 


August  13  East  St.  Louis— Christian  Wel- 
fare Hospital 

August  13  Peoria  General— Children’s 
Hospital 

August  14  Champaign-Urbana— McKinley 
Hospital 

August  15  Rockford— Rockford  Memorial 
Hospital 

August  15  Elmhurst  Cardiac  — Memorial 
Hospital  of  DuPage  County 

August  20  Belleville— St.  Elizabeth’s  Hos- 
pital 

August  21  Chicago  Heights  General— St. 
James  Hospital 

August  22  Effingham  Rheumatic  Fever  8c 
Cardiac— St.  Anthony’s  Memorial  Hos- 
pital 

August  22  Bloomington— St.  Joseph’s  Hos- 
pital 

August  23  Chicago  Heights  Cardiac— St. 
James  Hospital 

August  27  East  St,  Louis— Christian  Wel- 
fare Hospital 

August  27  Peoria  General— Children’s  Hos- 
pital 

August  28  Springfield  Cerebral  Palsy 
(P.M.)— Diocesan  Center 

August  28  Aurora— Copley  Memorial  Hos- 
pital 


More  than  five  million  veterans  visit 
Veterans  Administration  outpatient  clinics 
in  a year. 


Half  of  the  physicians  in  the  U.  S.  re- 
ceive some  part  of  their  training  in  the 
Veterans  Administration,  the  largest  medi- 
cal complex  in  the  world. 


86 


Illinois  Medical  Journal 


OBITUARIES 


*Dr.  George  B.  Bradburn,  Chicago,  died 
May  7 at  the  age  of  58,  He  had  been  senior 
attending  physician  of  the  department  of 
obstetrics  and  gynecology  at  Wesley  Me- 
morial Hospital  and  assistant  professor  at 
the  Northwestern  University  Medical 
_ School. 

*Dr.  Charles  K.  Carey,  73,  of  Rushville, 
a retired  physician  who  practiced  medicine 
for  34  years,  died  May  6.  He  was  a former 
secretary  of  Schuyler  County  Medical  So- 
ciety. 

*Dr  .William  L.  Fishbein,  65,  of  Lincoln- 
wood,  a medical  director  of  health  services 
for  the  Chicago  Board  of  Health,  died 
May  23. 

"^Dr.  Clare  A.  Garber,  95,  a Decatur  phy- 
sician for  more  than  60  years,  died  May 
16.  She  was  a member  of  the  American  In- 
stitute of  Homeopathy,  American  Medical 
Women’s  Association,  Pan-American  Medi- 
cal Women’s  Alliance  and  a member  of 
ISMS  Fifty-Year  Club. 

*Dr.  Joseph  L.  Gonzalez,  49,  Olympia 
Fields,  died  May  2.  He  was  a resident  phy- 
sician at  South  Suburban  Hospital. 

*Dr.  Samuel  Governale,  69,  Chicago,  a 
physician  for  more  than  42  years  and 
former  chief  of  surgery  at  St.  Bernard’s  Hos- 
pital, died  May  11. 

*Dr.  Harry  D.  Grossman,  69,  Chicago, 
died  April  21.  He  was  a physician  for  47 
years,  on  the  staffs  of  Michael  Reese  and 
Woodlawn  Hospitals. 

*Dr.  Ewald  E.  Hermann,  73,  a retired 
Highland  physician  and  surgeon,  died  May 
22.  He  was  a veteran  of  World  War  I,  a 
member  of  the  International  College  of 
Surgeons,  and  a member  of  ISMS  Fifty- 
Year  Club. 

*Dr.  Harold  L.  Klawans,  Chicago,  died 
April  28  at  the  age  of  65.  He  had  been 
the  chief  medical  officer  of  the  Chicago 
Board  of  Health,  on  the  faculty  of  the  Uni- 


FBLM REVIEW 

A fast  and  accurate  method  for  detect- 
ing elevated  Phenylalanine  levels  in  the 
first  few  days  of  a newborn  baby’s  life  is 
described  in  detail  in  an  18-minute,  16 
mm.,  color  film,  “Early  Detection  of  PKU 
in  the  Hospital  Nursery.’’  The  system  was 
developed  by  Dr.  Robert  Guthrie,  Child- 
ren’s Hospital,  Buffalo,  N.  Y.  and  is  dem- 


versity of  Illinois  Chicago  Circle  campus 
and  on  the  staff  of  Michael  Reese  Hospital. 
*Dr.  Nikolaus  Koenig,  Chicago,  died  May 
8 at  the  age  of  40. 

Dr.  G.  E.  Linden,  81,  of  Highland  Park, 
was  a practicing  physician  for  45  years. 
*Dr.  Ray  Logan,  79,  a Galena  physician 
and  benefactor  for  over  fifty  years,  died 
April  24.  He  was  former  mayor  of  Galena, 
past  president  of  the  Jo  Daviess  County 
Tuberculosis  Association,  former  president 
and  secretary  of  Jo  Daviess  County  Medi- 
cal Society,  a member  of  the  Galena  Board 
of  Education  and  a member  of  ISMS  Fifty- 
Year  Club. 

*Dr.  George  W.  Moxon,  72,  Chicago,  died 
May  5.  He  was  a past  president  of  the  Uni- 
versity of  Illinois  College  of  Medicine 
Alumni  Association. 

*Dr.  Alfred  Nienow,  77,  a Summit  physi- 
cian and  surgeon  for  more  than  48  years, 
died  May  16.  He  was  a member  of  ISMS 
Fifty-Year  Club. 

*Dr.  Willis  J.  Potts,  73,  the  children’s  sur- 
geon who  perfected  the  “blue  baby”  heart 
operation,  died  May  5.  He  was  a past  presi- 
dent of  the  Chicago  Heart  Association  and 
was  listed  among  the  100  leading  Chi- 
cagoans, as  well  as  one  of  the  10  Leaders 
of  American  Medicine. 

*Dr.  John  D.  Scouller,  92,  a Pontiac  phy- 
sician and  surgeon  for  45  years,  died  April 
11.  He  was  past  president  of  Livingston 
County  Medical  Society,  a member  of  Al- 
pha Omega  Alpha. 

*Dr.  V.  B.  Stanford,  79,  Illiopolis,  who 
practiced  general  medicine  for  42  years, 
died  May  11.  He  was  a member  of  ISMS 
Fifty-Year  Club. 

*Dr.  Pauline  D.  Stepleton,  61,  Glen  El- 
lyn, died  April  25.  She  was  a former  staff 
member  at  Michael  Reese  Hospital  and 
Medical  Center. 

^Indicates  member  of  Illinois  State  Medical  Society. 


onstrated  with  the  cooperation  of  the  State 
University  of  New  York  at  Buffalo  and  the 
hospital.  A grant  from  the  Children’s  Bu- 
reau of  the  Department  of  H.E.W.  made 
the  film  possible.  It  was  produced  by  De- 
signs For  Medicine  and  is  available  at  a 
rental  fee  of  $9  from  the  International 
Film  Bureau,  332  S.  Michigan  Ave.,  Chica- 
go, 60604. 


for  July,  1968 


87 


Do  you  have  patients 
who  try  to  hide  frustration 
behind  conformity? 


Jwu  see  many  depressed  patients 
who  hide  their  real  anxieties  behind 
a smoke  screen  of  pretense. 

The  more  they  try  to  conceal  reality, 
the  more  entrenched  the  disturbances 
become.  The  role  they  assume  is  not 
adequate  to  suppress  their  inner 
turmoil.  Unchecked,  the  turmoil 
finds  expression  in  other  symptoms. 


800314 


They  want  your  help  and  Aventyl 
HCl  can  help  you. 

Whether  depression  is  open  or 
secretive,  Aventyl  HCl  assists  in 
relieving  the  symptoms  and  the  state  of 
depression  itself.  It  may  aid  in  removing 
the  emotional  distortions  and,  in  lifting 
the  depression,  help  patients  face, 
accept,  or  change  their  life  patterns. 


Eli  Lilly  and  Company 
Indianapolis,  Indiana  46206 


Helps  remove  the  symptoms, 
lift  the  depression, 
and  release  the  patient 

AventyF  HCl 

Nortriptyline  Hydrochloride 


(See  last  page  for  prescribing  information.) 


CALLING  ALL 

ISMS  MEMBERS  AND  AUXILIANS 


ON  THE  LOOKOUT^^  for  physicians  and  clergymen 
in  your  area  who  have  worked  outstandingly  over  the  past  year 
to  apply  religious  principles  in  the  treatment  of  the  sick. 

Enter  their  names  and  achievements  in  the  Illinois  State  Medical 
Society's 

FIRST  ANNUAL  REIIGION/MEDICINE  AWARDS  PROGRAM 

Sponsored  by  the  ISMS  Committee  on  Religion  and  Medicine  to  ac- 
knowledge contributions  over  the  past  year  by  an  Illinois  physician 
and  clergyman  utilizing  the  skills  of  the  profession  cooperatively  to 
promote  total  patient  care.  Eligibility  restricted  to  physicians  licensed 
to  practice  medicine  in  Illinois  and  clergymen  of  all  faiths  residing  in 
the  state. 

DEADLINE  FOR  ENTRIES  AUGUST  31,  1968 

Send  name,  address,  and  200-word  summary  of  nominee's  achievements 
to; 

ILLINOIS  STATE  MEDICAL  SOCIETY 

COMMIHEE  ON  RELIGION  AND  MEDICINE 
360  NORTH  MICHIGAN  AVENUE 
CHICAGO,  ILLINOIS  60601 

State  winners— one  physician  and  one  clergyman— will  be  honored  at  the  ISMS 
Board  of  Trustees  dinner  meeting  in  October. 


Medical  Scholarships  for  Negro  Students 


Dr.  John  C.  Troxel,  President  of  National 
Medical  Fellowships,  Inc.,  and  Senior  Vice- 
President,  Blue  Cross-Blue  Shield,  an- 
nounced today  that  the  largest  number  of 
scholarships  and  grants-in-aid  have  been 
awarded  for  1968-69  since  the  organization 
began  offering  assistance  to  Negroes  in 
medicine.  A total  of  $190,000  was  awarded 
to  134  Negro  students  for  study  in  55  U.S. 
medical  schools.  The  awards,  ranging  from 
$900  to  $2,000  a year,  were  made  to  117 
men  and  17  women. 

Ten  outstanding  Negro  college  students 
have  been  awarded  four-year  medical  schol- 
arships with  awards  averaging  $8,000  each. 
These  top  students  are  the  recipients  of  the 
coveted  National  Medical— Sloan  Founda- 
tion Scholarships,  the  highest  awards  made 
by  National  Medical  Fellowships,  Inc.  to 


entering  medical  students.  Winners  for 
1968-69  will  study  at  the  medical  schools 
of  Harvard  University,  University  of  Michi- 
gan, Yale  University,  The  Johns  Hopkins 
University,  Columbia  University,  Univer- 
sity of  Florida,  University  of  California  at 
San  Francisco,  Einstein  Medical  College, 
Tulane  University,  and  Emory  University. 

Through  the  National  Medical  — Sloan 
Foundation  Scholarship  program  which  is 
administered  by  National  Medical  Fellow- 
ships and  hnanced  by  grants  which  have 
exceeded  $600,000  from  the  Alfred  P.  Sloan 
Foundation,  98  students  have  entered  medi- 
cal schools  since  1960. 

Dr.  Troxel  also  stated  that  through  a 
3-year  grant  from  The  Woods  Charitable 
Fund,  Inc.  of  Chicago,  seven  young  women 
will  study  medicine  at  the  medical  schools 


for  July,  1968 


91 


of  Louisiana  State  University,  Case-Western 
Reserve  University,  State  University  of  New 
York,  Howard  University  (2),  University  of 
Rochester,  and  Albany  Medical  College.  In 
announcing  the  grant.  Dr.  Troxel  said:  “I 
am  very  pleased  that  increased  attention  is 
being  given  to  opportunities  for  Negro 
women  in  medicine.  Well  over  50%  of  Negro 
college  students  are  women,  but  less  than 
10%  of  the  Negro  medical  students  are 
women.  It  is  estimated  that  at  present  less 
than  800  Negro  students  are  enrolled  in 
all  four  classes  of  U.S.  medical  schools.  The 
country  would  benefit  greatly  by  fully  ex- 
ploring the  potential  of  Negro  women  for 
medicine.” 


Other  foundations  providing  support  for 
National  Medical  Fellowships,  Inc.  are: 
Charles  A.  Frueaufif  Foundation,  Nathan 
Hofheimer  Foundation,  New  York  Founda- 
tion, Gustavus  and  Louise  Pfeiffer  Research 
Foundation,  Robert  R.  McCormick  Founda- 
tion, Shell  Companies  Foundation,  and  the 
Reader’s  Digest  Foundation. 

National  Medical  Fellowships,  Inc.  of 
3935  Elm  Street,  Downers  Grove,  Illinois, 
is  a non-profit  organization  which  provides 
assistance  to  Negroes  for  education  and 
training  in  medicine.  Since  its  organization 
in  1946,  it  has  awarded  $1,900,000  to  assist 
544  Negroes  with  their  medical  education 
and  careers. 


Develop  Photographic  Method 
of  Detecting  Radium  Leaks 


A low-cost  photographic  method  for  de- 
tecting leaks  in  sealed  radium  capsules  and 
needles  with  greater  speed  than  can  be 
achieved  with  currently  used  techniques 
has  been  developed  by  the  Public  Health 
Service’s  National  Center  for  Radiological 
Health. 

The  method  is  designed  to  facilitate  test- 
ing sealed  radium  sources  with  sufficient 
frequency  to  insure  discovery  of  leaks  before 
radioactive  contamination  is  spread. 

The  photographic  leak  detection  tech- 
nique, as  developed  in  the  Center’s  South- 
eastern Radiological  Health  Laboratory  at 
Montgomery,  Ala.,  requires  only  about  six 
minutes  for  film  exposure  and  print  process- 
ing. As  long  as  24  hours  may  be  needed  for 
methods  now  generally  used. 

The  photographic  technique  can  be  em- 
ployed to  detect  point  sources  of  leaking  or 
exposed  radium  salts  in  quantities  as  low  as 
500  picocuries.  Detection  of  this  low  level 
is  possible  in  sources  having  a total  strength 
of  up  to  50  milligrams  of  radium. 

Development  of  the  photographic  detec- 
tion method  primarily  was  the  work  of  Dr. 
Paul  H.  Bedrosian,  Chief  of  the  Radium 
Technology  Unit  at  the  Southeastern  Radi- 
ological Health  Laboratory. 

“The  new  technique  represents  a safe,  ef- 
fective system  which  can  be  used  easily  and 
at  relatively  little  cost  to  protect  physicians, 
patients,  and  the  general  public  against  a 
significant  source  of  unnecessary  radiation 
exposure,”  said  James  G.  Terrill,  Jr.,  Direc- 
tor of  the  National  Center. 

“It  should  be  emphasized  that  leaks  from 


radium  capsules  or  needles  often  cannot  be 
detected  visually,”  Mr.  Terrill  said.  “Many 
sealed  sources  which  appear  to  be  structur- 
ally sound,  leak  invisible  and  hazardous  ra- 
diations as  badly  as  obviously  broken  ones.” 

The  essence  of  the  new  detection  tech- 
nique lies  in  the  ability  of  radiations  of 
alpha  particles  to  interact  with  a zinc  sul- 
fide scintillator  to  produce  light.  Registra- 
tion of  the  light  on  high-speed  photographic 
film  shows  radium  capsules  or  needles  to  be 
leaking,  since  alpha  particles  cannot  pene- 
trate unfractured  walls  of  a sealed  source. 

Two  film  exposures  are  made  for  each 
detection  procedure.  In  one  exposure,  a 
shield  is  used  which  prevents  alpha  particles 
from  interacting  with  zinc  sulfide  but  does 
not  prevent  passage  of  beta  and  gamma  ra- 
diations. These,  therefore,  interact  with  the 
scintillator.  The  resulting  light  is  focused 
through  a lens  with  a well-defined  image. 

The  shield  is  removed  for  the  second  pic- 
ture so  that  light  from  alpha,  beta,  and 
gamma  interactions  with  zinc  sulfide  are 
registered  on  film.  Comparison  of  the  images 
on  the  two  films  shows  the  alpha  contribu- 
tion and,  therefore,  the  presence  of  a leak. 

Investigators  at  the  Southeastern  Radi- 
ological Health  Laboratory  have  found  that 
the  photographic  method  can  be  used  to  de- 
tect leaks  or  contamination  at  various  points 
along  the  lengths  of  radium  sources.  The 
technique  also  can  be  employed  to  distin- 
guish among  sources  containing  varying 
amounts  of  radium  and  to  detect  radioac- 
tive contamination  picked  up  by  wiping  a 
suspected  area. 


92 


Illinois  Medical  Journal 


I* 


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For  detailed  information  regarding  indica- 
tions, dosage,  contraindications,  and  adverse 
reactions,  refer  to  the  manufacturer’s  package 
insert  or  brochure. 

Single  Chemicals — Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products — Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products — Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms — Of  a preciously  introduced 
product. 

NEW  SINGLE  CHEMICALS 

ANTIHEMOPHILIC  FACTOR 
(Human),  METHOD  FOUR  Biological  B 

Manufacturer:  Hyland  Laboratories 
Nonproprietary  Name:  Antihemophilic  factor, 
hum^  (factor  VIII,  AHF,  AHG) 

Indications:  Classical  hemophilia  (hemophilia 

A);  patients  with  acquired  factor  VIII  inhib- 
itors. 

Contraindications:  None  known. 

Dosage:  Must  be  individualized. 

Supplied:  Dried  powder  with  diluent — 10  cc. 
vial,  300  and  450  AHF  units;  30  cc.  vial,  900 
AHF  units 

IMURAN  Renal  homotransplants  R 

Manufacturer:  Burroughs  Wellcome  & Co. 
Nonproprietary  Name:  Azathioprine 
Indications:  Adjunct  for  the  prevention  of  re- 
jection in  renal  homotransplants. 
Contraindications:  Hypersensitivity  to  the  drug. 
Dosage:  3 to  5 mg. /kg. /day,  orally.  Must  be  in- 
dividualized. 

Supplied:  Tablets — 50  mg.,  bottles  of  100. 

DUPLICATE  SINGLE  PRODUCTS 

CHLOROPTIC  Eye  preparation  R 

Manufacturer:  Allergan  Pharmaceuticals 
Nonproprietary  Name:  Chloramphenicol 
Indications:  Bacterial  conjunctivitis  and  other 
superficial  ocular  bacterial  infections  caused 
by  organisms  sensitive  to  chloramphenicol. 
Contraindications:  Hypersensitivity  to  the  drug. 
Dosage:  One  or  two  drops  q.4h.,  day  and  night 
for  the  first  72  hrs.  Therapy  should  be  con- 
tinued for  48  hrs.  after  an  apparent  cure  has 
been  attained. 

Supplied:  Plastic  dropper  bottles — 7.5  cc.,  5 
m./cc. 

T-I-GAMMAGEE  Biological  R 

Manufacturer:  Merck  Sharp  & Dohme 
Nonproprietary  Name:  Tetanus  immune  globu- 
lin, hxunan 

Indications:  Passive  tetanus  prophylaxis. 
Contraindications:  None  mentioned. 

Dosage:  Adults — 250  units,  i.m.;  Children — 4 
units/kg.  body  wt.,  i.m.;  Must  not  be  injected 
intravenously. 

Supplied:  Disposable  syringe  of  250  units. 

(Continued  on  page  100) 


for  July,  1968 


97 


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A- 


Tofranil®,  imipramine  hydrochloride 

Indications:  TolranW  is  recommended 
for  the  treatment  of  depressive  states 
of  diverse  psychopathology. 
Contraindications:  The  concomitant 
use  of  this  agent  and  monoamine  oxi- 
dase inhibiting  (M.A.O.I.)  compounds 
is  contraindicated.  Hyperpyretic  crises 
or  severe  convulsive  seizures  may 
occur.  Potentiation  of  adverse  effects 
can  be  serious  or  even  fatal.  An  inter- 
val of  at  least  7 days  after  M.A.O.I. 
therapy  has  been  discontinued  should 
be  allowed  before  this  drug  may  be 
substituted.  Initial  dosage  should 
be  low,  increases  should  be  gradual, 
and  the  patient’s  progress  should  be 
carefully  observed. 

Warning:  Clinical  reports  have  sug- 
gested that  there  may  be  a risk  of 
teratogenesis  associated  with  the  use 
of  this  compound  during  the  first  tri- 
mester of  pregnancy.  Unless,  in  the 
opinion  of  the  prescribing  physician, 


the  potential  benefits  outweigh  the 
possible  risks,  it  should  not  be  used 
during  the  first  trimester  of  pregnancy. 
Cardiovascular  complications,  includ- 
ing myocardial  infarction  and  arrhyth- 
mias, have  occasionally  occurred  in 
susceptible  individuals.  Patients  with 
cardiovascular  disease  should  be 
given  the  drug  only  under  careful  ob- 
servation and  in  low  dosage. 
Precautions:  Since  suicide  is  always  a 
possibility  in  severely  depressed  pa- 
tients and  one  which  may  persist  until 
significant  remission  occurs,  such 
patients  should  be  carefully  super- 
vised during  early  treatment.  Some 
severely  depressed  patients  may  alsd 
require  hospitalization  and/or  con- 
comitant electroconvulsive  therapy. 
Because  of  its  anticholinergic  effect, 
caution  should  be  observed  in  pre- 
scribing the  drug  for  patients  with 
increased  intraocular  pressure. 

In  rare  instances,  transient  cardiad 
arrhythmias  have  occurred  in  hyper- 


thyroid patients  and  in  patients  re- 
ceiving thyroid  medication  when 
this  compound  was  added  to  the 
regimen. 

Imipramine  may  block  the  pharma- 
cologic activity  of  guanethidine  anc 
other  related  adrenergic  neuron- 
blocking agents. 

The  drug  is  not  recommended  at  thi 
present  time  in  patients  under  12  y(| 
of  age.  i 

Adverse  Reactions:  Dryness  of  the  j 
mouth,  tachycardia,  constipation,  c 
turbances  of  accommodation,  swei 
ing,  dizziness,  weight  gain,  urinary  | 
frequency  or  retention,  nausea  and  ' 
vomiting,  peripheral  neuritis,  mild 
parkinson-like  syndrome,  tremors, 
rare  cases  of  falling  in  elderly  pa- 
tients, confusional  states  (with  sucf 
symptoms  as  hallucinations  and  dis 
orientation),  activation  of  psychosis 
schizophrenics  and  agitation  (inclu 
ing  hypomanic  and  manic  episodes 
which  may  require  dosage  reductio 


For  him,  commencement 


For  his  mother,  the  beginning 
of  his  career  may  seem  the  end 
of  hers.  The  end  of  feeling 
needed  and  useful.  The  begin- 
ning, perhaps,  of  a pathological 
depression. 


Magna 

cum 

depression 


nd/or  addition  of  a tranquilizer  or 
ismporary  discontinuation  of  the  drug, 
i pileptiform  seizures,  orthostatic 
lypotension  and  substantial  blood 
jiressure  fall  in  hypertensive  patients, 
jturpura,  transient  jaundice,  bone  mar- 
iow  depression  including  agranulocy- 
losis,  sensitization  and  skin  rash 
ncluding  photosensitization,  eosino- 
)hilia,  and  mild  withdrawal  symptoms 
>n  sudden  discontinuation  after  pro- 
onged  treatment  with  high  doses. 
Occasional  hormonal  effects  (im- 
)otence,  decreased  libido,  and  estro- 
jenic  effects)  may  be  observed. 
Vtropine-like  effects  may  be  more 
)ronounced  (e.g.  paralytic  ileus)  in 
susceptible  patients  and  in  those 
Jsing  anticholinergic  agents  (includ* 
ng  antiparkinsonism  drugs). 

Outpatient  Adult  Dosage:  Initially, 

^5  mg.  daily,  increased,  if  necessary, 
io  150  or  200  mg.  Maintenance  dosage 
flay  be  lower,  50  to  150  mg.  daily,  if 
possible. 

% 


Geriatric  and  Adolescent  Dosage: 
Initially,  30  or  40  mg.  daily,  which  may 
be  increased  according  to  response 
and  tolerance.  It  is  usually  unneces- 
sary to  exceed  100  mg.  daily. 

A lag  in  therapeutic  response,  lasting 
from  a few  days  to  a few  weeks, 
should  be  expected.  When  dosage 
recommendations  are  already  being 
followed,  increasing  the  dosage  does 
not  normally  shorten  this  latency 
period  and  may  increase  the  inci- 
dence of  adverse  reactions. 
Availability:  Round  tablets  of  25  and 
50  mg.;  triangular  tablets  of  10  mg. 
for  geriatric  and  adolescent  use;  and 
ampuls,  each  containing  25  mg.  in 
2 cc.  for  I.M.  administration. 
(B)R-46-850-C 


For  complete  details,  please  refer  to 
the  full  Prescribing  Information. 


Tofranil  can  often  relieve  the 
symptoms  of  her  depression.  If 
it  can  relieve  her  mental  anguish, 
you  may  be  able  to  help  her 
graduate  into  a new  and  fruitful 
life  of  her  own. 

Tofranil  could  be  her  commence- 
ment, too. 

Tofranil’  Geigy 

imipramine 

hydrochloride 

in  depression 


The  use  of  Tofranil  in  patients  receiving 
M.A.O.I.’s  is  contraindicated. 

In  patients  with  cardiovascular  disease, 
hyperthyroidism  or  increased  intraocular 
pressure;  in  those  receiving  anticholinergics 
(including  antiparkinsonism  agents),  thyroid 
medication  or  adrenergic  neuron-blocking 
antihypertensive  agents;  and  in  those  in  the 
first  trimester  of  pregnancy,  the  precautions 
discussed  in  the  Prescribing  Information 
should  be  carefully  observed.  Although  toxic 
reactions  severe  enough  to  require  discontinua- 
tion of  Tofranil  are  uncommon,  please  refer 
to  the  Prescribing  Information  for  a description 
of  such  instances  when  discontinuation  may 
be  necessary. 


Geigy  Pharmaceuticals 

Division  of  Geigy  Chemical  Corporation 

Ardsley,  New  York  10502 


anticostive^ 

hematinic 


%iiiiii»iiiihiaii«i*»^^‘^ 


PERm>il€ 

-wftfc  ; 

1,  1’ABLE1'S« 

ttnilAt  MftMHfl  : ' 

aa*p«Hu,  ■;/:; 


PERITINIC* 

Hematinic  with  Vitamins  and  Fecal  Softener 


A tablet-a-day  provides: 

• Elemental  Iron  (as  Ferrous  Fumarate) . 100  mg 

• Dioctyl  Sodium  Sulfosuccinate  (to 

counteract  constipating  effect  of  iron)  100  mg 

Vitamin  Bi 7.5  mg 

Vitamin  B2 7.5  mg 

Vitamin  Be 7.5  mg 

Vitamin  B12 50  mcgm 

Vitamin  C 200  mg 

Niacinamide 30  mg 

Folic  Acid 0.05  mg 

Pantothenic  Acid 15  mg 

f ^ Bottles  of  60 


anticostive,  adj,  {anti  opposed  to 
+ costive  causing  constipation.) 
Against  constipation.  (Now  isn't 
that  a good  idea  in  an  iron-contain- 
ing hematinic?  We'll  send  you 
samples  if  you'll  send  a request  on 
your  Rx  blank,  addressed  to 
Department  150.) 


A Division  of  American  Cyanamid  Company 


Pearl  River,  New  York  10965 

488.7-6062 


New  Pharmaceutical  Specialties 

(Coniivued  jrom  page  97) 

COMBINATION  PRODUCTS 

OVRAL  Progesterone /estrogen  comb.  R 

Manufacturer:  Wyeth  Laboratories 
Composition:  Nodgestrel  0.5  mg. 

Ethinyl  estradiol  0.05  mg. 

Indications:  Oral  contraception. 
Contraindications:  Thrombophlebitis,  or  history 
of  thrombophlebitis  or  pulmonary  embolism, 
liver  dysfunction  or  disease,  known  or  sus- 
pected carcinoma  of  breast  or  genital  organs, 
undiagnosed  vaginal  bleeding. 

Dosage:  Beginning  on  day  five  of  menstrual 
cycle,  one  tablet  daily  for  21  days.  Skip  7 
days  before  starting  next  cycle. 

Supplied:  Tablets — 21  per  dispenser,  packets  of 

6. 

NEW  DOSAGE  FORMS 

LASIX  Injection  Diiiretic — Other  R 

Manufacturer:  Hoechst  Pharmaceutical  Co. 
Nonproprietary  Name:  Furosemide 
Indications:  Edema  associated  with  congestive 
heart  failure,  liver  cirrhosis,  and  renal  dis- 
ease including  the  nephrotic  syndrome.  To  be 
used  when  oral  administration  is  not  possible. 
Contraindications:  Anura,  hepatic  coma,  electro- 
lyte depletion,  hypersensitivity  to  the  drug. 
Therapy  should  be  discontinued  if  increasing 
azotemia  and  oliguria  occur  during  treatment 
of  progressive  renal  disease. 

Dosage:  20  to  40  mg.,  i.m.  or  i.v.  A second  dose 
may  be  given  two  or  more  hours  after  the 
first.  Not  to  be  used  in  children. 

Supplied:  Ampuls — 2 cc.,  10  mg./cc. 


National  VD  Survey 

On  July  1,  1968,  all  practicing  physicians 
in  the  U.S.  received  a questionnaire 
asking  the  number  of  cases  in  infectious 
syphilis,  other  stages  of  syphilis  and  gonor- 
rhea treated  by  them  from  April  1 through 
June  30,  1968. 

This  survey,  entitled,  “National  Survey 
of  VD  Incidence,”  is  a repeat  of  a similar 
1962  poll  and  is  sponsored  jointly  by  the 
American  Medical  Association,  the  Ameri- 
can Osteopathic  Association,  the  National 
Medical  Association,  American  Social 
Health  Association  in  cooperation  with  the 
Public  Health  Service. 

Current  estimates  show  that  VD  is  in- 
fecting Americans  at  the  alarming  rate  of 
1,100,000  cases  a year  and  is  now  the  na- 
tion’s most  urgent  communicable  disease 
problem.  Indications  are  that  private  phy- 
sician reporting  has  increased  considerably 
since  the  1962  survey,  which  showed  the 
level  of  reporting  to  be  only  11%  of  the 
infectious  cases  treated.  The  1968  survey 
should  determine  the  extent  of  increase. 

The  questionnaire  card  requires  no  sig- 
nature and  replies  of  individual  physicians 
will  not  be  identified  by  name. 


100 


Illinois  Medical  Journal 


Post-Pericardiotomy  Syndrome 

(Continued  from  page  58) 

these  syndromes  is  the  scar  in  the  myocard- 
ial tissue  and  pericardium.  More  precisely 
the  nerve  lesions  in  these  scars— neuroma 
or  nerve  ending  hyperplasio— can  explain 
the  different  signs  or  different  aspects  of 
the  syndrome,  and  this  is  consistent  with 
the  present  role  of  the  nervous  system  in 
psycho-somatic  medicine.  In  other  words, 
this  syndrome  may  be  similar  to  the  phan- 
tom syndrome  of  amputation  neuroma. 
This  hypothesis  explains  also  why  the 
symptoms  develop  after  a latent  period.  We 
consider  that  in  general  we  must  pay  more 
attention  to  the  role  of  visceral  scars  in 
the  pathogenesis  of  diseases.^ 

If  some  authors  have  implicated  the 
trauma  of  surgery  (Wood,  1954,  January 
et  al.  1954,  Elster  et  al.  1954,  Papp  and 
Xion,  1956,  Bercu  1953,  Julian  et  al.  1954, 
Larson  1957,  quoted  by  H.  Geld®)  this  trau- 
ma may  act  through  the  scars  they  produce. 

The  concept  of  neurogenic  origins  in- 
spired us  to  give  her  vitamins  Bj  and  Bg 
—in  addition  to  her  other  cardiac  treatment 
—with  good  results. 


Concluiion 

We  consider  that  there  is  a similarity  be- 
tween the  pathogenic  mechanism  of  the 
post-pericardiotomy  syndrome  and  phan- 
tom syndrome  of  amputated  neuroma. 

References 

1.  Buchanan,  W.:  Chicago  Medicine,  1965, 
February  20,  Vol.  68  No.  4. 

2.  Cohen,  E.  J.:  Acta  Gastro-Enterologica,  Bel- 
gica,  1959,  Ease.  2,  Page  95. 

3.  Drusin,  M.  L.,  Engle,  M.  A.  Hagstrom,  J.W.C. 
and  Schwartz,  M.S.:  The  New  England  Journal 
of  Medicine,  1965,  March  25,  Vol.  272,  No.  12. 

4.  Fudenberg,  H.  H.:  Hospital  Practice,  1968, 
January,  Vol.  3,  No.  1. 

5.  Geld,  H.  van  der:  The  Lancet,  1964,  Septem- 
ber 19,  Vol.  II,  No.  7360. 

6.  Ito,  T.,  Engle,  M.,  and  Goldberg,  P.  H.,  1958, 
Circulation  17:549. 

7.  Soloff,  L.  A.,  Zaruchni,  J.,  Janton,  O.  H., 
O’Neil,  T.J.E.,  Glover  R.  P.,  1953,  Circula- 
tion 8:481. 


President  Johnson  ordered  the  establish- 
ment of  U.  S.  Veterans  Assistance  Centers 
in  20  major  cities.  He  told  Congress  he 
wants  a veteran  to  receive  in  one  place 
“personal  attention  and  counsel  on  all  the 
benefits  the  law  provides  him— from  hous- 
ing to  health,  from  education  to  employ- 
ment.” 


on 

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^^asy  on 

the  ^J[j^other 

(3^(jATablets  Elixir 
^J^or  ^ron  j^eficiency 


FAMOUS 


BREON  LABORATORIES  INC. 

Subsidiary  of  Sterling  Drug  Inc. 

90  Park  Avenue,  New  York,  N.Y.  10016 


brand  of  PERFROUS 


on 

GLUCONATE 


for  July,  1968 


101 


THE  VIEW  BOX 

(Continued  from  page  36) 


DIAGNOSIS:  ACUTE  TRAUMATIC 
RUPTURE  OF  THE  LEFT  HEMIDIA- 
PHRAGM. 

The  diaphragm  is  occasionally  injured  by 
blunt  abdominal  trauma.  It  may  be  lacer- 
ated by  a fractured  rib  end  or  may  rupture 
from  sudden  violent  increase  of  the  intra 
abdominal  pressure.  The  left  half  of  the 
diaphragm  is  by  far  the  most  commonly 
involved.  When  the  left  leaf  ruptures  ad- 
jacent abdominal  viscera  enter  the  thorax. 
Most  commonly  these  are  the  stomach, 
splenic  flexure,  small  bowel,  spleen  and 
omentum.  The  four  cardinal  signs  of  trau- 
matic diaphragmatic  hernia  are  (1)  an  arch 
like  shadow  resembling  an  abnormally  high 
diaphragm;  (2)  gas  bubbles,  homogenous 
densities  or  other  abnormal  markings  ex- 
tending about  the  anticipated  level  of  the 
normal  diaphragm;  (3)  shift  of  the  heart 
and  mediastinal  structures  (frequently  pres- 
ent and  dependent  upon  the  volume  of  vis- 
cera and  fluid  encroaching  on  the  thoracic 
space);  (4)  disc  or  plate  like  atelectasis  in 
the  lung  base.  Fig.  1 demonstrates  all  these 
findings.  The  diagnosis  can  be  definitely 
made  with  the  insertion  of  a gastric  tube 
which  will  show  the  stomach  herniating  up- 
ward. (Fig.  2).  The  additional  use  of  barium 
or  gastrografin  will  further  help  in  the  diag- 


nosis (Fig.  3)  and  eliminate  the  possibility 
of  confusing  this  entity  with  eventration. 

Complications  which  can  occur  with  this 
condition  are  incarceration  of  the  hernia 
which  can  be  suspected  if  the  barium  stops 
at  the  herniated  segment  and  does  not  enter 
the  stomach.  If  the  colon  is  incarcerated  the 
barium  enema  will  abruptly  terminate  at 
the  level  of  the  splenic  flexure.  Associated 
laceration  of  the  spleen  will  be  accompanied 
by  hemorrhage  into  the  thoracic  and  peri- 
toneal cavity.  The  use  of  pneumoperitone- 
ography is  valuable  and  can  be  diagnostic  in 
demonstrating  a tear  in  the  diaphragm  fol- 
lowing the  insertion  of  50  cc.  of  100%  car- 
bon dioxide  in  the  peritoneal  cavity.  If  a 
rent  is  present  in  the  diaphragm  the  carbon 
dioxide  will  enter  the  thorax  and  produce 
a small  pneumothorax. 

At  surgery  our  patient  demonstrated  a 
7-inch  laceration  of  the  muscular  and  tendi- 
nous portions  of  the  left  hemidiaphragm. 
There  was  a laceration  of  the  spleen.  Part 
of  the  stomach  and  omentum  were  up  in 
the  left  thoracic  cavity.  The  colon  was  in 
its  normal  location. 

Reference: 

Nelson,  James  F.  The  Roentgenologic  Evaluation  ot 

Abdominal  Trauma.  Rad.  Clinics  of  N.  Amer. 

Vol.  4(2)  :415-431.  Aug.  1966. 


Chemical  Discovery 
May  Reduce  Pain 


Certain  types  of  brain  damage  in  ani- 
mals have  been  reversed  by  chemicals  in 
experiments  at  The  University  of  Chicago. 
Under  the  direction  of  John  A.  Harvey, 
Associate  Professor  of  Psychology  and 
Pharmacology,  damage  caused  by  induced 
lesions  in  the  brains  of  rats  has  been  re- 
versed through  stimulation  of  production 
of  serotonin,  a natural  brain  chemical. 

In  his  research  sponsored  by  the  U.S. 
Public  Health  Service,  Harvey  has  created 
small  lesions  in  rat  brains  which  reduced 
the  animals’  tolerance  to  pain.  By  carefully 
studying  the  brains  of  such  rats,  he  found 
the  lesions  had  also  reduced  the  amount 
of  serotonin  in  the  front  of  the  brain.  By 
injecting  a serotonin  precursor,  a chemical 
which  would  induce  the  production  of 


serotonin,  the  rats  returned  to  their  nor- 
mal pain  tolerance  level. 

Harvey  and  his  co-workers  have  also 
given  the  rats  a drug  which  reduces  sero- 
tonin in  the  brain  and  causes  decreased 
tolerance  to  pain.  By  injecting  the  sero- 
tonin precursor  and  inducing  production 
of  the  chemical  in  the  brain,  he  was  able 
to  overcome  this  effect  of  the  drug. 

Although  clinical  application  of  this 
knowledge  to  humans  is  in  the  distant 
future,  Harvey  is  now  testing  his  knowledge 
on  larger  animals.  Perhaps  some  day  it 
will  be  possible  to  inject  humans  with 
chemicals  such  as  the  serotonin  precursor 
to  build  up  thresholds  of  pain,  overcome 
brain  damage  and  guard  against  central 
nervous  system  disease. 


102 


Illinois  Medical  Journal 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  an  effort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  phy- 
sicians, the  Journal  is  publishing  synopses 
submitted  to  the  Physicians  Placement  Serv- 
ice concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  who  know  of  any  out-of-state 
physicians  seeking  an  Illinois  residence  are 
urged  to  notify  the  placement  service. 

Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addition- 
al physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave., 
Chicago  60601. 

CLINTON  COUNTY:  Trenton;  popu- 
lation: 2,200.  Trade  area  7,000.  One  phy- 
sician; second  physician  died  recently;  need 
replacement.  Nearest  hospital  at  Breese,  8 
miles  and  Highland,  11  miles.  St  Louis  35 
miles.  Financial  assistance  can  be  arranged. 
Drive  underway  to  raise  funds  for  a medi- 
cal facility.  Predominant  nationality:  Ger- 
man. Agricultural  and  industrial  area.  Five 
Protestant  and  Catholic  Churches.  Grade 
and  high  schools.  Golf  courses  and  pools 
nearby.  Carlyle  Reservoir,  now  under  con- 
struction, will  result  in  large  increase  in 
population.  For  details  contact  Mr.  Leroy 
Zimmermann,  579  W.  4th  St.,  Trenton. 
Phone  224-7166  or  224-9258. 

DEKALB  COUNTY:  Kirkland;  popula- 
tion: 1,000.  Trade  area,  4,500.  Nearest  doc- 
tor eight  miles.  Nearest  hospitals  at  Bel- 
videre  and  Sycamore  12  and  15  miles.  Near- 
est large  city,  25  miles— Rockford.  One  pre- 
scription drug  store.  Sources  of  income:  ag- 
riculture and  industry.  Churches:  Luther- 
an, Methodist.  Grade  and  high  schools. 
Town  supported  two  physicians  for  many 
years.  Modern  type  medical  building  re- 
cently erected  as  suggested  by  Sears  Foun- 
dation. For  copies  of  economic  survey  made 
by  Sears  and  details  contact  Mr.  Edwin 
L.  Johnson,  500  S,  5th  St.,  Kirkland  60146. 

DOUGLASS-PIATT  COUNTY:  A t - 

wood;  population  1,500.  Trade  area,  4,000. 
Only  physician  died  July,  1965.  Nearest 


physician,  six  miles.  Nearest  hospital  at 
Tuscola,  eight  miles.  Nearest  cities,  De- 
catur, 30  miles,  and  Champaign,  29  miles. 
Office  space  available.  Financial  assistance 
if  desired.  Sources  of  income:  agriculture 
and  industry.  Four  churches;  grade  and 
high  school.  Adequate  recreational  facilities 
within  eight  miles.  For  details  contact:  Mr. 
Vernon  Cordts,  Secretary,  Chamber  of 
Commerce,  Atwood,  phone  3321;  or  George 
Baldridge,  P.O.  Box  22,  Atwood. 

DUPAGE:  Glendale  Heights;  popula- 
tion: 7,440.  Nearest  physicians  at  Glen 
Ellyn  and  Wheaton,  three  or  four  miles. 
Nearest  hospital  at  Winfield.  Two  prescrip- 
tion drug  stores.  Office  space  available  in 
shopping  plaza.  Predominant  nationality: 
Polish  and  Italian.  Churches:  Baptist, 

Catholic,  Faith  Congregational  and  Luth- 
eran. Seven  grade  schools.  High  school  to 
be  built.  Nearby  country  clubs  with  golf 
courses.  Very  fast  growing  area.  For  further 
information  contact:  Mr.  John  Williams, 
23  W.  458  North  Ave.,  Wheaton.  Phone: 
Mo  5-1960. 

EDGAR  COUNTY:  Hume;  population: 
450.  Trade  area:  2,500.  No  resident  physi- 
cian; nearest  at  Chrisman,  Newman,  Paris 
and  Danville,  six  to  40  miles.  Nearest  hos- 
pital at  Paris,  25  miles,  75  beds.  Hume 
Lions  Club  anxious  to  help  a physician 
become  established.  Agricultural  commun- 
ity. Churches:  Catholic,  Methodist,  and 
First  Christian.  Three  miles  to  consolidated 
high  school;  bus  service.  For  further  infor- 
mation contact:  Mr.  Sam  Cohen,  118  Front 
St,,  Hume.  Phone:  70. 

EDGAR  COUNTY:  Paris;  population: 
13,000.  Trade  area,  60,000,  Immediate 
opening  in  Medical  Center  Clinic,  estab- 
lished in  1958;  seven  physicians  in  group, 
including  three  GPs,  internist,  surgeon  and 
radiologist.  Salary  first  year.  Opportunity 
for  partnership  after  5 years.  New  air-con- 
ditioned building  with  lab,  EKG,  X-ray 
and  library  next  door  to  hospital.  Sixteen 
physicians  in  community  including  13  GPs. 
Paris  Hospital  with  75  beds.  New  120  bed 
hospital.  Eighteen  churches,  grade  and  high 
schools.  Eastern  Illinois  University  25  miles 
and  Indiana  State  University  25  miles.  Ex- 
cellent golf  course.  For  details  contact:  J. 
M.  Ingalls,  M.D.  Phone:  5-0514,  Paris. 


for  July,  1968 


103 


TofightTB- 
find  it  first! 


Make  tuberculin  testing  routine 
with  every  physical  examination. 


TUBERCULIN, TINE  TEST 

' (Rosenthal) 

Side  effects  are  possible  but  rare:  vesiculation,  ulceration,  or  necrosis 
at  test  site.  Contraindications:  none,  but  use  with  caution  in  active 
tuberculosis.  Available  in  5's  and  25’s. 


330—8/6135 


1 


ways  Doctor 

you  can  help  achieve 
TOTAL  REHABILITATION 
in  your  handicapped  patients. . 


OPPOR- 
Gover- 
of  the 


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YOUR 
on 


DIRECT  THEM  TO  EMPLOYMENT 
TUNITY — by  referring  them  to  the 
nor’s  Committee  on  Employment 
Handicapped. 

BECOME  AN  ACTIVE  FORCE  FOR 
EMPLOYMENT  OPPORTUNITY  IN 
COMMUNITY:  Join  your  Local  Council 
Employment  of  the  Handicapped. 

For  complete  information  write  . . . 
Louis  A.  Sabella 

Executive  Dir.— Governor’s  Committee 
on  Employment  of  the  Handicapped 
Frank  J.  Jirka,  M.D.,  Chairman 
188  W.  Randolph  St.  / Chicago,  III.  60601 
(AC  312)  372-3437 


Surgical  Grand  Rounds 

(Continued  from  page  56) 

centric  or  irregular,  as  Dr.  Shields  has  men- 
tioned, with  a thickened  irregular  edge, 
one  must  wonder  i£  the  abscess  was  pre- 
faced by  a malignant  process  rather  than 
infection. 

Dr.  Thomas  Shields:  I might  add  that 
there  are  two  other  conditions  that  may  re- 
sult in  abscess  formation.  One  is  Klebsiel- 
la pneumonia  which  causes  gangrene  of  the 
involved  lobe  which  will  evacuate  as  an  ab- 
scess. And  then  lastly  we  must  consider  the 
staphlococcic  abscesses  that  are  encount- 
ered in  the  young  child  and  the  debilitated 
adult.  These  result  probably  on  an  embolic 
basis  from  bacteremia  in  these  ill  patients. 
In  patients  which  the  staphlococcic 
abscess  or  where  abscesses  are  primary  the 
cure  rate  is  relatively  good.  When  they  are 
associated  with  severe  disease  such  as  neph- 
ritis, leukemia,  etc.  the  outlook  is  very  dim. 
As  far  as  the  etiology  in  the  patient  under 
discussion,  I believe  it  was  probably  a 
chronic  pneumonia  that  became  necrotic 
and  evacuated  and  then  filled  in  with  in- 
spissated material. 


Rehabilitation  Film  Available 

Filmed  at  the  Rehabilitation  Institute 
of  Montreal  (Canada),  “One  Step  at  a 
Time”  depicts  an  amputee’s  experiences  as 
he  accustoms  himself  to  an  artificial  leg 
and  learns  to  use  it  efficiently.  Consecutive 
steps  in  the  process  are  shown:  the  initial 
fitting  and  use  of  a practice  leg,  the  first 
session  with  the  parallel  bars,  the  learning 
to  walk  without  support,  the  first  fall,  the 
mastery  of  self-confidence,  rhythm,  and 
balance.  The  film  also  provides  a back- 
ground to  the  prosthetist’s  craft  of  designing 
and  creating  a limb  as  well  as  an  insight 
into  the  thoughts  and  emotions  of  the  pa- 
tients through  the  period  of  fitting,  ther- 
apy, temporary  defeats,  and  final  victory. 
“One  Step  at  a Time”  will  be  of  particular 
interest  to  professional  programs  in  reha- 
bilitation and  therapy,  and  to  adult  educa- 
tion and  community  groups.  It  is  16  mm., 
black  and  white,  running  time  18  minutes, 
and  may  be  purchased  for  $85  or  rented 
for  $5  from  International  Film  Bureau, 
Inc.,  332  S.  Michigan  Ave.,  Chicago  60604. 


104 


Illinois  Medical  Journal 


COMMITTEE  ON  CANCER  CONTROL 


Dr.  Thomas  Sellett,  chairman  o£  the 
Illinois  State  Medical  Society  Committee 
On  Cancer  Control,  believes  committees 
carry  responsibilities  to  the  membership 
and  should  attempt  to  discharge  them.  He 
is  specifically  concerned  about  the  unavail- 
ability in  many  sections  of  the  state  of 
expertise  in  the  different  disciplines  which 
are  necessary  for  the  most  effective  treat- 
ment of  cancer  patients.  Having  heard  that 
a planning  grant  under  the  Heart  Disease, 
Cancer  and  Stroke  Law  (89-239)  had  been 
awarded  Illinois  he  decided  to  call  a meet- 
ing of  his  committee  and  to  request  Dr. 
Wright  Adams  who  heads  the  Heart,  Stroke 
and  Cancer  Program  for  Illinois  to  meet 
with  them. 

The  meeting  was  quite  productive  in  that 
it  disclosed  the  extent  of  confusion  and  lack 
of  positive  information  that  now  exists.  No 
one  is  sure  to  what  extent  the  “Compre- 
hensive Planning  Law”  supersedes  or  com- 
plements the  Heart,  Stroke  and  Cancer 
Law.  Dr.  Adams,  noted  for  his  analytical 
ability,  although  not  sure  of  all  the  ramifi- 
cations of  the  Heart,  Stroke  and  Cancer 
Law,  stated  he  would  welcome  grant  appli- 
cations. Plans  for  demographic  studies  and 
for  medical  care  distribution  arrangements 
would  probably  be  accepted  by  the  govern- 
ment. Studies  in  the  basic  sciences  are  not 
acceptable. 

The  report  to  the  President  by  the  Presi- 
dent’s Committee  On  Heart  Disease,  Cancer 
and  Stroke  published  in  December,  1964, 
was  entitled  “A  NATIONAL  PROGRAM 
TO  CONQUER  HEART  DISEASE, 
CANCER  AND  STROKE.”  This  report 


requested  about  two  billion  dollars  to 
finance  the  program  for  three  years.  Not 
only  diseases  in  the  above  categories  were 
to  be  attacked,  but  any  disease  the  Secretary 
of  HEW  thought  advisable.  When  the  bill 
(89-239)  was  passed  it  provided  for  three 
hundred  million  dollars  and  limited  the 
authority  to  heart  disease,  cancer  and  stroke 
and  “related”  diseases.  The  plan  was  to 
formulate  research  and  teaching  groups, 
co-ordinating  the  facilities  in  a “region”  and 
with  everyone  working  together.  The 
medical  schools  were  to  take  a leading  part 
in  organizing  these  regional  programs. 

Somehow  this  program  seems  not  to  have 
gotten  off  the  ground.  The  schools,  hospitals 
and  practicing  physicians  apparently  have 
backed  away  from  it.  Throughout  the 
Nation  there  are  five  Regional  Medical  Pro- 
grams now  in  the  experimental  stage,  but 
none  are  located  in  Illinois.  Through  this 
law  fifty  million  dollars  was  spent  in  1966 
and  the  same  in  1967.  It  is  anticipated  that 
in  1968  one  hundred  million  dollars  will 
be  available. 

Dr.  Sellett  would  like  to  have  available 
in  every  cancer  patient’s  immediate 
geographic  area,  expert  surgery,  irradiation 
therapy,  chemotherapy  and  isotope  therapy. 
If  any  reader  can  think  of  a way  in  which 
this  may  be  accomplished  he  probably  could 
get  a grant  through  the  Heart,  Stroke  and 
Cancer  Law  to  investigate  his  plan.  Anyone 
who  has  such  an  idea  may  apply  to  Dr. 
Wright  Adams,  Executive  Director  of  the 
Illinois  Regional  Medical  Program,  122 
S.  Michigan  Ave.,  Chicago,  111. 

J.  Ernest  Breed,  M.D. 


§ PLEASE  PRINT 


lAP  MEMBERSHIP 

APPLICATION  FORM 


NAME 


ADDRESS 


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Please  return  this  application  | 
form  to  the  executive  office  | 
of  your  professional  society,  j 
along  with  your  check  for  $1  0 | 
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SOCIATION  OF  THE  PROFES-  | 
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member  In  good  standing  of  our  state  professional 
association.  Ex.  Dir.  Initials 


for  July,  1968 


105 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1968 

SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  1,  August  12 
SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  Part  1,  Sept. 
9 & 16. 

SPECIALTY  REVIEW  COURSE  IN  THORACIC  SURGERY, 
Sept.  16 

PATHOLOGY  REVIEW  COURSES  FOR  SPECIALTIES,  Re- 
quest Dates 

SURGERY  OF  HEAD  AND  NECK,  One  Week,  September  16 
SURGERY  OF  THE  HAND,  One  Week,  September  16 
PEDIATRIC  SURGERY,  One  Week,  September  30 
PROCTOSCOPY  & VARICOSE  VEINS,  One  Week,  September  9 
FIBEROPTIC  CULDOSCOPY  & PELVIC  PERITONEOSCOPY, 
Sept.  10 

SURGICAL  & RADIATION  Rx  OF  GYN.  MALIGNANCIES,  Sept.  9 
ADVANCES  IN  GYNECOLOGY  & OBSTETRICS,  One  Week, 
Sept.  16 

VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Sept. 
23 

DIAGNOSTIC  RADIOLOGY,  One  Week,  September  16 
RADIOISOTOPES,  One  or  Two  Weeks,  First  Monday  Each 
Month 

BASIC  ELECTROCARDIOGRAPHY,  One  Week,  October  7 
ANESTHESIA,  Inhalation,  Endotrachael,  Regional,  Request 
Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request. 

TEACHING  FACULTY 
Attending  Staff  of 
Cook  County  Hospital 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


TofightTB- 
find  it  first! 


Make  tuberculin  testing  routine 
with  every  physical  examination. 


TUBERCULIN.TINETEST 


* (Rosenthal) 

Side  effects  are  possible  but  rare;  vesiculation,  ulceration,  or  necrosis 
at  test  site.  Contraindications:  none,  but  use  with  caution  in  active 
tuberculosis.  Available  in  5’s  and  25’s. 


330-8/6135 


MEETING  MEMOS 

July  20-Aug.  10  —A  non-credit  laboratory 
course  in  basic  electronics  and  instrumen- 
tation techniques  will  be  given  at  the  Poly- 
technic Institute  of  Brooklyn.  This  is  a 
new  course  in  research  instrumentation. 

Aug.  2— Sponsored  by  the  Illinois  State 
Medical  Society,  the  Illinois  High  School 
Coaches  Ass’n.,  and  the  Univ.  of  Illinois 
Athletic  Association,  the  Fourth  Annual 
Athletic  Injury  Clinic  will  be  held  at  the 
Chicago  Circle  Campus  of  the  Univ.  of 
Illinois.  This  is  open  to  all  interested  par- 
ties, and  physicians  are  urged  to  attend 
and  participate.  They  are  also  urged  to 
have  their  school  coaches  attend. 

Aug.  8-10  —A  Seminar  and  Workshop  in 
techniques  of  Diagnostic  Ultrasonics  will 
be  held  in  Vail,  Colo.  Attendance  will  be 
limited  and  there  is  a fee  of  $60.  For  in- 
formation address  P.O.  Box  6222,  Denver, 
Colo.  80206. 

Aug.  15-17— Big  Sky  Medical  Pow  Wow, 
Great  Falls,  Mont.  A high  quality  sym- 
posium with  internationally  known  speak- 
ers. There  will  also  be  social  activities, 
trips,  and  a football  game.  Ten  significant 
medical  topics  will  be  discussed. 

Aug.  19— American  Medical  Writers  Ass’n. 
meeting,  Drake  Hotel,  Chicago.  Speaker: 
Jacqueline  Seavar,  free-lance  writer,  on 
“Jolly  White  Giants.” 


Hospital  Utilization 

(Continued  from  page  51) 

3.  Garrett,  Robert  Y.,  Jr.:  1)  Come,  Let  Us  Rea- 
son Together  Address,  April  1967;  2)  Hospital 
with  a Seven-day  Week,  Medical  Economics, 
June  28,  1965;  3)  Speech  before  the  Institute 
of  Nursing  Service,  Administration  of  the 
American  Hosp.  Association;  4)  Seven-Day 
Work  Week  Improves  Service,  Modern  Hospi- 
tal 103:  No.  5,  114,  Nov.  1964;  5)  Six-Day  Serv- 
ice Makes  Money  and  Sense,  Modern  Hospital, 
99:  No.  6,  89.  Dec.  1962. 

4.  Gluckman,  Earl  C.:  Operating  a Hospital 
Seven  Days  a Week,  Resident  Physician.  9:53, 
Jan.  1963. 

5.  Haas,  Ferdinand:  Shifting  to  a Seven-Day 

Week,  Hospitals  J.A.H.A.  40:59,  Mar.  1,  1966. 

6.  Hill,  M.  E.:  Hospital  Topics  41:  42.  Sept.  1963. 

7.  Mulvihill,  Sister  M.  Crescentia:  Seven-Day 
Schedule  Breaks  Weekend  Jam,  Modern  Hos- 
pital, 107:134,  1966. 

8.  Rauffenbart,  Mary:  Cooper  Hospital’s  Seven- 
Day  Week,  American  I.  Nursing  Vol.  63,  No. 
XII,  1963. 


106 


Illinois  Medical  Journal 


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for  July  1968 


107 


1 


Does  The 

Psychiatric  Hospital 
Serve  Medicine? 

Some  treatment  facilities  seem  to  pro- 
vide an  unusual  measure  of  aid  and  com- 
fort to  other  disciplines,  with  the  doctor's 
role  apparently  subsumed  in  a kind  of 
miscellany  of  therapeutic  activity. 

This  is  not  the  case  at  North  Shore 
Hospital,  In  policy  and  in  practice,  the 
doctor  creates  the  program  and  treatment 
regime,  drawing  upon  relevant  aspects  of 
the  existing  milieu  to  structure  his  pa- 
tient's day. 

While  obviously  beneficial  and  entirely 
necessary  in  patient  management,  the 
therapeutic  environment  must  be  astutely 
scaled  to  specific  patient  needs,  as  inter- 
preted by  the  attending  physician. 

Patients  referred  to  the  hospital  by  the 
general  practitioner  and  other  medical 
specialists  are  cared  for  by  the  hospital's 
own  psychiatric  staff  which,  at  the  same 
time,  provides  continuity  of  care  for  all 
patients. 

Hospital  administration  and  medical 
responsibility  are  under  one  and  the  same 
person  at  this  hospital:  the  superinten- 
dent and  psychiatrist-in-chief.  Conse- 
quently, patient  welfare,  and  nothing  else, 
defines  hospital  organization  and  the 
therapeutic  programs. 

The  private  psychiatric  facility,  as  com- 
pared to  other  institutions  and  units  of 
care,  remains  especially  suited  to  the 
treatment  of  a wide  range  of  mental  dis- 
ease entities.  This  is  true  in  those  in- 
stances where  the  patient  is  ambulatory, 
in  need  of  relative  freedom,  and  where 
an  appropriate  diversity  of  activity  is  in- 
dicated. Those  conditions  of  daily  living, 
in  other  words,  which  are  required  for 
the  therapeutic  rehearsal  of  recovery  are 
uniquely  available  in  such  a hospital. 

The  remotivation  programs  for  the 
medicare  patients,  the  class  rooms  for  the 
adolescents,  the  patient  library,  the  out- 
door and  indoor  games  and  parties,  all 
of  these  professionally  organized  activities 
make  up  the  hospital  day— but  again  with 
sharp  medical  emphasis.  Through  weekly 
stallings,  written  orders,  and  discussions 
with  staff  the  doctor  remains  entirely  in 
command. 

The  hospital,  in  fulfilling  its  medical 
commitments,  stands  ready  to  offer  con- 
sultation on  office  and  home  emergencies. 
In  short,  it  is  here  (in  a strikingly  beau- 
tiful section  of  the  North  Shore)  to  serve 
doctors  by  keeping  faith  with  the  profes- 
sion of  medicine. 

Telephone  or  write  to  Charles  H. 
Jones,  MD— Superintendent  and  Psychia- 
trist-in-Chief,  North  Shore  Hospital,  225 
Sheridan  Road,  Winnetka,  Illinois  60093 
—Telephone  (312)  446-8440. 


FOURTH  ANNUAL 
ATHLETICINJURY  CLINIC 

sopnsored  b)^ 

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Coaches  Association 

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Athletic  Association 

Illinois  State  Medical 
Society 

fRIDAY 

AUGUST  2,  ms 

at  the 

University  of  Illinois 
Chicago  Circle  Campus 

No  Registration  Fee 

Staff  of  23 

Open  to  Athletic  Directors,  Coaches, 
Physicians,  Therapists,  Trainers 

Betamethasone  17- Valerate 

(Continued  from  page  6$) 

2.  Coburn,  J.  G.:  A comparison  of  0.1%  betame- 
thasone 17-valerate  and  0.1%  fluocinolone  ace- 
tonide  in  the  treatment  of  psoriasis,  Brit.,  J. 
Derm.  77:590-592  (Nov.)  1965. 

3.  Ross,  C.  M.:  Local  steriods  under  polythene  in 
the  treatment  of  skin  diseases.  Double-blind 
trials  in  subtropical  conditions.  South  African 
M.J.  40:23-27  (Jan.  8)  1966. 

4.  Williams,  D.  I.,  et  al.:  Betamethasone  17-val- 
erate: A new  topical  corticosteroid.  Lancet  1: 
1177-1179  (May  30)  1964. 

5.  Zimmerman.  E.  H.:  Betamethasone  17-valerate: 
A custom  made  topical  corticosteroid,  A.M.A. 
Arch.  Derm.  P5:514-519  (May)  1967. 


108 


Illinois  Medical  Journal 


BLUE  SHIELD 


JvA 

_i\aLI 

FOR 


PUBLISHED  MONTHLY  BY:  BLUE  SHIELD  PLAN  OF  ILLINOIS  MEDICAL  SERVICE  • 425  NORTH  MICHIGAN  AVENUE  • CHICAGO.  ILLINOIS  60690 


Vol.  2,  No.  8 


August,  1968 


Blue  Cross  65-Blue  Shield  65 
In  Effect 

Our  new  Blue  Cross-Blue  Shield  plan  for  individ- 
uals over  65  became  effective  May  1, 1968.  We  have 
been  converting  members  from  our  Series  65  Major 
Medical  to  the  superior  new  Blue  Cross-Blue  Shield 
plan. 

During  the  month  of  July  we  continued  with  our 
campaign  to  convert  our  Group  65  members  to  the 
new  program  and  to  enroll  new  members  from  the 
community  who  heretofore  had  not  been  protected 
by  Blue  Cross-Blue  Shield. 

When  you  or  your  medical  assistant  see  your  pa- 
tient’s Blue  Cross-Blue  Shield  identification  card 
with  the  notation  “Blue  Cross  65-Blue  Shield  65” 
reproduced  below, 


k-mmm  '<> 

“at -■  :v  ; 


SMITH  JOHN 


23456-7890 


6e  8-16-68  6e  8-16-68 

BLUE  CROSS  65-BLUE  SHIELD  65 


J 


the  recommended  procedure  to  follow  is  the  same 
as  you  would  when  filing  a Blue  Shield  claim  for 
all  other  members  by  submitting  Blue  Shield’s 
regular  Physician’s  Service  Report  form.  Please  in- 
dicate the  service  you  performed,  your  fee  for  that 
service,  and  the  date  you  performed  the  service. 
We  will  pay  directly  to  you  our  proportion  of 
charges  not  paid  by  Medicare. 

\\dien  you  have  a patient  in  the  hospital.  Blue 
Cross  and  Blue  Shield  provides  the  kind  of  prac- 
tical protection  needed  to  fill  the  gaps  not  covered 
under  Medicare. 


BLUE  SHIELD  65 

• Pays  20%  of  physicians’  Usual  and  Customary 
fees  for  services  in  the  hospital 

• Blue  Shield  65  also  pays  20%  of  physicians’ 
Usual  and  Customary  fees  for  minor  surgery  or 
accident  care  in  the  outpatient  department  of  a 
hospital 

• Pays  20%  of  physicians’  Usual  and  Customary 
fees  for  radiation  therapy  when  a hospital  out- 
patient or  when  receiving  treatment  in  a physician’s 
ojffice  . . . including  X-ray  therapy,  radium  therapy 
or  radioisotope  therapy  for  cancer 

• Pays  20%  of  physicians’  Usual  and  Customary 
fees  for  visits  in  an  Extended  Care  Facility  while 
receiving  Medicare  benefits 

• In  foreign  countries.  Blue  Shield  65  will  pay 
up  to  $300  in  any  calendar  year  for  the  same  kind 
of  physician’s  services  this  program  provides  in  the 
United  States 

BLUE  CROSS  65 

• Pays  in  full  first  $40  of  hospital  charges  per 
benefit  period  when  a bed  patient  in  the  hospital 

• Pays  $10  per  day  of  hospital  charges  during 
a hospital  stay  from  the  61st  through  the  90th  day 

• Pays  $20  per  day  from  the  91st  through  the 
820th  day  in  each  benefit  period  if  hospital  bed 
care  is  required 

• Pays  $5  a day  from  the  21st  through  the  100th 
day  of  care  in  an  approved  Extended  Care  Facility 

• Outside  of  the  U.S.A.  . . . Medicare  usually 
does  not  provide  any  benefits  . . . this  new  Blue 
Cross  65  Plan  pays  as  much  as  $10  a day  for  as 
long  as  820  days  . . . when  a bed  patient  in  the 
hospital 


LET  US  HELP 

For  assistance  in  matters  pertaining  to  Blue 
Shield  or  Medicare,  contact  one  of  our  Special 
Representatives  in  our  Professional  Relations  De- 
partment, MO  4-7100  extension  235,  Blue  Shield 
Plan  of  Illinois  Medical  Service,  425  North  Mich- 
igan Avenue,  Chicago  60601. 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 


• • • ABOUT  MEDICARE 


NOTICE 

To  help  speed  Medicare  payments,  physicians 
in  the  counties  of  - Cook,  DuPage,  Kane,  Lake 
and  Will  may  obtain  a supply  of  SSA  1490  Re- 
quest for  Payment  forms  with  their  name  im- 
printed on  them  by  writing  to  Government  Con- 
tracts Division,  Blue  Cross-Blue  Shield,  300 
North  State  Street,  Chicago,  Illinois  60690. 


MEDICARE  STATISTICAL  HIGHLIGHTS—  July  1,  1966— June  30,  7968' 

iData  for  June  1968 — estimated 


Enrollment  July  7,  7968 

A.  Hospital  Insurance  (Part  A)  19.7  million 

B.  Supplementary  Medical  Insurance  (Part  B)  18.6  million 


Hospital  and  Extended  Care  Facility  Admissions  and  Plans 
For  Home  Health  Services  (July  7966 — June  7968) 


A.  Inpatient  Hospital  Admissions  10.6  million 

B.  Extended  Care  Facilities  Admissions  640,000 

C.  Start  of  Home  Health  Services  485,000 


Medicare  Bills  Paid  (July  7966 — -June  7968) 

A.  Inpatient  Hospital  

B.  Outpatient  Hospital 

C.  Home  Health  Services  

D.  Extended  Care  Facilities 

E.  Physicians’,  Independent  Laboratories  and  Other  Medical  Services 

Benefits  Paid  (July  7966 — June  7968) 


A.  Hospital  Insurance  (Part  A)  $6.3  billion 

B.  Supplementary  Medical  Insurance  (Part  B)  $2.1  billion 


Participating  Providers  of  Services  (As  of 
June  30,  7968) 

A.  Hospitals  

B.  Home  Health  Agencies 

C.  Extended  Care  Facilities  

D.  Independent  Laboratories  

Intermediaries  and  Carriers 

A.  Hospital  Insurance — Blue  Cross  Association 

Commercials  

Independent  

State  Agency  

Other  

B.  Medical  Insurance — Blue  Shield  

Commercials  

Independent  

State  Welfare  Department 

C.  Group  Practice  Prepayment  Plans — Direct  Dealing 

Carrier  Dealing 

(This  is  not  an  advertisement) 


1 (involving  74  plans) 
5 
4 
1 
1 

33 

15 

1 

1 

23 

42 


Beds 

6,900  (1,160,000) 
2,100 

4,700  ( 325,000) 
2,550 


10.6  million 

4.2  million 
1.4  million 

1.3  million 
45.0  million 


In  cystitis 

Rx 

NegGram 

brand  of 

nalidixic  acid 


Aggressive, 
well-tolerated, 
oral  therapy 
for  most  gram-negative 
urinary  tract  infections 


SUMMARY  OF  PRESCRIBING  INFORMATION 
INDICATIONS:  Urinary  tract  Infections  in  which  species  of  sensi- 
tive gram-negative  bacteria  are  predominant,  particuiarty  Pro- 
teus, Escherichia  coH,  Aerobacter,  Klebsiella,  and  certain  strains 
of  Pseudomonas.  Gram-positive  bacteria  are  less  sensitive  to 
NegGram  but  favorable  clinical  results  have  been  observed. 
WARNING:  Use  in  Pregnancy.  This  drug  is  not  recommended  in 
the  first  trimester  of  pregnancy.  However,  it  has  been  used  in 
several  patients  during  the  last  two  trimesters  without  producing 
apparent  ill  effects  in  either  mother  or  fetus. 

PRECAUTIONS:  Although  prolonged  treatment  with  NegGram 

’ has  been  generally  well  tolerated,  as  with  all  new  drugs  it  is 
advisable  to  carry  out  blood,  renal,  and  liver  function  tests 
periodically  if  treatment  is  continued  for  more  than  one  or  two 
weeks.  The  dosage  recommended  for  adults  and  children  should 
not  be  arbitrarily  doubled  unless  under  the  careful  supervision 
of  a physician. 

It  should  be  used  with  caution  in  patients  with  liver  disease, 
epilepsy,  or  severe  cerebral  arteriosclerosis,  and  in  patients  in 
whom  kidney  function  is  severely  impaired. 

Patients  should  be  cautioned  to  avoid  unnecessary  exposure  to 
direct  sunlight  white  receiving’ NegGram  and,  if  a photosensi- 
tivity reaction  occurs,  therapy  should  be  discontinued. 

During  treatment,  microorganisms  may  develop  resistance  to 
this  drug.  Resistant  bacteria,  not  previously  present  or  identi- 
fied, may  emerge.  Cultures  should  be  taken  and  bacterial  sensi- 
tivity tests  made  periodically,  particularly  if  the  clinical  response 
is  unsatisfactory  or  if  a relapse  occurs. 

Should  resistance  develop,  other  specific  chemotherapy  should 
be  instituted;  no  cross  resistance  has  been  observed,  if  new 
strains  of  bacteria  that  are  not  sensitive  emerge,  other  effective 

' antibacterial  agents  may  be  added. 

i When  Benedict's  or  Fehling’s  solutions  or  Clinitest®  Reagent 
Tablets  are  used  to  test  the  urine  of  patients  taking  NegGram, 
a false-positive  reaction  for  glucose  may  be  obtained  due  to  the 
liberation  of  glucuronic  acid  from  the  metabolites  excreted.  How- 
ever, a colorimetric  test  for  glucose  based  on  an  enzyme  reaction 
(using,  for  example,  Clinistix®  Reagent  Strips  or  Tes-Tape@) 
does  not  give  a false-positive  reaction  to  NegGram  giucuronide, 

L 


ADVERSE  REACTIONS;  Mainly  mild  nausea,  vomiting,  and  other 
gastrointestinal  disturbances;  less  frequently,  sleepiness,  drows- 
iness, weakness,  headache,  dizziness  and  vertigo,  and  rarely 
cholestasis,  paresthesia,  thrombocytopenia,  leukopenia,  or  hemo- 
lytic anemia  which  in  some  patients  may  have  been  associated 
with  a deficiency  in  activity  of  giucose-6-phosphate  dehydro- 
genase. Itching,  pruritus,  rash,  urticaria,  mild  eosinophilia, 
reversible  photosensitivity  reactions  primarily  involving  exposed 
surfaces,  and  reversible  subjective  visual  disturbances  (over- 
brightness of  lights,  change  in  visual  color  perception,  difficulty 
in  focusing,  decrease  in  visual  acuity  and  double  vision),  oc- 
curred occasionally.  Reversible  increased  intracranial  pressure 
with  bulging  anterior  fontanel,  papilledema,  and  headache  has 
been  observed  occasionally  in  infants  and  children.  Toxic  psy- 
chosis and  brief  convulsions  (the  latter  generally  in  patients 
with  possible  predisposing  factors,  and  both  usually  associated 
with  excessive  dosage)  have  been  recorded  in  rare  instances. 

DOSAGE  AND  ADMINISTRATION:  Adults-Four  Gm.  daily  by  mouth 
(2  Caplets®  of  500  mg.  four  times  daily)  for  one  to  two  weeks. 
Thereafter,  if  prolonged  treatment  is  indicated,  the  dosage  may 
be  reduced  to  two  Gm.  daily  (1  Caplet  of  500  mg.  four  times  daily). 
Children— According  to  age  and  weight:  approximately  25  mg.  per 
pound  of  body  weight  per  day,  administer^  in  divided  doses. 

Note:  The  dosage  recommended  above  for  adults  and  children 
should  not  arbitrarily  be  doubled  unless  under  the  careful  super- 
vision of  a physician.  Until  further  experience  is  gained,  infants 
under  1 month  should  not  be  treated  with  the  drug. 

HOW  SUPPLIED: 

• For  adults  — Buff-colored,  scored  Caplets  of  500  mg.,  conve- 
niently available  in  bottles  of  56  (sufficient  for  one  full  week  of 
therapy)  and  in  bottles  of  500  and  1000. 

• For  children  — Caplets  of  250  mg.,  available  in  bottles  of  56  and 
1000. 

Before  prescribing,  please  refer  to  complete  prescribing  informa- 
tion.   

yy/nfhrop 

Winthrop  Laboratories  New  York,  N.Y,  10016 


Practice  of  Medicine  in  Hospitals 


John  C.  Watson,  Director  of  the  Illinois 
Department  of  Registration  and  Education, 
has  reissued  an  opinion  of  his  department 
concerning  the  unlicensed  practice  of  medi- 
cine. In  light  of  recent  disclosures  of  un- 
licensed personnel  engaging  in  the  practice 
of  medicine  in  association  with  physicians 
in  private  practice  as  well  as  hospital  prac- 
tice, the  Journal  is  publishing  this  for  the 
benefit  of  members  of  the  ISMS.  The  pro- 
hibitions against  professional  connection  or 
association  with  another  who  is  illegally 
practicing  medicine  apply  to  physicians  in 
private  practice  as  well  as  those  in  hospital 
or  group  practice. 

Under  the  provisions  of  the  Illinois 
Medical  Practice  Act,  in  addition  to  a duly 
licensed  physician,  there  are  only  three 
classes  of  individuals  who  may  lawfully 
practice  medicine  in  a hospital: 

1.  The  holder  of  a Temporary  Certificate 
of  Registration 

2.  The  holder  of  a state  hospital  permit 

3.  An  intern  in  an  approved  internship 
program 

Temporary  Certificate  of  Registration 

A Temporary  Certificate  of  Registration 
is  issued  to  a person  who  is  licensed  to 
practice  medicine  in  another  state  and  who 
wishes  to  pursue  a program  of  graduate 
or  specialty  training  in  this  State  in  a hos- 
pital which  is  approved  by  the  Department 
of  Registration  and  Education  for  the  pur- 
pose of  such  training.  This  refers  to  a pro- 
gram of  specialty  or  residency  training 
which  is  approved  by  the  Department.  The 
holder  of  a Temporary  Certificate  of  Regis- 
tration is  entitled  thereby  to  perform  such 
acts  as  may  be  prescribed  by  and  incidental 
to  his  program  of  residency  training  in  such 
hospital.  He  is  not  entitled  to  otherwise 
engage  in  the  practice  of  medicine  in  this 
State. 

State  Hospital  Permit 

A state  hospital  permit  is  issued  in  the 
discretion  of  the  Department  to  a person 
who  is  a graduate  of  a medical  school  ap- 
proved by  the  Department  of  Registration 
and  Education  and  who  has  served  a one- 
year  internship  in  a hospital  approved  by 
the  Department  and  has  been  appointed 


a physician  in  a hospital  maintained  by  the 
State.  Such  state  hospital  permit  entitles  a 
physician  to  practice  medicine  in  all  its 
branches  in  hospitals  or  facilities  main- 
tained by  the  Illinois  Department  of  Men- 
tal Health,  the  Illinois  Department  of  Pub- 
lic Health,  Illinois  Department  of  Children 
and  Eamily  Services  or  affiliated  training 
facilities  where  such  practice  is  conducted 
under  the  authority  of  the  Director  of  the 
Illinois  Department  of  Mental  Health,  the 
Director  of  the  Illinois  Department  of  Pub- 
lic Health,  or  the  Director  of  the  Illinois 
Department  of  Children  and  Family  Serv- 
ices and  under  supervision  of  a physician 
duly  licensed  under  this  Act  to  practice 
medicine  in  all  its  branches. 

Intern 

The  internship  is  that  phase  of  medical 
education  and  training  which  ordinarily 
follows  immediately  upon  the  completion 
of  the  four  year  undergraduate  medical 
curriculum.  It  consists  of  the  supervised 
practice  of  medicine  in  a hospital  approved 
by  the  Department  for  such  training,  with 
continued  instruction  in  the  science  and 
art  of  medicine  by  the  hospital  staff. 

ECFMG  Requirements 

The  Education  Council  for  Foreign 
Medical  Graduates  (ECFMG)  commenced 
operations  in  October,  1957.  Sponsors  of 
this  agency  are  the  American  Hospital  As- 
sociation, American  Medical  Association, 
Association  of  American  Medical  Colleges, 
and  Federation  of  State  Medical  Boards  of 
the  United  States.  ECFMG  gives  two  ex- 
aminations a year  to  foreign  medical  gradu- 
ates. The  examinations  test  the  graduate’s 
general  knowledge  of  medicine  and  com- 
mand of  English. 

Persons  successfully  passing  this  examina- 
tion are  granted  an  ECFMG  certificate. 
This  certificate  in  the  State  of  Illinois  is 
not  a substitute  for  nor  is  it  the  equivalent 
of  licensure  to  practice  medicine.  It  simply 
indicates  that  the  holder’s  command  of 
English  has  been  tested  and  found  adequate 
for  assuming  an  internship  in  an  Ameri- 
can hospital.  The  holder  of  such  a certifi- 

(Continued  on  page  206) 


il8 


Illinois  Medical  Journal 


Until  now,  you  may  have  thought  professional  investment  advisory  services 
were  strictly  “milUon  dollar”  affairs.  Until  now,  that  was  roughly  true. 

But  now.  Continental  Bank  offers  the  services  of  our  top  professional  invest- 
ment management  staff  to  Illinois  residents  for  accounts  of  $20,000  or  more.  This 
is  the  very  same  staff  that  manages  our  many  million-dollar  trust  funds. 

These  men  base  their  investment  decisions  on  exhaustive  research.  A team  of 
specialists  uses  sophisticated  computer  programming  to  further  define  our  job  of 
investing  your  money. 

You  can  select  one  of  two  investment  portfolio  options.  One  is  geared  to  long 
term  capital  growth.  The  other  is  designed  for  optimum  current  income  with 
reasonable  potential  market  appreciation. 

Continental  Capital  Investment  Service 

We  call  this  investment  program  the  Continental  Capital  Investment  Service 
(C.C.I.S.).  Here’s  how  it  works: 

First,  we’ll  assist  you  in  opening  an  account  with  a leading  brokerage  firm.  Our 
staff  will  then  purchase  for  your  portfolio  a list  of  stocks  that  our  analysts  recom- 
mend most  highly  for  C.C.I.S. 

Semi-annual  Statements 

We  will  sell  and  re-invest  as  indicated  by  research,  without  your  having  to 
become  involved  in  the  intricacies  of  the  market.  The  brokerage  firm  will  notify  you 
of  every  transaction  that  has  been  made,  and  we  will  give  you  a semi-annual  state- 
ment on  the  status  of  your  account. 

Keep  in  mind,  Continental  Bank  knows  a great  deal  about  investments.  In 
111  years  we  have  given  financial  counsel  to  an  impressive  list  of  individuals  and 
corporations.  And  in  the  process,  our  financial  talents  have  grown  enormously. 
May  we  put  this  talent  to  work  for  you? 

If  your  investment  goals  are  long  term  growth  or  for  maximum  current  in- 
come, fill  in  our  coupon  or  call  us  at  312-828-3593  for  complete  details. 

It’s  what  you’d  expect  from 
the  biggest  bank  in  Chicago. 

Continental  Bank 


[~  Continental  Bank 
Chicago,  Illinois  60690 

I Attention  Trust  Department: 

I Please  send  me  information  on  your  new  Continental  Capital  Investment  Service.  Limited 
I to  residents  of  Illinois. 

I My  investment  goal  is : □ long  term  growth  □ current  income 


Name 

Address. 
1^  City 


-Telephone  number. 


State. 


.Zip  Code. 


J 


Continental  Illinois  National  Bank  and  Trust  Company  of  Chicago. 
231  South  LaSalle  Street,  Chicago,  Illinois  60690.  Member  F.D.I.C. 


for  August,  1968 


121 


NEW 

PHARMACEUTICAL 

SPECIALTIES 

by  Paul  deHaen 


For  detailed  information  regarding  indications, 
dosage,  contraindications,  and  adverse  reactions, 
refer  to  the  manufacturer’s  package  insert  or 
brochure. 

Single  Chemicals — Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products — Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products — Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms — Of  a previously  introduced 
product. 

NEW  SINGLE  CHEMICALS 

RhoGAM  Biological  R 

Manufacturer:  Ortho  Diagnostics 
Nonproprietary  Name:  Rho(D)  Immune  Globu- 
lin (Human) 

Indications:  Prevention  of  formation  of  active 
antibodies  in  the  Rh  negative  mother  who  has 
delivered  an  Rh  positive  infant. 
Contraindications:  Rho(D)  positive  or  D»^  posi- 
tive individual,  Rho(D)  negative  patient  who 
has  received  an  Rho(D)  positive  blood  trans- 
fusion, existing  immunization  to  the  Rho(D) 
blood  factor. 

Dosage:  One  vial,  i.m.,  within  72  hrs.  after  de- 
livery or  miscarriage. 

Supplied:  Vials — ^packages  of  1. 

VERACILLIN  Antibiotic-  Penicillin  R 

Nonproprietary  Name:  Sodium  Dicloxacillin 

Monohydrate 

Indications:  Infections  due  to  penicillinase -pro- 
ducing staphylococci,  streptococci,  pneumococ- 
ci, and  also  penicillin-sensitive  staphylococci. 
Contraindications:  Hypersensitivity  to  penicillin. 
Dosage:  Adults — 125  to  500  mg.  q6h. 

Children — 12.5  to  50  mg./kg./day  in  divided 
doses,  not  to  exceed  recommended  adult 
dosage. 

Supplied:  Capsules — 125  and  250  mg.;  bottles  of 
20  and  100. 

DUPLICATE  SINGLE  PRODUCTS 

PATHOCIL  Antibiotic-Penicillin  R 

Manufacturer:  Wyeth  Laboratories,  Inc. 
Nonproprietary  Name:  Sodium  Dicloxacillin 

Monohydrate 

Indications:  Infections  due  to  penicillinase-pro- 
ducing staphylococci,  streptococci,  pneumococ- 
ci, and  also  penicUlin-sensitive  staphylococci. 
Contraindications:  Hypersensitivity  to  penicillin. 
Dosage:  Adults — 125  to  250  q.i.d. 

Children — 12.5  to  25  mg./kg./day  in  divided 
doses,  if  body  wt.  more  than  40  kg.  follow 
adult  dosage. 

Supplied:  Capsules — 125  and  250  mg.;  bottles  of 
25  and  100.  Powder  for  oral  suspension — 62,5 
mg./5  cc, 

(Continued  on  page  136) 


Preludin  is  indicated  only  as  an 
anorexigenic  agent  in  the  treatment 
of  obesity.  It  may  be  used  in  simple 
obesity  and  in  obesity  complicated 
by  diabetes,  moderate  hypertension 
(see  Precautions),  or  pregnancy 
(see  Warning). 

Contraindications:  Severe  coronary 
artery  disease,  hyperthyroidism, 
severe  hypertension,  nervous  insta- 
bility, and  agitated  prepsychotic 
states.  Do  not  use  with  other  CNS 
stimulants.including  MAO  inhibitors. 
Warning:  Do  not  use  during  the  first 
trimester  of  pregnancy  unless  po- 
tential benefits  outweigh  possible 
risks.  There  have  been  clinical 
reports  of  congenital  malformation, 
but  causal  relationship  has  not  been 
proved.  Animal  teratogenic  studies 
have  been  inconclusive. 
Precautions:  Use  with  caution  in 
moderate  hypertension  and  cardiac 
decompensation.  Cases  involving 
abuse  of  or  dependence  on  phen- 
metrazine  hydrochloride  have  been 
reported.  In  general,  these  cases 
were  characterized  by  excessive 
consumption  of  the  drug  for  its  cen- 
tral stimulant  effect,  and  have 
resulted  in  a psychotic  illness 
manifested  by  restlessness,  mood  or 
behavior  changes,  hallucinations  or 
delusions.  Do  not  exceed  recom- 
mended dosage. 

Adverse  Reactions:  Dryness  or  un- 
pleasant taste  inthe  mouth, urticaria, 
overstimulation,  insomnia,  urinary 
frequency  or  nocturia,  dizziness, 
nausea,  or  headache. 

Dosage:  One  25  mg.  tablet  b.i.d.  or 
t.i.d.  Or  one  75  mg.  Endurets  tablet 
a day,  taken  by  midmorning. 
Availability:  Pink,  square,  scored 
tablets  of  25  mg.  for  b.i.d.  or  t.i.d. 
administration,  in  bottles  of  100  and 
1000. 

Pink,  round  Endurets®  prolonged- 
action  tablets  of  75  mg.  for  once-a- 
day  administration,  in  bottles  of 
100  and  1000. 

Under  license  from 
Boehringer  Ingelheim  G.m.b.H. 

(B)R3-46-560-B 

For  complete  details,  please  see 
full  prescribing  information. 

Preludirr 

phenmetrazine 

hydrochloride 

Geigy  Pharmaceuticals 
Division  of 

Geigy  Chemical  Corporation 
Ardsley,  New  York  10502 


122 


Illinois  Medical  Journal 


You  can  treat  combined 
deficiencies  with 


Trinsicon 

— the  multifactor  hematinic 


Vitamin  B12  plus  intrinsic  factor  (15  meg. 
Bi2  activity) — helps  provide  adequate 
levels  of  this  important  vitamin. 


Folic  acid  (1  mg.) — treats  nutritional 
macrocytic  anemias  and/or  malabsorp- 
tion syndromes. 


Ascorbic  acid  (75  mg.) — augments  the 
conversion  of  folic  acid  to  its  active  form 
and  helps  iron  absorption. 

Iron  (110  mg.) — treats  hypochromic 
anemia. 


clinical  and  laboratory  studies  are  considered  essential  and  are 
recommended. 

Adverse  Reactions:  In  rare  instances,  iron  in  therapeutic  doses 
produces  gastro-intestinal  reactions,  such  as  diarrhea  or  consti- 
pation. Reducing  the  dose  and  administering  it  with  meals  will 
minimize  these  effects. 

In  extremely  rare  instances,  skin  rash  suggesting  allergy  has 
followed  oral  administration  of  liver-stomach  material.  Instances 
of  apparent  allergic  sensitization  have  also  been  reported  after 
oral  administration  of  folic  acid. 

Dosage:  One  Pulvule  twice  a day.  (Two  Pulvules  daily  produce  a 
standard  response  in  the  average  uncomplicated  case  of  perni- 
cious anemia.) 

How  Supplied:  Pulvules  Trinsicon®  (hematinic  concentrate  with 
intrinsic  factor,  Lilly),  in  bottles  of  60  and  500.  [03256e] 


Additional  information 
available  to  physicians 
upon  request. 
Eli  Lilly  and  Company, 
Indianapolis,  Indiana  46206. 

801668 


Editor 

T.  R.  Van  Dellen,  M.D. 

Managing  Editor 
Richard  A.  Ott 

Medical  Progress  Editor 

Harvey  Kravitz^  M.D. 


Jacob  E.  Reisch,  M.D., 

Chairman 

J.  Ernest  Breed,  M.D. 

Editorial 

Edwin  F.  Hirsch,  M.D. 

Chairman 

James  H.  Hutton,  M.D. 

Samuel  A.  Levinson,  M.D. 


Executive  Administrator 

Roger  N.  White 

Business  Manager 
John  A.  Kinney 

Director  of  Business  Services 
Roland  I.  King 

Committee 

Darrell  H.  Trumpe,  M.D. 
Warren  W.  Young,  M.D. 

Board 

Charles  Mrazek,  M.D. 
Clarence  J.  Mueller,  M.D. 
Frederick  Steigmann,  M.D. 
Frederick  Stenn,  M.D. 

Arkell  M.  Vaughn,  M.D. 


ILLINOIS  STATE  MEDICAL  SOCIETY 


360  N.  Michigan  Ave.,  Chicago,  Illinois  60601 


OFFICERS 

Philip  G.  Thomsen,  President 

13826  Lincoln  Avenue,  Dolton,  60419 

Edward  W.  Cannady,  President-Elect 

4601  State  Street,  East  St.  Louis,  62205 

Casper  Epsteen,  1st  Vice-President 
25  E.  Washington  St.,  Chicago,  60602 

Carl  E.  Clark,  2nd  Vice-President 

225  Edward  Street,  Sycamore,  60178 

TRUSTEES 

Frank  J.  Jirka,  Chairman 

1507  Keystone  Ave.,  River  Forest,  60305 

Joseph  L.  Bordenave,  1st  District 

1665  South  Street,  Geneva,  60134 

William  A.  McNichols,  Jr.,  2nd  District 
101  W.  First  Street,  Dixon,  61021 

William  E.  Adams,  3rd  District 

55  E.  Erie  Street,  Chicago,  60611 

J.  Ernest  Breed,  3rd  District 

55  E.  Washington  Street,  Chicago,  60602 

James  B.  Hartney,  3rd  District 

410  Lake  Street,  Oak  Park,  60302 

Frank  J.  Jirka,  3rd  District 

1507  Keystone  Ave.,  River  Forest,  60305 

William  M.  Lees,  3rd  District 
7000  N.  Kenton  Ave.,  Lincolnwood,  60646 

Warren  W.  Young,  3rd  District 

10816  Parnell  Ave.,  Chicago,  60628 


Jacob  E.  Reisch,  Secretary-Treasurer 
1129  South  2nd  Street,  Springfield,  62704 

Maurice  M.  Hoeltgen,  Speaker 

1836  West  87th  Street,  Chicago,  60620 

Paul  W.  Sunderland,  Vice-Speaker 

216  N.  Sangamon  Street,  Gibson  City, 
60936 


Paul  P.  Youngberg,  4th  District 

1520  7th  Street,  Moline,  61265 

Darrell  H.  Trumpe,  5th  District 

St.  John’s  Sanatorium,  Springfield,  62700 

J.  Mather  Pfeiffenberger,  6th  District 

State  8c  Wall  Streets,  Alton,  62004 

Arthur  F.  Goodyear,  7th  District 

142  E.  Prairie  Avenue,  Decatur,  62523 

Wm.  H.  Schowengerdt,  8th  District 

301  E.  University  Avenue,  Champaign, 

Charles  K.  Wells,  9th  District 

117  N.  10th  Street,  Mt.  Vernon,  62824 

Willard  C.  Scrivner,  10th  District 

4601  State  Street,  East  St.  Louis,  62205 

Joseph  R.  O’Donnell,  11th  District 

444  Park,  Glen  Ellyn,  60137 

Newton  DuPuy,  Trustee-at-Large 
1101  Maine  Street,  Quincy,  62301 


126 


Illinois  Medical  Journal 


The  estrogen  component  in  MEDIATRIC  is  PREMARIN®  (conjugated  estrogens-equine),  the 
orally  active,  natural  estrogen  so  widely  prescribed  for  its  physiologic  and  metabolic  benefits. 
The  combination  of  estrogen  and  methyltestosterone  can  help  maintain  anabolic 
balance  to  forestall  premature  degenerative  changes  related  to  estrogen  deficiency. 
MEDIATRIC  also  supplies  a small  amount  of  methamphetamine  HCl  to  provide  a gentle 
mood  uplift,  and  nutritional  supplements  specially  selected  to  meet  the  needs  of  the  aging. 


contraindication:  Carcinoma 
of  the  prostate,  due  to 
methyltestosterone  component. 
warning:  Some  patients  with 
pernicious  anemia  may  not  respond 
to  treatment  with  the  Tablets  or 
Capsules,  nor  is  cessation  of  response 
predictable.  Periodic  examinations 
and  laboratory  studies  of  pernicious 
anemia  patients  are  essential  and 
recommended. 

SIDE  effects:  In  addition 


to  withdrawal  bleeding,  breast 
tenderness  or  hirsutism  may 
occur. 

SUGGESTED  DOSAGES:  Male  and 
female— I Tablet  or  Capsule,  or  3 
teaspoonfuls  Liquid,  daily  or  as 
required. 

In  the  female:  To  avoid  continuous 
stimulation  of  breast  and 
uterus,  cyclic  therapy  is  recom- 
mended (3  week  regimen  with  1 
week  rest  period— Withdrawal 


bleeding  may  occur  during  this 
1 week  rest  period). 

In  the  male:  A careful  check  should 
be  made  on  the  status  of  the  prostate 
gland  when  therapy  is  given  for 
protracted  intervals. 
supplied:  No.  752— mediatric 
Tablets,  in  bottles  of  100  and  1,000. 
No.  252— MEDIATRIC  Capsules,  in 
bottles  of  30,  100,  and  1,000. 

No.  9 10- MEDIATRIC  Liquid,  in 
bottles  of  16  fluidounces  ^ 


Each 

MEDIATRIC 
Tablet  or 
Capsule 
contains: 

Each  15  cc. 

(3  teaspoonfuls) 
of  MEDIATRIC 
Liquid 
contains: 

Conjugated  estrogens-equine  (PREMARIN®) 

0.25  mg. 

0.25  mg. 

Me  thy  1 tes  tos  terone 

2.5  mg. 

2.5  mg. 

Methamphetamine  HCl 

1 .0  mg. 

1 .0  mg. 

Cyanocobalamin 

2.5  meg. 

1 .5  meg. 

Intrinsic  factor  concentrate 

8.0  mg. 

— 

Thiamine  HCl 

_ 

5.0  mg. 

Thiamine  mononitrate 

10.0  mg. 

— 

Riboflavin 

5.0  mg. 

— 

Niacinamide 

50.0  mg. 

— 

Pyridoxine  HCl 

3.0  mg. 

— 

Calcium  pantothenate 

20.0  mg. 

— 

Ferrous  sulfate  exsiccated 

30.0  mg. 

— 

Ascorbic  acid 

100.0  mg. 

(Contains 
15%  alcoholt) 
tSome  Loss 
Unavoidable 

M^iahic 

Steroid-nutritional  compound 


tablets  • capsules  • liquid 


AYERST  LABORATORIES  . New  York,  N.  Y.  10017  . Montreal,  Canada 


6838 


for  August,  1968 


135 


New  Pharmaceutical  Specialties 

(Continued  from  page  122) 


1 


i 


Just  one  tablet  at  bedtime  • Prevents  pain- 
ful night  leg  cramps  • Permits  restful  sleep 

How  many  of  your  patients  stamp  their  feet  at  night 
and  lose  sleep  because  of  painful  leg  cramps?  Un- 
less prompted,  they  usually  fail  to  report  this  dis- 
tressing condition  and  suffer  needlessly. 

One  tablet  of  QUINAMM  at  bedtime  usually  con- 
trols distressing  night  cramps  and  permits  restful 
sleep  with  the  initial  dose. 


Prescribing  information  — Composition:  Each  white,  beveled, 
compressed  tablet  contains:  Quinine  sulfate,  260  mg.,Amino- 
phylline,  195  mg.  Indications:  For  the  prevention  and  treat- 
ment of  nocturnal  and  recumbency  leg  muscle  cramps,  in- 
cluding those  associated  with  arthritis,  diabetes,  varicose 
veins,  thrombophlebitis,  arteriosclerosis  and  static  foot  de- 
formities. Contraindications:  QUINAMM  is  contraindicated  in 
pregnancy  because  of  its  quinine  content.  Side  Effects/ 
Precautions:  Aminophylline  may  produce  intestinal  cramps 
in  some  instances,  and  quinine  may  produce  symptoms  of 
cinchonism,  such  as  tinnitus,  dizziness,  and  gastrointestinal 
disturbance.  Discontinue  use  if  ringing  in  the  ears,  deafness, 
skin  rash,  or  visual  disturbances  occur.  Dosage:  One  tablet 
upon  retiring.  Where  necessary,  dosage  may  be  increased  to 
one  tablet  following  the  evening  meal  and  one  tablet  upon 
retiring.  Supplied:  Bottles  of  100  and  500  tablets. 

THE  NATIONAL  DRUG  COMPANY 

DIVISION  OF  RICHARDSON  MERRELL  INC. 

PHILADELPHIA,  PENNSYLVANIA  19144 


COMBINATION  PRODUCTS 

ALDOCLOR  Hypotensive  R 

Manufacturer:  Merck  Sharp  & Dohme 

Composition:  Tablets:  150  250 

Methyldopa  250  mg.  250  mg. 

Chlorothiazide  150  mg.  250  mg. 

Indications:  Sustained  moderate  to  severe  hyper- 
tension. 

Contraindications:  Active  hepatic  disease,  pheo- 
chromocytoma,  anuria,  and  mild  or  libile  hy- 
pertension responsive  to  mild  sedation  or  thia- 
zide therapy  ^one. 

Dosage:  1 tab.  (either  strength)  2 or  3 times 
daily,  during  first  48  hours,  thereafter  to  be 
adjusted  individually.  Do  not  exceed  3 gm.  of 
methyldopa  or  1-1.5  gm.  of  chlorothiazide. 

Suppli^:  Tablets;  bottles  of  100. 


DIALOG  with  Codeine  Analgesic-Narcotic  R 
Manufacturer:  Ciba  Pharmaceutical  Co. 
Composition:  Tablet:  No.  2 No.  3 

Codeine  phosphate  15  mg.  30  mg. 

Allobarbital  15  mg.  15  mg. 

Acetaminophen  300  mg.  300  mg. 

Indications:  Tension  headache,  neuralgia,  more 
severe  pain. 

Contraindications:  None  mentioned. 

Dosage:  As  indicated  by  physician. 

Supplied:  Tablets 


NIFEREX  with  CALCIUM  Hematinic/Vitamin 
Comb.  o-t-c 

Manufacturer:  The  Central  Pharmacal  Co, 
Composition:  Iron  (elemental)  25  mg. 

Calcium  carbonate  312  mg. 

Ascorbic  acid  (as  sodium  ascorbate)  125  mg. 

Indications:  Miner^  supplement 
Contraindications:  Hemochromatosis  or  hemosi- 
derosis. 

Dosage:  2 tablets  daily. 

Supplied:  Tablets;  bottles  of  100  and  1,000. 
SEAFER  Hematinic  o-t-c 

Manufacturer:  S.  F.  Durst  & Co.,  Inc. 
Composition:  Iron  40  mg. 

Ascorbic  acid  _ 100  mg. 

Indications:  Iron  deficiency  anemias.  Need  for 
iron  supplementation  dxiring  pregnancy,  onset 
of  menses,  or  chronic  blood  loss. 
Contraindications:  None  mentioned. 

Dosage:  Adults — 3 or  4 tablets  daily. 

Chfidren  over  6 years — 1 or  2 tablets  daily, 
imder  6 years — as  directed  by  physician. 
Supplied:  Tablets;  bottles  of  100  and  1,000. 


NEW  DOSAGE  FORMS 


DIALOG  Elixir  Analgesic — ^Non-Narcotic  R 

Manufacturer:  Ciba  Pharmaceutical  Co. 
Composition:  Each  5 cc.  contains: 

Allobarbital  7 .5  mg. 

Acetaminophen  150  mg. 

Indications:  Relief  of  pain  in  children. 
Contraindications:  None  mentioned. 

Dosage:  As  indicated  by  physician. 

Supplied:  Elixir;  pint  bottles. 


136 


Illinois  Medical  Journal 


Abstracts  Of  Board  Actions 

Meeting  During  The  Annual  Convention,  May  18-22,  1968 

These  abstracts  are  published  so  that  members  of  the 
Illinois  State  Medical  Society  may  keep  advised  of  the  actions 
of  the  Board  of  Trustees.  It  covers  only  major  actions  ^d 
is  not  intended  as  a detailed  report.  Full  minutes  of  the 
meetings  are  available  upon  any  member’s  request  to  the 
headquarters  office  of  the  ISMS.  ''  }-\ 

PRlCEPTORSHiP  PROGRAM  IN  DuPAGE  COUNItI^ 

The  precept orship  program  is  being  accepted  by  the  physi- 
cians and  students  at  the  Chicago  Medical  School  and  has  been 
proving  to  be  quite  successful.  The  resources  iised  up  to  the 
present  time  have  been  depleted,  hnd  aftbr  the  present  ’’se- 
mester*’ the  program  will  come  %o  a halt.  ?Five  students  are 
left  and  may  have  to  cancel  if  money  is  not  available.  The 
program  was  a state  medical  society  project.'  Ferhaps^the^ 
students  will  continue  without  the  proposed  stipend  for  the^ 
three  months  time  which  is  involved,  but  puFage  Obimty  has 
notified  the  Board  of  Trustees  and  the  Chicago  rMedi cal 
School  that  they  are  now  paying  the  last  threjK students,  and 
. in  the  future,  this  program  will  hot 'be  a' couhiy/'Society  re-^r  ' 
sponsibility.  It  has  been  a good  program  and  thU  Ideal  socie- 
ty appreciates  the  opportunity  afforded  its  members  toyork^ 
with  these  young  people.  Perhaps  AMA-lFF''wili  .Mve^^^^ 
funds  available  if  this  program  is  considered  eligible. 


GUIDELINE  FOR  CARDIAC  CARE, 

In  again  discussing  the  request  from  the  hU^ses  that  their 
’’guide  lines"  dealing  with  acute  cardiac  care  be  approved, 
reconsideration  was  asked.  This  was  approved  ahd" the  ma- 
terial submitted  by  the  Illinois  Nurses  Association  will  be 
reproduced  and  mailed  for  consideration  at  a fiiturameeting 
of  the  Board  of  Trustees.  ^ 


HEALTH  PLANNING  IN  COOK  COUNTY  4 

It  was  reported  that  Comprehensive  Health  Flalnning  in 
Cook  County  was  progressing  well.  Representatives  of  the 
Chicago  Medical  Society  and  five  other  agencies  have  held  a 
series  of  meetings.  Some  decisions  have  been  made  to  the  ef- 
fect that  at  the  outset  of  the  development  planning  period 
the  area  involved  will  be  Cook  County.  Part  of  the  study  of 
this  group  will  be  the  matter  of  geography  with  the  idea  of 
ultimately  making  a recommendation  as  to  whether  the  area 
involved  should  be  Cook  County,  or  more  extensive.  It  ap- 
pears that  this  work  is  well  up  among  the  "leaders"  through- 
out the  country.  At  a meeting  to  be  held  at  the  Board  of 
Health  offices,  a new  Board  of  Directors  will  come  into  ex- 
istence consisting  of  representatives  from  the  Chicago  Med- 
ical Society,  Chicago  Board  of  Health,  Cook  County  Depart- 
ment of  Public  Health,  the  Metropolitan  Welfare  Council, 
Northeastern  Illinois  Planning  Commission  and  the  Hospital 
Planning  Council  of  Metropolitan  Chicago,  The  representa- 
tive of  CMS  will  be  the  Chairman  of  the  CMS  Board  of  Trustees. 


for  August,  1968 


137 


MERGING  OF  EMERGENCY  SERVICE 

Present  law  makes  it  mandatory  for  every  hospital  to  have 
an  emergency  room.  In  many  places  there  are  two  or  more  hos- 
pitals close  together,  and  one  might  be  able  to  equip  and 
man  an  emergency  room,  admit  all  emergency  cases,  and  elimi- 
nate duplication  of  effort,  supplies,  manpower,  etc.  The 
Director  of  Public  Health  has  appointed  a committee,  on 
which  ISMS  will  be  represented,  to  study  possibilities  for 
improvement  in  the  methods  of  handling  emergency  cases. 

MD  ABILITY  TO  PRACTICE  OPINION 

Mr,  Pfeifer,  legal  counsel,  discussed  the  request  that 
county  medical  societies  develop  a means  of  cooperating  with 
the  state  in  determining  whether  or  not  a physician  is  men- 
tally or  physically  able  to  practice.  Some  of  the  counties 
have  questions  relative  to  procedure  and  relative  to  lia- 
bility. Mr.  Pfeifer  was  preparing  an  opinion  which  will 
state  that  the  county  society  does  have  the  right  to  make  a 
discrete  investigation,  and  report  the  findings  back  to  this 
Society,  and  the  ISMS  can  relay  the  situation  to  the  Depart- 
ment of  Registration  and  Education  for  further  investiga- 
tion and  action. 

VOCATIONAL  REHABILITATION  FUNDS  DISCUSSED 

The  necessity  to  document  the  need  for  funds  for  voca- 
tional rehabilitation  exists.  After  lengthy  discussion  it 
was  decided  that  the  ISMS  should  not  appear  before  the  legis- 
lature asking  for  financing  without  facts  to  back  up  such  a 
request.  The  Board  rescinded  its  previous  action  and  re- 
ferred the  entire  matter  back  to  the  Advisory  Committee  on 
Rehabilitation  to  meet  with  the  Division  of  Vocational  Re- 
habilitation. The  Committee  is  to  report  back  to  the  Board 
with  facts  about  the  need  for  money.  The  use  of  the  advisory 
committee  throughout  the  state  was  stressed  as  one  of  the 
important  basic  requests.  There  should  be  no  departure  from 
the  use  of  an  active  medical  advisory  committee  in  any  area 
where  service  is  rendered. 

LASER  MANUAL  TO  BE  REPRINTED 

One  thousand  laser  manuals  were  printed  last  year,  and  the 
supply  has  been  exhausted.  Requests  are  being  received  for 
more,  and  a minimum  number  of  changes  will  bring  the  manual 
up  to  date.  The  booklet  deals  with  safety  precautions  for 
the  use  of  laser  beams. 

DUES  STRUCTURE  APPROVED 

By  official  action,  the  Board  approved  recommending  the 
same  dues  structure  for  1969.  The  distribution  of  this  is  as 
follows : 


AMA-ERF 

$20.00 

HCCI 

2.00 

Benevolence 

5.00 

Reserves 

8.00 

Operating  Fund 

70.00 

1105.00 

(Abstracts  continued  on  page  205) 


138 


Illinois  Medical  Journal 


Philip  G.  Thomsen,  M.D. 


Throughout  the  state,  starting  this  fall, 
your  ISMS  will  go  to  you  as  never  before. 

We’ll  then  be  resuming  the  President’s 
Tour  visits  inaugurated  last  year— a n d 
they’ll  be  larger  in  substance  and  purpose. 

The  whole  new  format  is  built  around 
this  basic  question:  How  can  ISMS  bring 
the  greatest  good  to  you.  . .and  to  the  great- 
est number  of  physicians? 

To  provide  the  greatest  good,  the  visits 
will  consist  of  an  afternoon  Workshop  on 
Government  Health  Programs. . .and  an 
evening  presentation  on  problems  vital  to 
your  profession  and  your  role  in  society. 

To  serve  the  greatest  number  of  physi- 
cians, most  of  the  gatherings  will  be  district- 
wide, and  held  in  a city  central  to  the  dis- 
trict. The  gatherings  will  be  county-wide, 
however,  in  the  very  largest  counties. 

Our  first  stops  will  be  Rockford,  Peoria, 
Joliet,  Carbondale  and  Rock  Island/Mo- 
line, and  Alton. 

The  afternoon  workshops  will  cover 
Medicare,  public  aid  and  combinations  of 
the  two. . .townships  general  assistance,  vo- 
cational rehabilitation,  children  and  family 
services,  military  dependents  care  (CHAM- 
PUS).  Representatives  of  state  agencies  and 
insurance  carriers  will  outline  the  proce- 
dures that  participating  physicians  must 
follow.  . .explain  the  necessary  forms  point 
by  point. . .answer  your  questions. 

Because  of  confusion  over  the  procedures 
and  forms,  Illinois  doctors  have  been  losing 
hundreds  of  thousands  of  dollars  in  right- 


ful payments.  Mindful  of  this,  we  held  a 
“pilot”  workshop  last  February  in  St.  Clair 
County— a heavy  public  aid  area;  more 
than  200  physicians  and  medical  assistants 
attended.  Other  areas  across  the  state  called 
for  similar  workshops— and  we  look  for- 
ward to  accommodating  them. 

In  the  evening  of  each  President’s  Tour 
visit,  a prominent  public  official— most 
likely  your  Congressman— will  speak  on  the 
political,  economic  and  social  challenges 
that  affect  you  and  your  district. 

As  your  President,  I (or  in  my  place  Dr. 
Edward  W.  Cannady,  your  President-Elect) 
will  talk  that  evening  on  issues  covered  in 
the  ISMS  questionnaire  sent  you  this  sum- 
mer. I will  tell  you  how  ISMS  aims  to  work 
for  the  ideas  that  most  of  you  favored  in 
the  questionnaire.  Earlier  in  the  day  I will 
bring  your  ISMS  message  to  a civic  club 
and  radio  or  TV  station  in  the  visited  dis- 
trict. 

Throughout  the  visit  there  will  be  give- 
and-take.  The  official  family  of  ISMS  will 
not  only  bring  messages  and  counsel  to 
you,  but  take  your  sentiments  and  spirit 
back  home.  The  day’s  association  will  long 
outlast  the  day.  It  will  be  an  enduring 
source  of  strength  and  purpose  for  ISMS. . . 
and  for  all  of  us. 


for  August,  1968 


141 


.ydrDchlorilif' 
tg,  caifieine. 


Each,PuIwile®  coatalns  65  rag.  propox^ 
227  mg.  aspirin,  162  mg.  phenacetin,  anj 


Additional  information  available  to 
physicians  upQj.request. 

ELI  ULLV  jTO  COMPANY 
INDlANAP^fi,  INDIANA  46266 


Illinois  Medical  Journal 

A 


Illinois  Medical  Journal 


volume  134,  number  2 


August,  1968 


Myocardial  Infarction  During  Pregnancy 

By  Jack  J.  Adler,  M.D.,  Meyer  J.  Barrash,  MD.,  and  Sidney  R.  Lash,  M.D./Chicago 


The  prevalence  and  mortality  of  myo- 
cardial infarction  in  pre-menopausal 
women  is  less  than  that  in  men  of  similar 
age4’2  A more  rare  event  is  myocardial  in- 
farction during  pregnancy.  The  exact  num- 
ber of  such  cases  reported  in  the  medical 
literature  cannot  be  determined  because  of 
variation  in  the  diagnostic  criteria  of  myo- 
cardial infarction  over  the  years;  probably 
no  more  than  30  documented  cases  have 
been  reported.  Presented  is  a patient  with 
a myocardial  infarction  substantiated  by 
electrocardiographic  and  enzymatic  changes 
occurring  in  the  second  trimester  of  preg- 
nancy. Although  she  recovered  unevent- 
fully, she  had  electrocardiographic  changes 
of  ischemia  during  labor  which  promptly 
regressed  after  delivery. 

Case  Presentation 

E.  K.  (180-094),  a 40-year-old  white 
woman,  gravida  IV,  para  II,  six  months 
pregnant,  experienced  sharp,  throbbing,  in- 
trascapular pain  that  radiated  to  the  pre- 
cordium  and  left  arm  shortly  after  a meal  of 
spaghetti  and  wine.  She  became  diaphoretic 
and  vomited  without  relief,  and  was  ad- 
mitted to  the  hospital  on  Oct.  4,  1965. 


Jack  J.  Adler,  M.D.  is  Senior  Medical  Resident  in 
the  Department  of  Medicine,  Michael  Reese  Hos- 
pital and  Medical  Center,  Chicago.  He  received  his 
M.D.  from  the  University  of  Chicago  and  served  his 
internship  at  Philadelphia  General  Hospital. 

Meyer  J.  Barrash,  M J).,  is  Associate  Attending  Physi- 
cian in  the  Department  of  Medicine,  Michael  Reese 
Hospital  and  Medical  Center.  He  received  his  M.D. 
from  the  University  of  Chicago  and  did  both  his 
internship  and  residency  at  Mt.  Sinai  Hospital, 
Chicago.  Dr.  Barrash  is  also  Clinical  Assistant  Pro- 
fessor of  Medicine  at  the  Chicago  Medical  School. 
Sidney  R.  Lash,  M.D.,  is  from  the  Department  of 
Obstetrics  and  Gynecology,  Michael  Reese  Hospital 
and  Medical  Center,  Chicago,  where  he  is  an  At- 
tending Physician. 


Menarchc  at  age  12  was  normal,  but  at 
age  20  she  was  evaluated  for  irregular 
menses.  X-ray  studies  revealed  polycystic 
ovaries  confirmed  at  surgery;  in  addition, 
the  uterus  was  described  as  hypoplastic.  A 
wedge  resection  of  both  ovaries  was  per- 
formed with  the  histology  interpreted  as 
simple  ovarian  cysts.  She  continued  to  have 
irregular  menses  with  one  to  three-month 
intervals  between  periods.  The  patient  was 
married  for  the  first  time  in  1959  at  age 
34  years.  In  December,  1959  she  spontane- 
ously aborted  a fetus  of  approximately  eight 
weeks  gestation.  In  1961  and  1963  she  de- 
livered normal,  full-term,  female  infants. 
No  contraceptive  measures  were  employed, 
and  the  patient  states  that  following  her 
abortion  in  1959  she  was  unsuccessful  in  her 
attempts  to  become  pregnant  until  1961. 
However,  she  did  have  difficulty  in  con- 
ceiving her  second  and  third  children. 

An  electrocardiogram  taken  in  1961  was 
reported  as  within  normal  limits.  She  was 
known  to  have  a low-normal  blood  pressure 
for  many  years,  she  was  slightly  obese,  and 
she  smoked  one  to  three  packs  of  cigarettes 
daily  for  more  than  20  years.  At  the  time  of 
admission  she  was  not  taking  any  medica- 
tion. Pertinent  family  history  was  that  her 
father  had  had  a myocardial  infarction  and 
congestive  heart  failure;  two  maternal  un- 
cles were  known  to  have  heart  disease  and 
diabetes. 

Physical  examination  revealed  a slightly 
obese,  afebrile,  white  woman  in  no  acute 
distress,  with  a regular  pulse  of  60/minute, 
blood  pressure  90/60,  and  respiration  16/ 
minute.  Funduscopic  examination  was  nor- 
mal. The  heart  and  lungs  were  normal.  The 
uterus  was  enlarged  to  2 cm.  below  the 
umbilicus.  The  peripheral  pulses  were  nor- 


foT  August,  1968 


143 


TABLE  1 

SERIAL  CHANGES  IN  SERUM  ENZYMES 
Normal  Admission 


ENZYME 

Values 

Date  (10/4/65) 

10/5 

10/6 

. 10/8 

10/9 

10/10 

SGOT 

(15-40  units) 

70 

100 

47 

28 

23 

15 

SGPT 

(15-40  units) 

16 

19 

11 

19 

17 

17 

LDH 

(200-450  units) 

186 

491 

572 

306 

281 

230 

mal  and  there  was  no  edema. 

The  patient  was  mildly  anemic  with  a 
hemoglobin  of  10.3  gm%.  An  initial  leuko- 
cytosis of  12,000  WBC  cleared  over  several 
days.  The  sedimentation  rate  was  14  mm.  in 
one  hour  (uncorrected).  Serum  iron  was  104 
mcg%  with  iron  binding  capacity  of  488 
mcg%.  Fasting  blood  glucose,  blood  urea 
nitrogen,  amylase,  and  lipase  were  within 
normal  limits.  Serial  changes  in  SCOT, 
SGPT,  and  LDH  Values  were  as  noted  in 
Table  1.  The  SGOT  was  more  than  twice 
normal  values  on  the  day  after  admission, 
but  fell  rapidly  to  normal.  The  LDH  values 
were  elevated  on  the  second  and  third  days. 
Serum  cholesterol  was  230  mg%,  with  74% 
esterified.  Total  lipids  and  phospholipids 
were  within  normal  limits. 

The  first  oral  glucose  tolerance  test  shown 
in  Table  2 revealed  borderline  abnormali- 
ties for  a pregnant  woman.^  Chest  x-ray  was 
within  normal  limits.  Electrocardiograms 
taken  on  the  first,  second  and  third  hospital 
days  are  shown  in  Fig.  1.  The  initial  tracing 
showed  alterations  of  acute  coronary  insuf- 
ficiency which  had  regressed  markedly  by 
the  next  day.  However,  on  Oct.  6 the  elec- 
trocardiogram revealed  evolution  compati- 
ble with  a recent  posterior-inferior  wall 
myocardial  infarction.  She  did  not  receive 
anticoagulants,  and  was  treated  with  bed 
rest  and  sedation.  In  the  following  four 
weeks  the  electrocardiographic  changes 


were  those  of  a healing  posterior-inferior 
wall  myocardial  infarction.  An  electrocar- 
diogram on  Feb.  3,  1966  did  not  differ  sig- 
nificantly from  the  earlier  tracings.  A sec- 
ond glucose  tolerance  test  at  37  weeks  gesta- 
tion (seen  in  Table  2)  was  definitely  diabetic. 

On  February  22,  1966  she  was  admitted 
in  active  labor.  Analgesia  consisted  of  me- 
peridine and  scopalamine;  a pericervical 
and  pudendal  block  was  used  for  anesthesia. 
Her  vital  signs  were  stable  and  she  denied 
chest  pain  during  labor.  Six  hours  after  the 
onset  of  labor  she  delivered  a 3610  gm.  male 
infant.  Electrocardiograms,  seen  in  Fig.  2, 
taken  during  labor,  immediately  after  de- 
livery, and  one  day  after  delivery  showed 
the  residue  of  the  previous  posterior-inferior 
wall  myocardial  infarction  with  the  appear- 
ance of  new  injury  around  the  area  of  the 
infarction  during  active  labor.  These 
changes  cleared  immediately  after  delivery. 
An  electrocardiogram  taken  eight  weeks 
postpartum  did  not  differ  from  one  taken 
before  delivery. 

Discussion 

Myocardial  infarction  during  pregnancy 
and  pregnancy  occurring  in  a woman  known 
to  have  had  a myocardial  infarct  are  both 
rare  events.  In  1960  Watson  et  al  reported 
two  cases  of  myocardial  infarction  occurring 
during  pregnancy,  and  surveyed  the  world 
literature,  summarizing  26  cases  of  myo- 


144 


Illinois  Medical  Journal 


cardial  infarction  occurring  during  preg- 
nancy or  the  puerperium>  A later  summar}^ 
was  that  of  Magner  in  which  35  cases  were 
enumerated.  He  included  several  patients 
with  the  only  diagnosis  being  “angina  dur- 
ing pregnancy,”  and  he  did  not  include  the 
more  recent  cases  of  AVatson.®  In  an  earlier 
paper,  Mendelsohn  presented  four  patients 
with  the  diagnosis  of  myocardial  infarction 
during  pregnancy.®  However,  one  patient 
had  had  a myocardial  infarct  approximately 
three  years  before  the  onset  of  pregnancy;  in 
two  other  cases  the  electrocardiographic 
findings  were  only  suggestive  and  no  firm 

TABLE  2 

ORAL  GLUCOSE  TOLERANCE  TESTS 
TAKEN  DURING  THE  COURSE 
OF  PREGNANCY 
(true  glucose  method) 


19  weeks  37  weeks 

gestation  gestation 


Fasting  75  mg%  98  mg% 

Vz  hour  90  mg%  147  mg% 

1 hour  149  mg%  176  mg% 

2 hour  156  mg%  141  ing% 

3 hour  118  mg%  141  mg% 

4 hour  80  mg%  103  mg% 


evidence  of  myocardial  infarction  was  pre- 
sented; one  could  not  rule  out  pulmonar)' 
embolism.  Another  case  report  and  review 
was  that  of  Lyons  and  Lyons. 

Since  1960  there  have  been  occasional  case 
reports  in  the  literature.®-®-^®  Magner  pre- 
sented a case  of  myocardial  infarction  and 
acute  pulmonary  edema  occurring  during 
labor  confirmed  by  autopsy  which  showed 
complete  occlusion  of  the  left  coronar}' 
arter)^®  Another  case  is  reported  by  Pfaffen- 
schlager  in  a 21-year-old  woman.^®  Although 
the  occurrence  of  a myocardial  infarction  is 
a rare  event,  one  cannot  assume  that  all  such 
cases  have  been  reported  in  the  medical 
literature.  Also,  some  cases  may  be  over- 


looked, as  for  example,  case  2 of  "U^atson, 
which  was  detected  only  by  a fortuitous 
electrocardiogram.'^ 

Another  source  of  information  indicates 
that  myocardial  infarction  in  women  of 
childbearing  age  may  not  be  as  rare  an 
event.  On  the  basis  of  cardiovascular  exami- 
nations, including  electrocardiograms,  of 
approximately  7000  people,  representing  a 
nationwide  probability  sample  of  the  ci- 
vilian, non-institutional  population,  Gor- 
don and  Garst  of  the  Division  of  Health 
Examination  Statistics,  National  Health 
Survey,  predicted  that  19,000  women,  24-34 
years  of  age,  and  29,000  women,  35-44  years 
of  age,  would  have  definite  evidence  of  myo- 
cardial infarction.  The  only  criterion  for 
the  diagnosis  of  myocardial  infarction  in 
this  study  was  well  accepted  electrocardio- 
graphic changes  of  myocardial  infarction. ^ 
If  these  prevalence  figures  are  correct,  one 
might  anticipate  that  pregnancy  in  a woman 
who  has  had  a myocardial  infarction  is  an 
unusual,  but  not  a rare  event. 

Another  explanation  of  why  myocardial 
infarction  is  rare  in  pregnant  women  might 
be  that  women  who  are  prone  to  develop 
this  disease  are  less  fertile  or  abort,  thus 
making  the  development  of  myocardial  in- 
farction during  the  pregnant  state,  or  preg- 
nancy after  myocardial  infarct  less  likely. 
AVinkelstein  and  Rakate  reported  on  about 
60  women  with  atherosclerotic  cardiovascu- 
lar disease  who  showed  an  excess  of  preg- 
nancy loss  when  compared  with  a matched 
group. Of  note  was  that  diabetes  was  not 
responsible  for  this  observed  difference.  The 
obstetrical  histor}'  of  this  patient  is  interest- 
ing in  this  regard. 

Several  long  term  prospective  studies  have 
elucidated  the  factors  that  predispose  to  the 
development  of  coronary  heart  disease.  The 
data  from  Framingham  indicate  that  hyper- 


Fig.  2.  Electrocardiograms  during  labor,  immediately  after  delivery,  and  one  day  after  deii\ery. 


for  August,  1968 


145 


tension,  elevated  serum  cholesterol,  other- 
lipid  changes,  electrocardiographic  abnor- 
malities, decreased  vital  capacity,  excessive 
cigarette  smoking,  and  perhaps  other  factors 
are  associated  with  a higher  incidence  of 
coronary  heart  disease.^^  Diabetics  are 
known  to  be  more  prone  to  the  premature 
development  of  coronary  heart  disease  and 
one  study  of  myocardial  infarction  indi- 
cated that  a high  proportion  of  young  men 
had  abnormalities  of  carbohydrate  metabo- 
lism.13  The  patient  presented  here  would  be 
classified  as  a pre-clinical  or  chemical  dia- 
betic who  with  the  physiologic  stresses  of 
pregnancy  developed  significant  alterations 
of  carbohydrate  metabolism.  In  the  case  re- 
ports studied  5-10%  of  women  with  myo- 
cardial infarction  during  pregnancy  are 
clinically  diabetic.  The  criteria  for  the  diag- 
nosis of  diabetes  vary  from  case  to  case;  in 
addition,  more  elaborate  testing  of  the  pa- 
tients classified  as  non-diabetics  might  have 
revealed  subtle  alterations  in  carbohydrate 
metabolism. 

However,  one  cannot  assume  that  these 
various  factors  have  the  same  pathogenetic 
significance  for  a pregnant  woman.  For  ex- 
ample, studies  of  lipid  alterations  indicate 
that  normally  during  pregnancy  the  total 
cholesterol  increases  with  its  distribution 
between  alpha  and  beta  protein  altered  in 
a fashion  similar  to  that  found  in  men  with 
coronary  heart  disease.!^  Clearly,  these  lipid 
changes  in  this  population  of  pregnant 
women  do  not  predispose  to  clinically  sig- 
nificant coronary  heart  disease.  It  is  doubt- 
ful that  a long  range  study  of  coronary  heart 
disease  in  pregnancy  will  be  carried  out; 
only  one  case  of  coronary  heart  disease  in 
women  30-39  years  of  age  was  noted  during 
eight  years  of  study  at  Framingham.^^  The 
number  of  women  and  length  of  years  in- 
volved in  such  a prospective  study  would  be 
prohibitive. 

Techniques  of  obstetrical  management  in 
the  reported  cases  varied  depending  upon: 
1)  at  what  time  during  pregnancy  the  myo- 
cardial infarction  occurred;  2)  the  parity  of 
the  patient;  3)  the  patient’s  general  health 
and  other  complicating  factors.  From  the 
case  reports  in  the  literature,  there  is  no 
indication  that  a myocardial  infarction,  per 
se,  is  an  indication  for  Caesarian  section.  As 
in  any  patient,  anesthesia  should  be  such 
to  avoid  periods  of  hypotension  and  anoxia, 
and  enough  analgesia  should  be  employed 
to  relieve  pain  and  emotional  distresss.  Con- 
tinuous caudal  or  epidural  anesthesia  may 


well  meet  both  objectives  by  providing 
analgesia  during  labor  and  anesthesia  for 
delivery.  In  our  patient  the  stresses  of  labor 
produced  electrocardiographic  changes  of 
acute  injury  although  she  was  not  hypoten- 
sive and  did  not  complain  of  chest  pain  dur- 
ing labor.  Anticoagulants  have  been  used  in 
pregnant  women,  usually  for  the  more  com- 
mon problem  of  thrombophlebitis.  Heparin, 
which  does  not  cross  the  placenta,  is  prefer- 
able to  warfarin  and  similar  preparations. 

Summary 

A 40-year-old  white  woman  suffered  an 
acute  myocardial  infarction  in  the  second 
trimester  of  her  third  pregnancy.  Following 
an  uneventful  recoverey,  she  developed  sig- 
nificant electrocardiographic  changes  dur- 
ing labor  that  regressed  promptly  post 
partum.  The  recent  literature  on  coronary 
heart  disease  during  pregnancy  is  briefly 
reviewed  and  techniques  of  obstetrical  man- 
agement summarized. 

References 

1.  Gordon,  T.  and  Garst,  C.  G.  Coronary  Heart  Dis- 
ease in  Adults.  National  Center  for  Health  Statis- 
tics, Series  II,  No.  10,  September.  1965. 

2.  Cardiovascular  Disease:  1960  Data  on  National 
and  State  Mortality  Experience.  U.S.  Dept. 
Health,  Education  and  Welfare  Publication 
#1083,  September,  1963. 

3.  O’Sullivan,  J.  B.  and  Mahor,  C.  M.  Criteria  for 
the  Oral  Glucose  Tolerance  Test  in  Pregnancy. 
Diabetes  3:278-285,  May,  1964. 

4.  Watson,  H.,  et  al.  Myocardial  Infarction  During 
Pregnancy  and  Puerperium.  Lancet  2:523-25, 
September  3,  1960. 

5.  Magner,  D.  Coronary  Artery  Disease  and  Preg- 
nancy. J.  Obstet.  Gynec.  Brit.  Comm.  69:317-23, 
April,  1962. 

6.  Mendelsohn,  C.  L.  Coronary  Artery  Disease  in 
Pregnancy,  Amer.  J.  Obstet.  Gynec.  63:381-91, 
February,  1962. 

7.  Bedford,  J.  R.  D.  Myocardial  Infarction  in  Preg- 
nancy. J.  Obstet.  Gynec.  Brit.  Comm.  71:459-60, 
June,  1964. 

8.  Lyon,  B.  H.  and  Lyon,  R.  Coronary  Artery  Dis- 
ease in  Pregnancy.  Canad.  Med.  Ass.  J.  71:267- 
72,  September,  1954. 

9.  Magner,  D.  Coronary  Occlusion  in  Labour. 
68:128-9,  February,  1961. 

10.  J.  Obstet.  Gynec.  Brit.  Comm. 

11.  Pfaffenschlager,  F.  Myokardinfarkt  and  Schwan- 
gerschaft.  Wien.  Klin.  Wschr.  76:297-99,  April, 
1964. 

11.  Winkelstein,  W.,  Jr.  and  Rekate,  A.  C.  Age 
Trend  of  Mortality  from  Coronary  Artery  Dis- 
ease in  Women  and  Observation  on  the  Repro- 
ductive Pattern  of  those  Affected.  Amer.  Heart  J. 
67:481-88,  April,  1964. 

12.  Kagan,  A.,  et  al.  The  Framingham  Study:  A 
Prospective  Study  of  Coronary  Heart  Disease. 
Federation  Proceedings  21:52-7,  July,  1962. 

13.  Sievers,  S.,  Blomquist,  G.  and  Biorck,  G.  Studies 
of  Myocardial  Infarction  in  Malmo,  1935  to  1954. 
Acta.  Med.  Scand.  169:95-103,  1961. 

14.  Oliver,  M.  F.,  and  Boyd,  G.  S.  Plasma  Lipid  and 
Serum  Pipoprotein  Pattern  During  Pregnancy 
and  Puerperium.  Clinical  Science  14:15-23, 
February,  1955. 


146 


Illinois  Medical  Journal 


Report  of  a Case  with  an  Unusual  Complieation 


Cystic  Fibrosis  Of  The  Pancreas 

By  Richard  E.  Dukes  , M.D.,  and  Ruth  Stern,  M.D./Urbana 


The  various  clinical  symptoms  of  cystic 
fibrosis  have  been  well  documented  in 
medical  literature  since  their  first  descrip- 
tion in  1936^.  This  hereditary  disease  of 
the  exocrine  glands  is  usually  manifested 
during  the  first  year  of  life  by  both  pul- 
monary and  intestinal  symptoms.  Schwach- 
man^  found  this  symptomatology  existing 
in  80  per  cent  of  his  cases,  with  15  per 
cent  showing  predominantly  respiratory 
symptoms.  Frequently  incorrect  diagnoses 
of  asthma,  chronic  pneumonia,  bronchiect- 
asis, or  even  atypical  tuberculosis  had  been 
made  for  these  patients.  He  reported  the 
cases  of  two  small  infants  whose  presenting 
symptoms  were  hypoproteinemia,  edema, 
and  anemia.  Other  investigators  have  re- 
ported additional  cases  of  hypoproteinemia 
and  edema.3’4'®'®  In  a review  of  children 
with  hypoproteinemia  and  edema,  lacking 
signs  of  proteinuria  or  grossly  faulty  nutri- 
tion, pancreatic  dysfunction  was  the  most 
outstanding  finding.®  Our  case  is  reported 
to  call  attention  to  this  association. 

Case  Report 

The  patient  was  first  seen  in  our  clinic 
on  April  19,  1961,  when  she  was  seven 
months  old.  She  had  been  an  apparently 
normal,  full  term  infant  whose  birth  weight 
was  six  pounds  1 ounce,  and  length  was  19 
inches.  The  mother  had  had  an  uneventful 
primiparous  pregnancy,  and  the  delivery 
was  normal.  Family  history  was  non-in- 
forming. At  the  age  of  two  months  the  in- 
fant had  started  having  severe  respiratory 
infections  which  responded  poorly  to  anti- 
biotic therapy,  and  ultimately  a diagnosis 
of  allergy  to  cow’s  milk  had  been  made. 


As  she  refused  the  various  milk  substitutes, 
her  protein  intake  was  sharply  limited. 

When  we  first  saw  the  child  on  April 
19th,  the  physical  examination  revealed  a 
fairly  well  developed  infant  of  seven 
months.  Her  weight  was  13  pounds  7 ounc- 
es; length,  26  inches;  circumference  of  the 
head,  15^  inches;  and  chest  circumference 
15^  inches.  The  eyes,  ears,  nose  and  throat 
were  normal,  and  her  chest  was  clear  to 
auscultation.  The  heart  rate  and  rhythm 
were  normal,  and  no  murmurs  were  heard. 
The  abdominal  examination  was  negative. 
No  medication  was  prescribed. 

On  April  28th  she  returned  with  acute 
otitis  media.  A myringotomy  was  per- 
formed, and  medication  with  Suspension 
of  Panalba  (Tetracycline  and  Novobiocin) 
was  started. 

On  May  5th  her  ear  drum  had  healed; 
however,  her  temperature  was  elevated  to 
100.2°F.  rectally.  There  was  some  puffiness 
about  her  eyes,  and  there  were  rhonchi 
throughout  both  lung  fields.  Laboratory 
tests  were  scheduled  for  May  9th.  That 
evening,  following  the  removal  of  18  cc. 
of  blood  for  the  tests,  the  infant  started  hav- 
ing rapid,  shallow  respirations.  Her  mother 
was  apparently  unconcerned  and  did  not 
bring  her  in  until  May  12th.  At  that  time 
the  positive  findings  on  physical  examina- 
tion were:  weight,  15  pounds  2i/2  ounces; 
temperature,  101  °F.;  bilateral  serus  otitis 
media;  rales  and  rhonchi  throughout  both 
lung  fields;  ascites  and  pitting  edema  of  the 
extremities. 

The  infant  was  hospitalized  immediately, 
and  a catheterized  urine  specimen  obtained 
as  the  mother  had  been  unable  to  collect 


Rickard  E.  Dukes,  M.D.,  is  Chairman,  Department  of  Pediatrics, 
Carle  Clinic  and  Carle  Foundation  Hospital.  He  received  his  medical 
training  at  the  University  of  Indiana  Medical  School  where  he  served 
a rotating  internship  as  well  as  his  residency  in  pediatrics.  Ruth  Stern, 
M.D.,  collaborated  in  this  preparation  and  was  from  the  Department  of 
Pediatrics,  Carle  Foundation  Hospital. 


for  August,  1968 


147 


a voided  specimen.  Urinalysis  showed  an 
acid  reaction,  albumin  negative,  sugar  2 + , 
acetone  negative,  and  microscopic  negative. 
Glycosuria  persisted  until  May  17th;  subse- 
quent urine  tests  were  negative  for  glucose. 
Several  urinalyses  were  done,  and  at  no 
time  was  albumin  present.  Additional  lab- 
oratory studies  on  May  9th  revealed  a hem- 
oglobin of  10  grams  per  cent;  erythrocytes, 
3,500,000;  leucocytes,  6,800  with  35  per  cent 
neutrophiles;  61  per  cent  lymphocytes;  and 
4 per  cent  monocytes.  Platelets  were  pres- 
ent in  adequate  numbers.  Blood  serum 
cholesterol  was  305  mgm.  per  hundred  cub- 
ic centimeters.  Serum  protein  was  4.2  gms, 
with  2.5  gms.  albumin,  and  1.7  gms.  globu- 
lin. Fasting  blood  sugar  was  175  mgm.  on 
May  12th.  This  test  was  repeated  on  May 
27th,  and  the  fasting  blood  sugar  was  69 
mgm. 

The  blood  urea  on  May  15th  was  10 
mgm.  Blood  serology,  both  Kline  and 
Kahn,  were  negative.  Protein  bound  iodine 
was  9 meg.  per  hundred  cc.  A Fibros  paper 
test  for  detection  of  increased  chloride  ion 
in  the  sweat  was  interpreted  as  negative  on 
May  5th;  however,  this  test  was  repeated 
on  May  27th  at  which  time  it  was  definitely 
positive,  3 + . On  May  26th,  determination 
of  the  sweat  chlorides  using  the  Schales 
method  was  208  mEq.  per  liter. 

Treatment  and  Results 

The  patient  was  treated  with  140  cc.  of 
citrated  whole  blood  on  May  12th,  and 
again  with  120  cc.  on  May  14th.  Total 
serum  protein  on  May  16th  was  4.9  gms. 
with  albumin  3.2  gms.,  and  globulin  1.7 
gms.  She  had  marked  diuresis  following  the 
transfusions,  and  by  May  23rd  her  weight 
was  11  pounds  14  ounces,  a loss  of  three 
pounds  four  and  one  half  ounces.  The  as- 
cites and  edema  had  cleared;  however, 
auscultation  of  her  chest  still  revealed  num- 
erous rales  and  rhonchi. 

A culture  taken  from  the  stomach  wash- 
ings on  May  20th  revealed  a pure  culture 
of  Pseudomonas  aeruginosa.  On  May  25th 
she  was  started  on  Coly-mycin,  (Colisti- 
methate  sodium)  6.25  mgs  given  intramus- 
cularly every  12  hours,  and  her  lung  fields 
started  to  clear  immediately.  She  was  dis- 
charged from  the  hospital  on  May  31st. 

At  the  time  of  her  discharge,  her  weight 
was  12  pounds  9^  ounces  and  her  general 
condition  was  good.  Occasional  rales  in 
both  lung  fields  were  the  only  positive 
physical  findings.  She  was  taking  a Probana 


formula,  and  her  medication  consisted  of 
Zymadrops,  0.6  cc.  three  times  daily; 
Troph-Iron  liquid,  1/2  teaspoon  twice 
daily;  CotazymrB,  one  tablet  with  each 
feeding;  and  syrup  of  Aureomycin,  1/2  tea- 
spoon daily.  A serum  protein  determina- 
tion on  May  29th  showed  the  total  protein 
to  be  5.5  gms.,  of  which  3.5  gms.  was  al- 
bumin, 0.67  gms.  alpha  globulin,  0.72  gms. 
beta  globulin,  and  0.65  gms.  gamma  globu- 
lin. 

Since  her  discharge  from  the  hospital  the 
patient  has  been  followed  as  an  out-patient. 
She  has  had  numerous  respiratory  infec- 
tions and  has  been  under  constant  super- 
vision because  of  her  chronic  ailment. 

Comments 

This  case  report  illustrates  a number  of 
pertinent  points  in  the  diagnosis  and  treat- 
ment of  cystic  fibrosis  of  the  pancreas  in 
infancy.  Care  must  be  exercised  in  using 
the  Fibros  paper  test  to  detect  increased 
chloride  ion  in  the  sweat.  If  the  test  is 
read  as  negative  but  clinical  symptoms  war- 
rant, the  test  should  be  repeated  or  a more 
definitive  sweat  analysis  should  be  per- 
formed. Even  when  the  tests  are  negative, 
caution  must  be  exercised  before  assuming 
that  cystic  fibrosis  does  not  exist.  Goldman 
et  aF  reported  a fibrocystic  infant  with  hy- 
poproteinemia  and  edema  whose  sweat  test 
first  showed  a chloride  content  of  32  mEq. 
per  liter.  The  repeat  sweat  test  made  after 
remission  of  the  edema  showed  a chloride 
content  of  119  mEq.  per  liter. 

As  is  so  often  the  case,  a misdiagnosis  of 
allergy  was  made  for  this  infant.  Allergy 
and  cystic  fibrosis  may  co-exist  in  many  pa- 
tients. This  fact  was  well  demonstrated  in 
a series®  when  the  presence  of  allergy  was 
confirmed  in  47  of  266  patients  with  fibro- 
cystic disease.  It  is  especially  important  that 
all  infants  with  allergic  respiratory  symp- 
toms also  be  checked  carefully  for  cystic 
fibrosis. 

The  dietary  restrictions  of  this  patient, 
and  her  failure  to  take  the  milk  substitutes, 
along  with  her  repeated  infections,  undoub- 
tedly contributed  to  her  hypoproteinemia. 
The  type  of  protein  consumed  might  also 
be  a factor  as  one  fibrocystic  infant  with 
hypoproteinemia  was  found  to  have  ex- 
creted as  much  as  80  per  cent  of  the  in- 
gested nitrogen  as  fecal  nitrogen  while  re- 
ceiving a soybean  formula.^  The  removal  of 
18  cc.  of  blood  from  an  infant  already  show- 


148 


Illinois  Medical  Journal 


ing  some  evidence  of  edema  was  the  final 
factor  in  precipitating  the  anasarca. 

Marie  et  aP  reported  hyperglycemia  in 
one  of  their  cases.  In  our  patient  the  gly- 
cosuria and  hyperglycemia  cleared  spon- 
taneously, but  not  before  causing  consider- 
able confusion.  We  do  not  have  an  ade- 
quate explanation  for  the  cause  of  the  gly- 
cosuria and  hyperglycemia. 

The  use  of  gastric  lavage  to  obtain  stom- 
ach washings  for  culture  should  not  be 
overlooked.  The  finding  of  a pure  culture 
of  pseudomonas  in  the  gastric  washings  of 
this  infant  while  receiving  therapeutic 
doses  of  tetracycline  and  novobiocin  re- 
sulted in  a change  of  therapy.  Coly-mycin 
(colistimethate  sodium),  given  intramuscu- 
larly twice  daily,  had  an  immediate  benefi- 
cial effect,  and  within  six  days  her  lungs 
were  clear  to  auscultation.  This  occur- 
rence further  points  out  the  importance 
of  bacterial  cultures  in  treating  this  con- 
dition. 

Summary 

A case  of  cystic  fibrosis  of  the  pancreas 
with  hypoproteinemia  and  edema  is  pre- 
sented. The  importance  of  differentiating 
cystic  fibrosis  from  allergy  is  emphasized  as 
well  as  the  help  that  may  be  derived  from 
bacterial  cultures.  The  practice  of  using 


stomach  washings  to  obtain  material  for 
culture  from  infants  should  not  be  over- 
looked. 

References 

1.  Fanconi,  G.;  Uehlinger,  E.;  and  Knauer,  C.: 
Das  Coeliakiesyndrom  bei  Angebroener  Zystis- 
cher  Pankreasfibromatose  and  Bronchiektasien, 
Wien.  med.  Wschr.  86:753-756  (July  4)  1936. 

2.  Schwachman,  Harry:  Therapy  of  Cystic  Fibro- 
sis of  the  Pancreas,  Pediatrics  25:155-163  (Jan.) 
1960. 

3.  Marie,  J.;  Salet,  J.;  Debris,  P.;  Hebert,  S.; 
Corbin,  J.  L.;  and  Bezri,  A.:  Les  Formes 
Oedemateuses  avec  Hypoproteinimie  et  Anemie 
de  la  Fibrose  Kystique  du  Pancreas,  Semaine 
des  Hopitaux  de  Paris  35:2140-2146,  June-July 
1959. 

4.  Fleisher,  Daniel  S.;  DiCeorge,  Angelo  M.; 

Auerbach,  Victor  H.;  Huang,  Nancy  N.;  and 
Barness,  Lewis  A.:  Protein  Metabolism  in 

Cystic  Fibrosis  of  the  Pancreas,  Am.  J.  Dis. 
Child.  100:590.  (Oct.)  1960. 

5.  Henderson,  W.:  Fibrocystic  Disease  of  the  Pan- 
creas with  Hypoproteinaemic  Oedema  in 
Early  Infancy.  Proc.  Roy.  Soc.  Med.  48:1107, 
(Dec.)  1955. 

6.  Bille,  B.  S.  V.  and  Vahlquist,  B.:  Idiopathic 
Hypoproteinaemia  Versus  Hypoproteinaemia 
Due  to  Pancreatic  Dysfunction.  Acta  Paediat. 
44:435-443.  1955. 

7.  Goldman,  A.  S.;  Travis,  L.  B.;  Dodge,  W.  F.; 
and  Daeschner,  C.  W.,  Jr.:  Correspondence: 
Falsely  Negative  Sweat  Tests  in  Children  with 
Cystic  Fibrosis  Complicated  by  Hypoproteine- 
mic  Edema,  J.  Pediat.  59:301.  (Aug.)  1961. 

8.  Kulckycki,  L.  L.;  Mueller,  H.;  and  Shwach- 
man,  H.:  Respiratory  Allergy  in  Patients  with 
Cystic  Fibrosis,  I.  A.  M.  A.  175:358-364.  (Feb. 

' 4)  1961. 


Northwestern  Neurologist  Pinpoints  Four 
Critical  Periods  in  the  Life  of  the  Epileptic 


A Northwestern  University  neurophysi- 
ologist has  pinpointed  the  four  critical 
periods  in  the  life  of  the  epileptic. 

Dr.  John  Hughes,  a specialist  in  electro- 
encephalographic  (EEG)  research,  located 
the  danger  periods  in  a study  of  brainwave 
patterns  of  1,355  epileptics. 

The  research  was  singled  out  by  Dr. 
James  A.  Shannon,  director  of  the  National 
Institutes  of  Health  in  Washington,  in  a 
recent  report  to  the  U.S.  Surgeon  General. 
The  Hughes  work  was  performed  under 
an  NJH  grant. 

Dr.  Hughes  found  that  epileptic  brain 
wave  patterns  occur  most  frequently  around 
the  ages  of  six,  14,  35,  and  60.  Epileptic 
seizures  could  be  expected  to  occur  more 
often  in  these  age  periods  than  at  other 
intervals  of  life,  he  reported. 

His  findings  suggest  that  the  four  periods 
are  critical  because  of  external  and  inter- 


nal stresses  facing  epileptics  during  these 
intervals. 

At  six,  he  theorizes,  the  child  has  his 
first  confrontation  with  formal  elementary 
school  education.  At  14,  he  enters  the  hor- 
monal and  behavioral  turmoil  of  adoles- 
cence. 

Around  35,  he  can  anticipate  a peak  in 
his  struggle  to  succeed  professionally  or  a 
period  of  soul-searching  about  his  career 
—under  the  theory  that  if  one  hasn’t  made 
his  mark  by  then,  he  never  will. 

And  at  60,  he  faces  the  prospect  of  re- 
tirement, with  all  of  its  emotional  by- 
products and  feelings  of  uselessness  in  ad- 
dition to  organic  changes  during  the  aging 
process. 

The  full  Hughes  study  was  recently  pub- 
lished in  the  journal,  “Epilepsia,”  the  of- 
ficial scientific  journal  of  the  International 
League  Against  Epilepsy. 


for  August,  1968 


149 


Report  of  a Panel  from  the  Illinois  Psychiatric  Society 


The  Treatment  of  Schizophrenia 

Reported  by  Hyman  L,  Muslin,  M.D. /Chicago 


On  18  October,  1967,  the  Illinois  Psychia- 
tric Society  had  as  its  first  scientific  presen- 
tation of  the  year  a panel  meeting  to  discuss 
the  treatment  of  schizophrenia.  This  meet- 
ing chaired  by  Dr.  Nathaniel  Apter  featured 
Dr.  Peter  Giovacchini  and  Dr.  Daniel  X. 
Freedman  who  presented  their  particular 
overviews  of  the  treatment  of  schizophrenia. 

Dr.  Freedman  presented  his  remarks  first 
and  emphasized  that  “Currently,  treatment 
for  those  disorders  called  schizophrenia  can- 
not be  directly  coupled  with  questions  about 
etiology.  There  are  several  schizophrenias 
probably  determined  by  the  relative  weight- 
ing of  genetic,  neonatal,  experiential,  psy- 
chosocial, as  well  as  biochemical  factors. 
Really  conclusive  evidence  for  the  specific 
role  of  any  factor  is  lacking.  The  only  credi- 
bly solid  advance  has  been  in  the  field  of 
the  potent  tranquilizers  which  freqently  aid 
but  do  not  insure  cure  . . Dr.  Freedman 
then  pointed  out  that,  “.  . . the  patient's 
needs  and  his  assets  and  liabilities  for  ad- 
justment are  practically  assessed,  and  from 
the  range  of  available  treatment  strategies, 
selections  are  made.”  Continuing  along  this 
line  Dr.  Freedman  pointed  out  that,  “The 
objective  evidence  (Davis,  J.M.:  Arch.  Gen. 
Psychiat.,  13:552,  1965)  clearly  indicates 
that  appropriate  phenothiazine  treatment  is 
a definite  advantage  in  most  schizophren- 
ias.” 

Dr.  Freedman’s  thoughts  about  the  rela- 
tive merit  of  psychotherapy  were  continued 
in  the  following  remarks,  “Classical  psycho- 
analysis can  refer  to  theory  or  to  Freud’s 
clinical  method.  He  did  not  recommend  the 


Hyman  Muslin,  M.D.,  is  Associate  Professor 
of  Psychiatry,  the  University  of  Illinois  at  the 
Medical  Center.  He  received  his  M.D.  from  the 
University  of  Illinois  and  took  his  internship 
at  Cook  County  Hospital  and  his  residency  in 
Psychiatry  at  the  University  of  Illinois. 


method  for  the  major  psychoses  since  the 
procedure  requires  considerable  personality 
strength  and  sustained  ability  to  make  dis- 
tinctions in  reality.  Selecting  elements  from 
the  classical  approach,  some  skilled  thera- 
pists of  schizophrenic  patients  have  applied 
—not  imitated— the  techniques  and  princi- 
ples of  psychoanalysis.  Appropriate  talking 
therapies  can  assist  some  patients  (even  the 
schizophrenic)  to  improve,  yet  occasionally 
patients  may  decompenstate  just  as  with 
other  therapies.  There  is  no  evidence  that 
suicide  is  more  closely  associated  with  one 
rather  than  another  therapy;  rather  suicide 
is  associated  with  a variety  of  stresses  and 
disorders.” 

Dr.  Freedman  summarized  his  comments 
about  psychoanalytic  treatment  in  the  fol- 
lowing manner:  “Any  systematic  use  of  psy- 
choanalytically  informed  therapy  is  in  my 
opinion  useful  on  occasion  and  any  strictly 
psychoanalytic  procedure  is  investigational.” 

Schizophrenic  Patients  Can  Be  Treated 

Dr.  Giovacchini’s  remarks  emphasized  to 
the  contrary  that,  “More  analysts  today  be- 
lieve that  many  schizophrenic  patients  pre- 
viously thought  inaccessible  to  psychoanaly- 
sis can  be  so  treated.  Schizophrenic  patients 
may  seek  and  benefit  from  a therapeutic  re- 
lationship that  does  not  include  advice  to 
relatives,  elimination  of  tension  states  and 
symptoms  before  their  adaptive  significance 
can  be  understood  (as  sometimes  happens 
with  tranquilizers),  or  any  activity  designed 
to  manage  their  lives.” 

Dr.  Giovacchini  felt  that  treatment  ap- 
proaches in  schizophrenia  in  many  instances 
is  eclectic  unnecessarily  and  the  eclectic  ap- 
proach bypasses  coming  to  grips  with  the 
fundamental  causes,  namely,  the  intra- 
psychic malfunctioning.  In  his  words,  “It 
has  often  been  stated  that  not  too  much  is 
known  about  its  intrapsychic  aspects.  This 
raises  several  questions: 


150 


Illinois  Medical  Journal 


1)  The  intriguing  question  as  to  the  type 
of  data  required  to  gain  more  infor- 
mation. 

2)  The  relevance  of  such  knowledge  to 

therapeutic  approaches. 

S)  What  constitutes  improvement  be- 
yond conformity  and  superficial  social 
adjustment. 

He  went  on  to  state,  “The  first  two  ques- 
tions are  interrelated  and  can  be  partially 
answered  together.  Intrapsychic  aspects  re- 
fers to  psychic  processes  determined  by 
archaic  ego  levels  that  are  reproduced  in 
the  transference.  In  psychoanalysis  the 
transference  recapitulates  infantile  traumas 
and  disruptive  object  (interpersonal)  re- 
lationships that  determine  later  psycho- 
pathology. To  learn  about  these  etiological 
factors  one  has  to  offer  the  patient  an  an- 
alytic setting.  Investigative  approaches  and 
therapy  are  congruent.  The  transference 
relationship  is  the  most  relevant  tool  we 
have  to  learn  about  intrapsychic  processes 
and  character  structure  from  a microscopic 
viewpoint.” 

“Improvement  can  thus  be  viewed  in 
terms  of  structural  changes  rather  than  mere 
phenomenology.  Again  this  assessment  re- 
quires the  transference  setting.  One  can 
look  at  changes  from  a gross  viewpoint  but 
as  in  medicine  the  disappearance  of  symp- 
toms does  not  necessarily  indicate  that  the 
patient  is  fundamentally  better.  The  trans- 
ference offers  us  the  opportunity  of  observ- 
ing changes  that  are  not  phenomenologi- 
cally apparent.  It  is  analogous  to  a micro- 
scope. One  can  infer  considerably  about 
micro-organisms  but  to  see  them  one  re- 
quires a special  instrument.” 

As  a brief  example  of  some  aspects  of 
clinical  material  that  emerges  in  a psycho- 
analytic setting  Dr.  Giovacchini  gave  the  fol- 
lowing, “A  videotaped  interview  of  a with- 
drawn schizophrenic  supplies  the  data  to 
illustrate  certain  aspects  of  the  analytic  set- 
ting which  I believe  make  it  possible  to 
treat  more  such  patients  than  is  initially 
believed.  If  the  patient  allows  the  therapist 
not  to  intrude  in  his  psychopathological 
frame  of  reference,  then  it  becomes  possible 
to  establish  a therapeutic  relationship.  In- 
trusion means  becoming  involved  with  the 
patient’s  content  rather  than  focusing  upon 
its  intrapsychic  sources  and  adaptive  value. 
Having  told  the  patient  that  he  could  with- 


draw to  reveal  himself  as  he  chooses  caused 
him  to  become  agitated  and  unable  to  main- 
tain apathy.  He  became  aware  of  some  au- 
tonomy which  had  been  submerged  by  a 
defensive,  super-structure.  This  created  con- 
flict (ambivalence  about  symbiotic  fusion) 
but  also  a realization  that  the  psychopatho- 
logical world  was,  at  the  moment,  his  crea- 
tion. By  not  entering  his  world  the  intra- 
psychic sources  of  his  difficulties  were  high- 
lighted and  he  became  therapeutically  ac- 
cessible.” 


Treatment  Plans 

The  discussion  from  the  floor  and  from 
the  principal  speakers  (including  Dr.  Apter) 
made  it  clear  that  in  discussing  the  treat- 
ment of  schizophrenia  the  focus,  i.e.,  the 
material  for  discussion,  has  to  be  sharply 
defined.  Dr.  Giovacchini’s  frame  of  refer- 
ence, the  focus  on  the  intrapsychic  aspects 
of  mental  functioning,  including  the  func- 
tioning of  the  schizophrenic  as  valid  data 
for  analysis  is  not  Dr.  Freedman's  focus  per 
se.  Dr.  Freedman’s  view  represents  an  at- 
tempt to  assess  the  multitude  of  variables 
serving  as  causal  factors  and  serving  to  in- 
fluence the  course  of  treatment.  Treatment 
for  Dr.  Freedman  implies  reduction  in 
symptoms  of  disordered  interpersonal  rela- 
tionships and  ability  to  function,  i.e.,  a treat- 
ment plan  may  include  a variety  of  treat- 
ments perhaps  including  intensive  psycho- 
therapeutic work. 


Summary 

Dr.  Apter  and  Dr.  Daniels  summarized 
the  results  of  the  meeting  appropriately  by 
reminding  the  audience  that  achieving  a 
synthesis  of  differing  points  of  view  is  some- 
times unattainable  especially  in  complex 
areas  of  diagnosis  and  treatment.  From  an- 
other point  of  view,  Drs.  Giovacchini  and 
Freedman’s  research  approaches  and  re- 
search goals  in  this  area  more  clearly  define 
their  interests;  Dr.  Giovacchini's  research 
leads  him  to  defining  the  nature  of  the  intra- 
psychic experiences  and  processes  in  the 
schizophrenic.  Dr.  Freedman’s  research 
leads  him  to  defining  and  describing  neuro- 
physiologic, biochemical,  social  and  intrap- 
sychic mechanisms  some  necessary,  some 
sufficient  in  the  production  and  mainte- 
nance of  the  schizophrenic  disorders. 


for  August,  1968 


151 


Cancer  of  the  Breast.  By  John  S.  Spratt, 
Jr.,  and  William  L.  Donegan.  Volume  V 
in  the  series,  “Major  Problems  in  Clinical 
Surgery”  edited  by  J.  Englebert  Dunphy. 
W.  B.  Saunders  Co.,  Philadelphia,  1967. 
This  volume  is  No.  V in  a series  of  mono- 
graphs, “Major  Problems  in  Clinical  Sur- 
gery.” The  high  calibre  of  presentation  es- 
tablished by  the  previous  four  volumes  has 
been  maintained  in  this  latest  publication 
under  the  supervision  of  the  consulting  edi- 
tor, Dr.  J.  Englebert  Dunphy. 

The  authors  have  reviewed  the  subject  of 
mammary  cancer  and  have  based  their  pres- 
entation on  information  from  the  literature 
and  clinical  material  from  the  Ellis  Fischel 
State  Cancer  Hospital.  They  have  gathered 
together  an  impressive  amount  of  informa- 
tion and  presented  it  in  a concise  and  under- 
standable manner.  The  book  is  well  orga- 
nized and  well  illustrated. 

The  first  chapter  which  deals  with  the 
anatomy  of  the  breast  includes  a lucid  de- 
scription of  the  lymphatic  and  vascular  sup- 
ply of  the  breast.  The  next  chapter  is  con- 
cerned with  epidemiology  of  mammary 
cancer.  The  presentation  concerned  with 
diagnosis  is  particularly  well  illustrated. 
The  diagnostic  value  of  mammography, 
thermography,  and  cytology  are  thought- 
fully evaluated. 

A section  which  describes  the  pathology 
of  mammary  carcinoma  was  written  by  Doc- 
tor Carlos  Perez-Mesa,  Chief  Pathologist  of 
the  Ellis  Fischel  Hospital,  and  correlates  the 
prognosis  with  various  types  of  breast  can- 
cer. 

The  surgical  techniques  which  are  de- 
scribed include  not  only  mastectomy,  but 
oophorectomy,  and  adrenalectomy. 

Staging  and  end  results  are  given  ade- 
quate consideration.  There  are  a few  minor 
discrepancies  in  this  portion  of  the  book. 
The  author  states  that  there  has  not  been  a 


sufficient  lapse  of  time  to  allow  adequate 
evaluation  of  the  so-called  “modified”  radi- 
cal mastectomy,  and  yet  later  states  that  “it 
appears  likely  that  the  modified  procedure 
may  play  an  increasing  role  in  the  treatment 
of  early  mammary  cancer”.  This  is  in  con- 
trast to  most  of  the  highly  objective  discus- 
sion elsewhere  in  the  book. 

The  role  of  radiation  therapy  receives  at- 
tention. Mammary  cancer  and  pregnancy, 
cancer  of  the  second  breast,  recurrent  dis- 
ease, sarcoma  of  the  breast  are  discussed. 

Endocrine  ablation,  hormone  therapy, 
and  chemotherapy  receive  appropriate  at- 
tention, and  a plan  of  management  for  pa- 
tients with  disseminated  mammary  cancer  is 
presented 

The  final  chapter  is  a useful  presentation 
of  statistical  methods  in  cancer  research  as 
applied  to  breast  cancer  and  should  be  of 
value  to  anyone  who  is  assembling  data  in 
this  or  related  fields. 

Each  chapter  is  followed  by  a carefully  se- 
lected bibliography. 

The  volume  is  recommended  to  those  who 
are  interested  in  breast  cancer  and  should 
be  of  particular  value  to  physicians  in  resi- 
dency training. 

John  M.  Beal,  M.D. 

A small  brochure,  entitled  “What’s  New 
on  Smoking  in  Films”  has  been  issued  by 
the  Department  of  HEW,  Public  Health 
Service,  4040  N.  Fairfax  Dr.,  Arlington,  Va. 
22203.  Listed  are  films  and  filmstrips  of 
the  member  agencies  of  the  National  In- 
teragency Council  on  Smoking  and  Health. 
The  subjects  cover  a wide  range  of  inter- 
ests and  are  directed  to  many  audiences, 
including  both  young  people  and  adults, 
smokers  and  non-smokers.  “What’s  New 
on  Smoking  in  Print,”  a companion  leaflet, 
is  also  available. 


152 


Illinois  Medical  Journal 


iHiiW 


Surgical  Grand  Rounds  are  held  weekly 
on  Saturday  at  8:00  A.M.,  alternating  be- 
tween the  Staff  Room,  Chicago  Wesley 
Memorial  Hospital  and  Offield  Auditor- 
ium, Passavant  Memorial  Hospital.  Patient 
presentations  from  these  hospitals  and 
from  the  Veterans  Administration  Re- 
search Hospital  form  the  basis  of  the  dis- 
cussions. This  case  report  was  part  of  the 
Surgical  Grand  Rounds  held  at  Passavant 
Memorial  Hospital  on  November  18,  1967. 

Case  Presentation: 

Dr.  Charles  McHagh:  The  patient,  a 57 
year  old  salesman,  entered  Passavant  Hos- 
pital with  a chief  complaint  of  pain  in 
his  left  leg.  Approximately  three  years  be- 
fore his  admission  he  had  the  onset  of  back 
pain,  which  radiated  to  his  left  hip,  to  the 
left  anterior  lateral  thigh  and  later  into 
the  calf  of  the  left  leg.  At  first  he  noted 
this  pain  only  when  playing  golf  so  that 
he  could  play  only  five  holes.  Over  the 
following  three  years  the  pain  increased 
in  severity  so  that  he  was  able  to  walk 
only  about  50  feet  when  admitted.  He 
described  the  pain  as  sharp  and  cramping 
pain  in  the  calf  and  relieved  by  rest.  In 
addition  to  the  pain  associated  with  exer- 
tion, he  also  noticed  a constant  discomfort 
in  the  calf,  and  at  night  he  was  frequently 
awakened  by  a pain  in  the  calf  which  was 
relieved  by  flexing  his  legs  repeatedly.  He 
has  been  impotent  for  a three  year  period. 

Examination  at  the  time  of  admission 
revealed  blood  pressure  160/90  and  pulse 
90.  The  fundi  demonstrated  mild  athero- 
sclerotic changes  of  the  retinal  vessels.  Chest 
and  abdomen  were  normal.  In  the  ex- 
tremities the  only  significant  findings  were 
limited  to  the  left  lower  extremity  where 
femoral,  popliteal,  dorsalis  pedis,  and  pos- 
terior tibial  pulses  were  present  but  di- 
minished. Neither  trophic  changes  nor 
atrophy  of  the  musculature  of  the  left  leg 
were  present.  Diminished  dorsal  flexion  of 
the  left  foot  was  detected.  The  oscillometry 
was  diminished  in  the  left  calf.  Neurologi- 
cal examination  demonstrated  a slight  loss 
of  vibratory  sense  in  the  left  lower  extrem- 
ity and  slightly  diminished  competence  in 
straight  leg  raising  on  the  left  with  discom- 
fort in  the  low  back  with  forced  dorsal 
flexion.  Laboratory  examination  revealed 
a diabetic  glucose  tolerance  test.  An  elec- 


Neurogenic  Claudication 

trocardiogram  was  unremarkable.  Electro- 
myography demonstrated  a general  slowing 
of  nerve  conduction,  particularly  in  the 
lower  extremities.  A number  of  x-ray 
studies  were  obtained. 

Dr.  Hirsch  Handmaker:  The  lumbar 
spine  radiograms  show  bilateral  facet 
changes,  with  narrowing  and  minimal  re- 
active sclerosis.  The  left  hip  demonstrates 
joint  space  narrowing  and  considerable 
proliferative  change  and  an  appearance 
suggesting  old  slipped  capital  femoral  epi- 
physis. A right  retrograde  femoral  injec- 
tion of  contrast  media  was  performed,  and 
normal  left  iliac  superficial  and  deep  fe- 
moral arteries  were  outlined  by  reflux  into 
the  aorta  and  crossover.  The  entire  right 
iliac  deep  and  superficial  femoral  arteries 
and  their  branches  were  normal.  Neither 
side  showed  intimal  irregularities.  A lum- 
bar myelogram  was  performed  next  and 
showed  asymmetry  at  the  L4  level  on  the 
right  with  a filling  defect  strongly  sugges- 
tive of  an  extradural  lesion,  most  likely 
herniation  of  the  L4  nucleus  pulposus 
(Eig.  1).  Additionally  there  is  questionable 
extrinsic  pressure  at  L5  on  the  right. 


Fig.  1 : View  obtained  when  lumbar  myelo- 
gram was  performed  is  compatible  with  hernia- 
tion of  L4  nucleus  pulposus. 


154 


Illinois  Medical  ]ournal 


Dr.  Nicholas  Wetzel:  A hemilaminec- 
tomy was  planned.  The  operation  was  be- 
gun with  the  patient  in  the  customary 
prone  position.  The  patient  had  a rather 
large  abdomen.  After  the  patient  had  been 
anesthetized,  the  anesthesiologist  reported 
considerable  irregularity  of  pulse.  The  pa- 
tient was  removed  from  the  operating 
table.  Pulse  and  blood  pressure  were  found 
to  be  normal  so  that  he  was  repositioned 
and  operated  upon  in  a lateral  position. 
This  is  a very  reasonable  way  to  operate 
on  people,  particularly  obese  people,  and 
is  probably  harder  on  the  surgeon  than  it 
is  on  the  patient.  Patients  breathe  better 
when  they  are  lying  on  the  side  rather  than 
prone,  particularly  if  they  have  a large  ab- 
domen. The  lateral  position  relieves  pres- 
sure on  the  abdomen  which  may  cause 
venous  congestion  in  the  extradural  veins 
and  create  technical  difficulty.  We  in- 
spected the  L4-5  interspace  and  found  a 
bulging,  rather  lumpy  anulus,  opened  this 
and  removed  a moderate  amount  of  soft, 
obviously  degenerating  disc  material.  His 
postoperative  course  was  quite  uneventful 
and  he  has  been  relieved  of  his  pain  on 
walking.  He  has  been  able  to  return  to 
his  work. 

The  causes  of  back  pain  and  sciatica  are 
varied.  There  are  even  recent  reports  from 
Philadelphia  of  some  patients  with  herni- 
ated nuclei  in  the  cervical  region  associated 
with  fairly  typical  sciatica.  They  were  re- 
lieved of  their  sciatica  by  an  operation  on 
their  neck.  The  case  which  has  been  pre- 
sented illustrates  the  need  to  distinguish 
vascular  disease  from  herniated  nucleus 
pulposus.  An  occasional  patient  with  vas- 
cular disease  has  been  subjected  to  opera- 
tion for  herniated  disc. 

Sciatica  has  been  attributed  to  many 
causes.  At  one  time  a group  of  orthopedic 
surgeons  considered  sciatica  to  be  caused  by 
a disturbance  of  the  lumbosacral  joint.  A 
variety  of  operations  were  proposed.  Over 
30  years  ago  Doctors  Mixter  and  Barr  of 
Boston  described  the  symptom  complex 
associated  with  herniated  nucleus  pulposus. 
Unfortunately  many  consider  all  back  pain 
and  sciatica  as  being  due  to  the  herniated 
nucleus.  This  is  certainly  not  true  because 
anything  that  impinges  on  the  appropriate 
nerve  root  can  cause  sciatic  radiation  of 
pain.  A serious  problem  is  found  in  pa- 
tients with  retroperitoneal  malignancies. 
An  accurate  diagnosis  may  be  difficult.  We 


managed  to  collect  a series  in  which  pre- 
sumably competent  surgeons,  including 
ourselves,  had  operated  upon  people  for 
herniated  nucleus  and  then  subsequently 
discovered  that  they  had  a retroperitoneal 
malignancy.  This  patient  today  illustrated 
that  herniated  nucleus  can  mimic  vascular 
disease. 

I find  that  intermittent  claudication  is 
a misnomer.  Claudication  comes  from  the 
Latin  meaning  to  limp.  These  people  don’t 
limp  so  much  as  they  just  stop  walking. 

Dr.  John  Beal:  Dr.  Conn  was  involved 
in  the  evaluation  of  the  patient  and  per- 
formed the  angiograms  in  association  with 
the  radiologist. 

Dr.  Julius  Conn:  This  patient’s  physi- 
cal findings  were  responsible  for  the  initial 
impression  that  he  had  vascular  disease. 
In  addition  he  had  typical  rest  pain.  He 
would  awaken  at  night  with  pain  and  hang 
his  feet  over  the  side  of  the  bed  much 
as  people  will  with  vascular  insufficiency. 
The  arteriogram  on  this  patient  illustrates 
certain  diagnostic  points.  It  seemed  inad- 
visable to  perform  a translumbar  aorto- 
gram  because  of  the  vagaries  of  his  back 
pain  and  hip  pain.  Therefore,  the  ap- 
parently normal  femoral  artery  was  can- 
nulated  and  a retrograde  injection  was 
done  which  visualized  the  opposite  side. 
This  demonstrated  a normal  aorto-iliac  seg- 
ment and  good  distal  vessels. 

The  diagnosis  of  neurogenic  claudication 
is  a term  coined  by  an  English  neurosur- 
geon. Three  case  reports  now  appear  in 
the  British  literature.  This  symptom  com- 
plex has  been  found  with  herniated  discs 
and  with  arachnoiditis.  The  elimination  of 
occlusive  peripheral  arterial  disease  by  ar- 
teriogram is  essential.  The  presence  of 
pulse  at  rest  is  not  enough.  TTis  patient 
was  exercised  and  his  pulses  did  not  dis- 
appear. Many  patients  who  complain  of 
claudication  about  the  hip  will  have  nor- 
mal pulses  and  yet  have  iliac  obstruction. 
If  they  exercise  their  peripheral  pulse  will 
disappear.  The  English  have  reported  that 
exercise  to  the  point  of  pain  will  accen- 
tuate the  neurologic  findings. 

In  addition  to  the  causes  of  sciatica  men- 
tioned by  Dr.  Wetzel,  hypogastric  aneurysm 
may  be  added,  which  may  cause  typical 
sciatic  distribution  pain  when  the  aneurysm 
impinges  on  the  sciatic  nerve. 

Dr.  John  Beal: Dr.  Conn,  are  there  any 
clinical  features  of  the  pain  in  a patient 


/or  August,  1968 


155 


* 


with  claudication  that  might  arouse  sus- 
picion of  neurogenic  rather  than  vascular 
origin? 

Dr.  Julius  Conn:  Usually  pain  of  neu- 
rogenic origin  will  be  located  in  anterio- 
lateral  portion  of  the  thigh,  and  progresses 
from  a proximal  to  a distal  location.  Vas- 
cular pain  usually  arises  first  in  the  calf 
and  progresses  proximally.  Vascular  pain 
is  commonly  described  as  an  aching  pain 
\ rather  than  the  burning  pain  associated 
with  nerve  disease.  The  most  significant 
physical  finding  in  a patient  with  neuro- 
genic pain  is  the  presence  of  normal  iliac 
femoral  popliteal  pulses  bilaterally,  at  rest 
and  after  exercise. 

Dr.  Joseph  Sherrick:  Ihe  histopatho- 
logical  findings  in  degeneration  of  the  nu- 
cleus pulposus  are  not  well  described  in 
textbooks.  Normally  the  intervertebral  disc 
is  composed  of  a peculiar  type  of  fibrocar- 
tilage.  In  Figure  2 fragmentation,  fibrillar 
degeneration  and  condensation  at  the  edges 


of  the  fragment  are  demonstrated.  These 
are  the  changes  associated  with  herniation. 


Fig.  2:  Microscope  examination  of  interver- 
tebral disc  demonstrates  degeneration  in  fibro- 
cartilage  of  the  disc. 


Inpatient  Unit  for  Retarded 
Children  Opens  in  Springfield 


The  first  inpatient  habit-training  unit 
for  mentally  retarded  children  in  the  Il- 
linois mental  health  zone  system  was 
opened  recently  at  the  Andrew  McFarland 
Zone  Center  in  Springfield. 

The  new  unit,  Stephen  A.  Douglas  Flail, 
is  the  fourth  inpatient  unit  to  be  opened 
at  the  center  and  will  service  the  18  coun- 
ties of  Zone  V in  west-central  Illinois. 

“The  program  for  these  children  will 
provide  intensive  training  in  meeting  such 
personal  needs  as  dressing,  toileting,  bath- 
ing and  feeding,”  Dr.  Charles  E.  Beck, 
Zone  V director,  said.  “We  expect  the  train- 
ing period  will  range  from  three  to  six 
months  for  most  children  involved  in  the 
program.” 

The  training  program  will  be  open  to 
mentally  retarded  children,  ages  three 
through  15,  from  Adams,  Brown,  Hancock, 
Pike,  Schuyler,  Calhoun,  Cass,  Greene, 
Jersey,  Morgan,  Scott,  Logan,  Mason,  Men- 
ard, Sangamon,  Christian,  Macoupin  and 
Montgomery  Counties. 

“One  of  the  major  problems  confronting 
families  of  mentally  retarded  children  is 
management,  both  in  the  home  and  the 
community,”  Beck  said.  “If  a retarded  child 


can  be  taught  ways  to  meet  these  vital, 
everyday  needs,  his  chances  of  becoming  a 
lifetime  resident  of  a state  institution  are 
reduced  greatly  and,  hopefully,  elimin- 
ated.” 

Beck  said  one  of  the  most  important  as- 
pects of  the  new  program  will  be  the 
mother’s  direct  participation  in  her  child’s 
training  program.  Whenever  possible,  the 
mother  or  person  directly  responsible  for 
the  child’s  care  at  home  will  be  encouraged 
to  take  part  in  the  program  on  a daily  ba- 
sis, he  explained. 

“By  learning  the  specific  techniques  the 
training  team  used  to  develop  these  habits, 
the  mother  will  be  able  to  follow  through 
successfully  when  the  child  returns  home,” 
the  director  said. 

If  commuting  problems  prevent  a moth- 
er from  regular  participation,  arrangements 
will  be  made  so  she  can  take  part  in  the 
training  program.  Beck  said. 

In  addition  to  the  new  unit,  McFarland 
also  operates  three  other  inpatient  units 
offering  diagnostic  and  short-term  treat- 
ment to  children  through  age  12  years; 
adolescents,  ages  13  through  17;  and  adults 
from  Macoupin,  Montgomery  and  Chris- 
tian Counties. 


156 


Illinois  Medical  Journal 


Illinois  Medicine  - A Century  Ago 


By  W.  D.  Snively,  Jr.,  M.D.,  F.A.C.P.  and  Barbara  Becker,  B.A./Evansville,  Ind. 


To  envision  what  it  was  like  to  practice 
medicine  in  Illinois  a century  ago,  let  us 
focus  on  the  decade  between  1860  and 
1870;  that  period  in  which  the  United 
States  suffered  a hideous  Civil  War  which 
threatened  the  very  future  of  the  nation, 
Pasteur  discovered  anaerobic  bacteria.  Lis- 
ter introduced  antiseptic  surgery,  Hoff- 
mann discovered  formaldehyde,  and  Lie- 
breich  demonstrated  the  hypnotic  effects  of 
chloral  hydrate. 

As  the  bells  tolled  in  the  first  year  of 
that  eventful  decade,  most  Illinois  doctors 
could  easily  remember  the  rough  pioneer 
times.  Only  15  years  before.  Dr.  Patrick 
Gregg,  respected  physician  of  Rock  Island, 
had  attended  Col.  George  Davenport,  re- 
vered Indian  trader  and  founder  of  Daven- 
port, Iowa  after  “Banditti  of  the  Prairie”, 
who  were  later  to  hang  for  their  crime,  at- 
tacked the  good  colonel  in  his  island  home. 
After  shooting  him  through  the  thigh,  beat- 
ing him  and  pouring  water  over  him  they 
took  all  the  valuables  in  the  house  and  fled. 
We  can  be  sure  that  Dr.  Gregg  put  a tourni- 
quet on  the  colonel’s  thigh,  gave  him  stim- 
ulants and  did  all  then  possible.  To  sur- 
vive, the  patient  needed  a skilled  operating 
team  in  a modern  hospital.  Neither  was 
available  nor  would  they  be  for  many  years 
to  come.  Colonel  Davenport— and  thou- 
sands like  him— could  not  wait. 

Today,  most  of  us  feel  that  we  live  in 
haza»dous  times.  The  toll  of  death  and  in- 
juries from  traffic  accidents  appalls  us. 
The  world  finds  itself  in  a state  of  turmoil 
abounding  in  wars  and  threats  of  wars. 
The  menace  of  bombs  riding  interconti- 
nental missiles  hangs  over  us.  Many  believe 
that  the  stresses  of  modern  living  con- 
tribute to  such  ailments  as  peptic  ulcer, 
neurosis,  and  coronary  artery  disease. 

Not  surprisingly  then,  we  sometimes  gaze 
nostalgically  at  the  19th  Century.  We  pic- 
ture heartwarming  Currier  and  Ives  scenes: 
“Home  to  Thanksgiving,”  “A  Home  in  the 
Country,”  “Skating  in  Central  Park,” 
scenes  of  hunting  in  the  virgin  forests,  fish- 
ing in  roiling  streams,  pursuing  buffalo  on 


broad  prairies.  Continuing  our  contempla- 
tion of  the  past,  wintertime  vignette  of 
drifting  snow,  sleigh  bells  and  bountifully 
festive  tables  flow  before  our  mind’s  eye. 
But,  a forbidding  spector  stands  in  the 


background  of  each  cheery  scene,  its  grim 
presence  more  a threat  to  life  and  limb 
than  all  today’s  hazards  to  health  added  to- 
gether. That  spector  was  disease,  but  not 
disease  as  we  know  it  today. 

THE  AHAIENTS 

Disease  of  the  1860s  revealed  its  ugly  face 
in  many  ailments,  most  of  them  striking 
down  infants,  children  and  young  people. 
An  appalling  percentage  of  infants  died, 
chiefly  because  of  primitive  sanitation  and 
fulminating  infections.  The  grisly  hand  of 
disease  might  strike  anyone  at  any  time 
with  ague,  or  abscesses,  buboes  or  consump- 
tion, Asiatic  cholera,  erysipelas,  malaria, 
milk  sickness,  pneumonia,  scarlet  fever, 
smallpox,  scrofula,  scurvy,  and  the  stran- 
gling diptheria.  Surgery,  in  truth  a last  re- 
sort, was  primitive,  and  accompanied  by  an 
awesome  mortality  rate. 

Inevitably,  our  19th  Century  forebearer’s 
lives  were  deeply  involved  with  disease.  A 
letter  written  to  Mrs.  Margaret  T.  Lam- 
phier,  daughter  of  John  Hart  Crenshaw,  of 
Shawneetown,  by  her  sister-in-law,  Ade- 


for  August,  1968 


157 


line  Crenshaw,  gives  an  intimate  view  of 
its  terror.  She  wrote: 

“We  have  been  very  much  troubled 
with  sickness  this  summer;  Margaret 
Ann  and  Mary  Lawler  are  both  sick  but 
I do  not  think  dangerously.  Little  Sis  is 
very  ill;  she  has  been  so  three  days  and 
without  a great  change.  Soon  I fear,  we 
shall  lose  her." 

“I  began  this  letter  yesterday,  but  Sis  got 
so  much  worse  I had  to  quit  and  she  is 
but  little  better  today.  She  had  a very 
hard  fit  and  about  50  spasms.  She  has 
no  fever  today,  but  is  perfectly  exhaus- 
ted for  want  to  sleep,  as  she  is  so  trou- 
bled with  worms  she  gets  choked  every 
few  minutes ...  I am  very  uneasy  about 
her.  If  she  does  not  get  a great  deal  bet- 
ter soon,  she  can’t  live  long." 

Asiatic  cholera  frequently  visited  Illinois. 
This  diarrheal  disease  repeatedly  swept 
over  the  world  in  great  pandemics,  often 
killing  its  victims  in  less  than  one  day. 
Four  centuries  before  Christ,  someone  de- 
scribed a patient  with  cholera  thus: 

“The  lips  blue,  the  face  haggard,  the 
eyes  hollow,  the  stomach  sunk  in,  the 
limbs  contracted  and  crumpled  as  if  by 
fire,  those  are  the  signs  of  the  great  ill- 
ness which,  invoked  by  a malediction  of 
the  priests,  comes  down  to  slay  the 
braves.  . .” 

Doctors  of  the  sixties  could  remember 
all  too  well  the  terrible  cholera  epidemic 
of  1854,  and  they  knew  that  the  scourge 
could  return  at  any  time.  Cholera  plagued 
the  entire  Midwest  until  about  1875  when 
improved  sanitation  dispelled  the  filth  that 
caused  the  epidemics. 

Milk  Sickness 

Milk  sickness  remained  a dreaded  plague 
in  rural  areas  during  the  decade  of  the  six- 


ties although  its  incidence  had  decreased 
from  the  early  pioneer  days  when  it  was 
probably  a leading  cause  of  death.  Older 
doctors  remembered  how  it  killed  one  of 
four  in  some  pioneer  communities;  how 
Abraham  Lincoln’s  mother,  great  aunt, 
great  uncle  and  two  neighbors  died  from  it 
in  1818  in  one  six-week  period.  Milk 
sickness  followed  the  drinking  of  milk  from 
cows  which  had  eaten  white  snakeroot,  a 
lovely,  inoffensive-looking  flowering  plant 
with  a faint  aroma  of  lilacs.  Even  today, 
white  snakeroot  abounds  in  the  Illinois 
countryside;  take  a leisure  drive  in  the 
autumn  and  you  will  see  it  in  shady  zones 
along  the  roadsides. 

Malaria,  too,  remained  a feared  disease 
during  the  sixties  and  later.  Dr.  C.  D. 
Johnson,  who  practiced  in  Champaign 
County,  was  to  write  in  his  memoirs: 
“Towards  the  close  of  the  summer  in 
1872  came  the  last  general,  extensive 
endemic  of  malaria  fever  experienced  in 
Central  Illinois.  This  endemic  lasted 
from  the  last  days  of  July  to  the  coming 
of  a killing  frost  and  within  the  bounds 
of  my  practice  I think  almost  no  one 
escaped  an  attack." 

An  integral  part  of  the  life  of  the  time, 
malaria  received  little  more  attention  by 
many  writers  than  the  common  cold  does 
today.  A writer  described  children  with 
malaria  thus: 

“. . . as  we  drew  near  Burlington  [Iowa] 
in  front  of  a little  hut  on  the  river  bank, 
sat  a girl  and  a lad— most  pitiable  look- 
ing objects,  uncared  for,  hollowed  eyed, 
sallow-faced.  They  had  crawled  out 
into  the  warm  sun  with  chattering  teeth 
to  see  the  boat  pass.  To  a Mother’s  in- 
quiries, the  captain  said:  ‘If  you’ve  never 
seen  that  kind  of  sickness  I reckon  you 
must  be  a Yankee.  That’s  the  ague.  I’m 


W.  D.  Snively,  M.D.  (left)  is  Clinical  Pro- 
fessor of  Pediatrics,  th®  University  of  Alabama 
Medical  Center  and  Vice  President  of  Medical 
Affairs,  Mead  Johnson  International.  He  is  a 
noted  historian.  Mrs.  Barbara  Becker  (right) 
is  Supervisor,  Medical  Affairs,  the  Mead  John- 
son International.  She  is  a graduate  of  the 
University  of  Evansville.  This  article  is  one  of 
a continuing  series  in  honor  of  Illinois’  Ses- 
quicentennial. 


158 


Illinois  Medical  Journal 


feared  you  will  see  plenty  of  it,  if  you 
stay  long  in  these  parts.  They  call  it 
here  the  swamp  devil  and  it  will  take 
the  roses  out  of  the  cheeks  of  these 
plump  little  ones  of  yours  mighty  quick. 
Cure  it?  No,  Madam,  No  cure  for-  it: 
have  to  wear  it  out.  I had  it  a year  when 
I first  went  on  the  river’.” 

Ultimately,  farm  land  drainage  eliminated 
malaria  from  Illinois. 

For  the  most  part,  the  great  infections 
headed  the  list  of  diseases  that  afflicted  pa- 
tients in  the  1860s.  Having  enjoyed  a gris- 
ly hey-day  from  earliest  recorded  history, 
they  continued  until  the  advent  of  the 
sulfanilamide-antibiotic  period  early  in  the 
forties.  Diseases  of  aging  played  a minor 
role  in  the  sixties;  relatively  few  people 
became  aged. 

THE  REMEDIES 

How  well  equipped  were  physicians  to 
combat  disease?  At  the  beginning  of  this 
decade,  in  1860,  the  physician-poet,  Oliver 
Wendell  Holmes  wrote: 

“Excluding  opium,  which  the  creator. 
Himself,  seems  to  prescribe,  and  exclud- 
ing wine,  which  is  a food,  and  excluding 
the  vapors  which  produce  the  miracle  of 
aneithesia,  I firmly  believe  that  if  the 
whole  materia  medica,  as  now  used, 
could  be  sunk  to  the  bottom  of  the  sea, 
it  would  be  all  the  better  for  mankind 
and  all  the  worse  for  the  fishes.” 

Just  how  did  physicians  treat  diseases  in 
those  days?  We  are  fortunate  to  have  an 
early  notebook  dated  1858  belonging  to  a 
German  physician.  Dr.  Aloysius  Sieffert, 
who  practiced  in  Evansville,  Ind.  Written 
in  English,  the  book  presents  a fascinating 
picture  of  the  way  the  early  doctors  com- 
batted disease.  Much  of  the  therapy  came 
amazingly  close  to  the  mark. 

Take,  for  example,  scurvy:  Dr.  Sieffert 
lists  its  treatment  (as  he  does  the  treat- 
ment of  most  ailments)  under  five  head- 
ings; 

Dietetics 

Astringents 

Temperants 

Tonics 

Refrigerants 

Under  dietetics,  we  read;  “.  . . change  of 
diet  is  the  best;  no  animal-salted  food  but 
acid  fruits:  citrons,  lemons,  oranges  and 
green  vegetables:  pickles,  potatoes,  sauer- 


craut,  salad;  cleanliness  and  pure  air.”  To- 
day we  could  scarcely  improve  upon  that 
treatment.  Under  the  heading  of  astrin- 
gents, we  see:  “Mouth-washes  of  citric  acid, 
of  chlorate  of  potash,  or  oximel,  vinegar 
and  water.”  Under  temperants,  we  find: 
“. . . acidulous  drinks  or  fermented  bever- 
ages: beer,  cider,  lemonade,  oximalet;  these 
are  useful  in  acute  or  hot  scurvy.”  Under 
tonics.  Dr.  Sieffert  wrote:  “In  chronic  or 
cold  scurvy,  cinchona,  quinine,  sulphuric 
elixir  and  tincture  of  Iron”  are  useful. 
Under  refrigerants,  he  recommended:  “. . . 
cold  affusions  or  tipid  ablution,  cold 
mouth-washes  and  shower  baths.” 

In  his  recommendations.  Dr.  Sieffert  had 
much  else  that  makes  good  sense  today. 
Take  the  treatment  of  an  insect  in  the  ear 
canal;  “. . . in  the  case  of  a living  insect  in 
the  ear,  a physician  conceived  the  idea  of 
asphyxiating  the  insect  by  means  of  chloro- 
form. He  dropped  four  drops  of  it  upon  a 
small  piece  of  cotton  which  he  introduced 
into  the  ear.  Immediately,  the  pain  ceased 
and  an  injection  of  warm  water  brought 
away  a dead  insect.”  He  suggested  this 
treatment  for  warts:  “Three  or  four  appli- 
cations of  chromic  acid  suffices  to  cause 
the  disappearance  of  warts  however  hard 
and  thick.  The  application  causes  neither 
pain,  suppuration  nor  cicatrices,  but  the 
warts  become  of  a blackish  brown  color. 
Chromate  of  Potassium  grain  2,  lard  1 
ounce,  mix  well  and  apply  to  the  wart  twice 
a day;  the  w'art  will  disappear  in  three 
weeks.” 

For  itching,  the  good  doctor  recom- 
mended tepid  baths  or  washings  of  flax- 
seed mucilage,  starch  water,  soapsuds,  and 
cleanliness.  He  added:  “.  . . the  external 
or  local  treatment  is  seldom  sufficient  to 
cure  the  itch  if  the  eruption  is  chronic  or 
inveterate.” 

Of  a special  interest  are  Dr.  Sieffert’s 
recommendations  for  persons  with  mental 
ailments  or  “psychopathies:” 

1.  Bleedings  when  there  is  much  vascular 
excitement  or  signs  of  cerebral  con- 
jestion 

• Venesection  (that  meant  opening  a 
vein) 

• Leeches  to  the  temple  or  anus 

2.  Refrigerants 

• Cold  applications  to  the  shaved  head 

• Cold  shower  bath  or  unexpected 
plunging  into  cold  water 


for  August,  1968 


159 


DRUG  MILLS 

Drug  mills  of  various  types  were  used  to  pulverize  the 
coarser  ingredients,  such  as  herbs  and  barks  from  trees, 
for  drugs.  Both  types  shown  can  be  adjusted  to  grind  fine 
or  coarse  powder. 


3.  Revulsives 

• Blisters  to  the  head 

• Setons  (a  hole  made  with  a needle 
which  was  then  kept  open  by  run- 
ning a thread  or  hair  through  it) 

• Actual  cautery  to  the  feet 

4.  Derivatives 

• Vomitives  and  purgatives  repeated 
alternatively,  especially  when  there 
is  disorder  of  digestion 

5.  Alternatives 

• Nauseants— emetic  or  lavage 

• Bromides,  mercurials  or  sustained 
mercurial  courses 

6.  Narcotics 

• Full  doses  of  opium  or  morphia 

7.  Tonics  in  long-protracted  insanity  to 

support  the  strength 

(With  the  treatment  prescribed  under 

the  first  six  categories,  the  patient  would 

need  a tonic) 

These  specific  measures  may  not  appeal 
to  the  modern  physician,  but  on  the  next 
page.  Dr.  Sieffert  discussed  what  he  called 
psychiatria,  or  moral  treatment:  “A  sooth- 
ing, mild  management;  separation  of  the 
patient  from  his  relatives;  distraction; 
exercise;  occupation;  travail  [meaning 
work];  music.  The  whole  moral  treatment 
can  be  reduced  to  the  following  indica- 
tions: 

“1.  Never  excite  the  ideas  or  passions  of 
the  patient  on  the  subject  of  his  de- 
lirium. 

“2,  Avoid  direct  contradictions  of  his 
erroneous  opinions  whether  by  jests 
or  sarcasms. 

“3.  Draw  his  whole  attention  to  the  ob- 
jects foreign  to  his  folly. 


“4.  Communicate  to  his  mind  new  im- 
pressions and  sentiments  by  varied 
impressions.” 

Dr.  Sieffert  concluded: 

“The  care  of  the  human  mind  is  the 
most  noble  branch  of  medicine.” 

What  were  the  drugs  in  Dr.  Sieffert’ s 
armamentarium?  We  find  carefully  listed 
in  his  book,  either  individually  or  as  part 
of  prescriptions: 


Arsenic 

Digitalis 

Lobelia 

Atropine 

Ergot 

Podophyllin 

Bismuth 

Mercury 

Quinine 

Bromide 

Iodine 

Rhubarb 

Chalk 

Morphine 

Santonin 

Camphor 

Opium 

Strychnine 

Cantharis 

Oxalic  acid 

Sulphur 

Cyanide 

Ether 

Veratrine 

Calomel 

Ipeca 

The  War’s  Effect  On  Progress 

The  Civil  War  could  not  but  heavily 
influence  Illinois  Medicine.  Even  though 
no  major  battles  occurred  in  the  state,  its 
southern  portion,  Egypt  and  Little  Egypt, 
abounded  in  Southern  Sympathizers,  since 
most  of  southern  Illinois  had  been  settled 
by  people  from  Virginia  and  the  Carolinas. 

Sisters  of  the  Holy  Cross  served  self- 
lessly in  caring  for  wounded  men  during 
the  War.  They  reported  to  young  Gen. 
Ulysses  S.  Grant,  serving  aboard  the  hos- 
pital ship  Red  Rover  and  in  10  land-based 
hospitals.  They  remained  in  the  Cairo  area 
after  the  conflict  and,  in  1867,  established 
an  infirmary.  Later  this  was  enlarged  to 
a hospital  which  still  serves  the  community. 

Most  wars  in  history  have  made  signi- 


160 


Illinois  Medical  Journal 


ficant  contributions  to  medical  progress. 
Was  this  true  of  the  Civil  War?  We  be- 
lieve it  was,  but  only  to  a limited  extent. 

Under  the  impetus  of  the  War,  surgery 
flourished,  but  for  all  the  enormous  battle- 
field experience,  it  remained  shockingly 
crude.  Surgeon  Benjamin  Howard  advo- 
cated hermetic  sealing  of  chest  wounds, 
relieving  the  frightening  breathlessness  of 
chest  wound  patients  by  inserting  a plug 
of  lint  held  together  and  made  airtight  by 
coatings  of  collodion.  A follow-up  study 
of  six  cases  showed  100  per  cent  mortality. 


Although  opposed  by  the  majority  of  doc- 
tors, one  of  the  division  hospitals  of  the 
Army  of  the  Potomac  adopted  Howard’s 
treatment. 

Gen.  Carl  Schurz,  a controversial  but 
articulate  Union  general,  described  a typi- 
cal operation  at  Gettysburg: 

“Most  of  the  operating  tables  were 
placed  in  the  open  where  the  light  was 
best,  some  of  them  partially  protected 
against  the  rain  by  tarpaulins  or  blankets 
stretched  upon  poles.  There  stood  the 
surgeons,  their  sleeves  rolled  up  to  their 


AMPUTATION  KIT 


for  August,  1968 


i6I 


elbows,  their  bare  arms  as  well  as  their 
linen  aprons  smeared  with  blood,  their 
knives  not  seldom  held  between  their 
teeth,  while  they  were  helping  a patient 
on  or  off  the  table  or  had  their  hands 
otherwise  occupied  ...  a wounded  man 
was  lifted  on  the  table,  often  shrieking 
with  pain  as  the  attendants  handled  him, 
the  surgeon  quickly  examined  the  wound 
and  resolved  upon  cutting  off  the  in- 
jured limb.  Some  ether  was  administered 
and  the  body  put  in  position  in  a mo- 
ment. The  surgeon  snatched  his  knife 
from  between  his  teeth  . . . , wiped  it 
rapidly  once  or  twice  across  his  blood- 
stained apron,  and  the  cutting  began." 

If  a wound  miraculously  escaped  con- 
tamination, it  faced  the  gantlet  of  repeated 
washings  from  a communal  basin  and 
sponge.  The  same  sponge  and  basin  of  pus- 
filled  water  might  contact  every  wound  in 
a ward.  Every  operating  location  had  its 
reeking  pile  of  amputated  parts;  at  one 
makeshift  hospital,  the  heaps  rose  to  the 
second  story  of  the  building. 

The  military  surgeon  of  1861  employed 
not  only  carbolic  acid  but  many  other 
antiseptics,  yet  he  used  them  too  late,  after 
permitting  infections  to  reach  horrifying 
bloom.  Of  course,  doctors  of  the  period 
knew  nothing  of  the  nature  of  infection  or 
its  communication. 

Still,  the  War  brought  some  improve- 
ments in  medical  care.  Although  primitive 
and  inadequate  at  the  outset,  American 
ambulance  and  field  hospital  systems  be- 
came models  of  their  kind  by  1865.  The 
Union  medical  corps  created  a hospital  sys- 
tem which  became  one  of  the  wonders  of 
the  medical  world.  During  the  four  years 
of  the  war,  the  general  hospitals  of  the 
north  cared  for  1,057,523  soldiers  with  a 
mortality  of  only  8 per  cent,  the  lowest  ever 
recorded  for  military  hospitals,  even  lower 
than  in  many  civil  institutions. 

The  Doctor’s  Bare  Cupboard 

During  the  sixties,  disease  presented  a 
formidable  picture,  while  the  doctor’s  arm- 
amentarium to  conquer  ailments  appeared 
shockingly  inadequate.  Yet  doctors,  usually 
the  most  learned  men  of  the  community, 
possessed  high  intelligence  and  strong  de- 
votion. To  most,  death  was  lighter  than 
a feather  and  duty  heavier  than  a moun- 
tain. Their  rugged  days,  laced  with  searing 
heartbreak,  began  early  in  the  morning, 
and  continued  often  through  the  night. 


Medicine,  while  a respected  profession, 
existed  mostly  as  an  art  with  little  wrience 
thrown  in;  too  few  facts  had  been  scien- 
tifically established  to  form  a basis  for  ef- 
fective treatment.  Such  treatment  had  to 
wait  until  much  more  could  be  discovered. 
The  patients  could  not  wait;  they  sickened, 
they  cried  for  physicians  who  could  cure 
them;  too  frequently,  they  died.  Patients 
longed  for  doctors,  who  were  sure  of  them- 
selves, and  who  believed  their  treatments 


FIELD  MICROSCOPE 
Used  hy  an  Army  physician  during  the  Civil 
War,  this  microscope  was  carried  in  the 
small  compact  wooden  box.  When  needed, 
it  could  he  quickly  fitted  together  and 
screwed  into  the  top  of  the  box. 

worked.  Someone  said  of  one  early  surgeon 
of  this  period:  “he  had  great  force  and 
positiveness  of  character  . . . his  profes- 
sional convictions  were  absolute.”  Self-con- 
fidence remained  a prime  requisite  for  a 
successful  practitioner  through  the  sixties 
and  long  thereafter.  Woe  to  the  doctor  who 
used  his  eyes  and  his  intelligence,  and  saw 
that  most  of  his  remedies  failed.  Perhaps 
this  was  how  the  ponderous  manner,  the 
solemn  dignity,  the  formalized  behavior  of 
the  early  physician  developed.  He  looked 


162 


Illinois  Medical  Journal 


wise  while  examining  a tongue.  He  con- 
sulted a ponderous  watch  while  taking  the 
pulse,  perhaps  he  pretended  to  be  calculat- 
ing. 

A Perceptive  Picture 

Over  the  ages,  poetry  has  often  sur- 
passed prose  as  a medium  of  description. 
Indiana  had  a physician-poet  during  the 
19th  Century,  Dr.  James  Newton  Matthews, 
member  of  the  Marion  County  Medical 
Society  and  friend  of  James  Whittcomb 
Riley.  He  read  one  of  his  poems.  Ballad 
of  the  Busy  Doctor,  at  a banquet  of  his 
county  medical  society  in  the  year  1888.  It 
presents  a somber  but  amazingly  perceptive 
view  of  the  doctor’s  lot  in  a small  Mid- 
western town  during  a 19  th  Century  win- 
ter. And  while  it  was  written  by  a Hoosier 
doctor,  about  a Hoosier  town,  it  applies 
just  as  well  to  Illinois: 

Ballad  of  the  Busy  Doctor 

“When  winter  pipes  in  the  poplar  tree. 
And  soles  are  shod  with  the  snow  and 
sleet— 

When  sick-room  doors  close  noiselessly. 
And  doctors  hurry  along  the  street; 

When  the  bleak  north  winds  at  the  gables 
beat, 

And  the  flaky  noon  of  the  night  is  nigh. 

And  the  reveller’s  laugh  grows  obsolete. 
When  Death,  white  Death,  is  a-driving 
by. 


“When  the  cowering  sinner  crooks  his  knee 
At  the  cradle  side,  in  suppliance  sweet. 
And  friends  converse  in  a minor  key. 

And  doctors  hurry  along  the  street; 
When  Croesus  flies  to  his  country  seat. 
And  castaways  in  the  garrets  cry. 

And  in  each  house  is  a ‘shape  and  a sheet,’ 
Then  Death,  white  Death,  is  a-driving 
by. 


“When  the  blast  of  the  autumn  blinds  the 
bee. 

And  the  long  rains  fall  on  the  ruined 
wheat. 

When  a glimmer  of  green  on  the  pools 
we  see. 

And  doctors  hurry  along  the  street; 

When  every  fellow  we  chance  to  meet 
Has  a fulvous  glitter  in  either  eye. 

And  a weary  wobble  in  both  his  feet. 
When  Death,  white  Death,  is  a-driving 
by. 


ENVOY 


“When  farmers  ride  at  a furious  heat. 
And  doctors  hurry  along  the  street. 
With  brave  hearts,  under  a scowling  sky. 
Then  Death,  white  Death,  is  a-driving 

by.” 


OXYGEN  THERAPY 

The  serious  consequences  of  ventilatory  depression  by  oxygen  therapy 
are  well  known  and  can  be  avoided  by  the  proper  use  of  the  masks  in  pa- 
tients with  chronic  pulmonary  disease.  It  is  not  commonly  appreciated, 
however,  that  their  use  is  contraindicated  in  certain  types  of  respiratory 
failure  also  associated  with  progressive  respiratory  acidosis.  These  are 
clinical  situations  in  which  Alveolar  carbon  dioxide  tension  can  rise  sig- 
nificantly during  oxygen  therapy,  not  as  a result  of  ventilatory  depression 
but  simply  because  the  underlying  disease  has  become  worse.  For  ex- 
ample, in  some  patients  with  intractable  asthma  who  are  receiving  high 
inspired  oxygen  concentrations  progressive,  severe  respiratory  acidosis 
develops,  not  because  of  decreased  ventilatory  effort  but  as  a result  of 
continued  increase  in  airway  resistance.  Under  these  conditions,  fatal  hy- 
poxia may  ensue  if  the  rise  in  alveolar  carbon  dioxide  tension  is  misin- 
terpreted as  evidence  of  ventilatory  depression  and  the  inspired  oxygen 
concentration  is  therefore  not  kept  at  a high  level.  (Mithoefer,  J.  C., 
etal;  New  England  Jl.  Med.  (Nov.  2)  1967.) 


for  August,  1968 


1«3 


HAY  FEVER  INJECTIONS 


A group  of  New  York  pediatricians  made 
a five-year  study  on  the  effectiveness  of  im- 
munization in  the  prevention  of  hay  fever. 
The  injections  were  given  prior  to  the  pol- 
lination season  which  is  in  late  August.  An 
equal  number  of  children  received  a place- 
bo that  was  similar  in  appearance  but  lack- 
ing in  ragweed  extract.  Some  beneficial  re- 
sults were  noted  among  those  receiving  the 
ragweed  extract  but  the  improvement  in 
this  group  as  compared  to  the  control 
group  was  not  significant. 

Similar  studies  on  allergic  adults  with  a 
variety  of  sensitivities  are  somewhat  more 
encouraging  because  those  receiving  the  ex- 
tract derived  more  relief.  In  other  words, 
the  value  of  allergen  injections  is  being 
questioned  and  time  will  tell  whether  the 
plan  has  as  much  merit  as  we  have  been 
led  to  believe. 

In  many  of  these  experiments  the  re- 
sponse to  desensitization  varied  consider- 
ably with  the  individual  and  the  year  they 
received  the  injections.  Prevention  is  dif- 
ficult when  the  pollen  count  is  excessive 
due  to  favorable  weather.  When  the  season 
is  mild  we  are  likely  to  give  the  ragweed 
extract  more  credit  than  it  deserves. 


It  also  is  difficult  to  explain  why  so 
many  receiving  the  placebo  are  helped. 
Both  groups  have  access  to  other  anti-aller- 
gy remedies  such  as  the  antihistamines, 
steroids,  decongestants,  and  filters.  In  ad- 
dition some  persons  are  more  sensitive 
than  others  to  ragweed  pollen  and  begin 
to  sneeze  when  the  pollen  count  is  rela- 
tively low.  Rest,  peace  of  mind,  and  co-ex- 
isting allergies  also  play  a role  in  hay  fever. 
Therefore,  it  is  not  easy  to  evaluate  the  ef- 
fect of  an  allergy  preventive. 

The  investigators  found  that  the  skin 
tests  of  those  receiving  the  ragweed  extract 
for  three  consecutive  years  were  developing 
immunity.  This  was  encouraging  except 
that  many  continued  to  sneeze  and  com- 
plain of  nasal  congestion  and  other  rag- 
weed symptoms  despite  the  favorable  skin 
tests. 

T.  R.  Van  Dellen,  M.D. 

References 

Effectiveness  in  Hyposensitization  Therapy  in  Rag- 
weed Hay-Fever  in  Children.  Vincent  J.  Fontana, 
M.  D.,  L.  Emmett  Holt,  Jr.,  M.D.,  and  Donald  Main- 
land, M.D.  J.A.M.A.  195:12  (Mar.  21)  1966,  pp. 
985-^2.  (Also  in  letters  to  the  editor-same  issue — 
Hyposensitization  Therapy  in  Ragweed  Hay  Fever, 
J.A.M.A.  pp.  1071-1072.) 


164 


Illinois  Medical  Journal 


Subdural  hematomas  are  common  in 
pediatric  age  groups,  particularly  in  in- 
fants and  children  under  the  age  of  two 
years.  The  frequency  is  notably  diminished 
in  older  children  and  adolescents,  in  fact 
the  latter  group  has  the  lowest  incidence 
of  all  age  groups. 

It  is  the  etiology  of  subdural  hematomas 
which  accounts  for  the  wide  discrepancy 
benveen  the  age  gioups.  Some  of  the 
causes  are  worth  recapitulation: 

1.  Traumatic  birth; 

2.  Carelessness  in  handling  infants; 

3.  Accidents,  such  as  falling  in  the  case  of 
toddlers,  bicycle  or  playground  acci- 
dents in  older  children; 

4.  Accidents  incidental  to  our  motorized 
age. 

All  of  these  take  their  toll  and  present 
either  acute  or  chronic  subdural  hema- 
tomas. 


Medical  Progress  in  the  Care  of 
Subdural  Hematomas  In  Infants  And 

Children 


By  C.  Luis-Porras,  M.D.,  and  L.  V.  Amador,  M.D. /Chicago 


This  study  excludes  newborns.  There- 
fore, our  cases  range  in  age  from  two  days 
to  the  late  teenage  group.  The  total  num- 
ber of  these  cases  was  76.  The  interesting 
feature  about  them  is  that  there  are  dif- 
ferent clinical  manifestations  in  this  group 
when  compared  to  adults  with  subdural 
hematomas. 


Cesar  Luis-Porras,  M.D.,  is  on  staff  at  St. 
Joseph  Hospital,  Children’s  Memorial,  and  Luth- 
eran General  Hospitals,  in  the  Chicago  area.  He 
received  his  pre-med  training  at  P.  Suarez  Col- 
lege, Spain  and  his  M.D.  from  the  University  of 
Madrid  Medical  School.  An  internship  was  served 
at  Memorial  Hospital,  New  York  City  with  a resi- 
dency at  Mt.  Sinai  Hospital,  New  York,  Philadel- 
phia Episcopal  Hospital,  and  Queen  Square  and 
Hospital  for  Sick  Children,  London. 

Luis  V.  Amador,  M.D.,  is  Associate  Clinical  Pro- 
fessor of  Neurological  Surgery,  the  Univ.  of  Illinois 
College  of  Medicine,  as  well  as  attending  neuro- 
surgeon at  St.  Joseph’s,  Children’s  Memorial  and 
Lutheran  General  Hospitals.  He  is  a graduate  of 
the  Northwestern  School  of  Medicine  and  served 
his  internship  at  St.  Lukes,  Chicago.  Post  grad- 
uate studies  were  completed  at  the  Neuropsychia- 
tric Institute,  and  under  the  auspices  of  the  Rocke- 
feller and  the  Guggenheim  Foundation. 


Before  mentioning  the  different  signs 
and  symptoms  in  infants  and  children,  it 
is  helpful  to  bear  in  mind  the  patho-phy- 
siology  involved.  By  definition,  a subdural 
hematoma  is  an  accumulation  of  blood 
from  ruptured  blood  vessels  which  collects 
in  the  subdural  space.  This  lesion  is  gen- 
erally classified  as  acute  or  chronic.  It  has 
been  suggested  by  McKissock^®  that  three 
types  of  hematomas  may  be  differentiated, 
based  on  a temporal  classification:  acute 
(up  to  three  days),  subacute  (4  to  20  days) 
and  chronic  when  the  hematoma  is  more 
than  twenty  days  old. 

In  addition  to  subdural  hematomas, 
there  is  another  entity,  sometimes  found 
in  the  subdural  space,  known  as  a hygroma. 
This  is  a lesion  which  consists  of  serous 
fluid  in  the  subdural  space.  Such  fluid  may 
be  either  clear  or  colorless.  In  chronic  cases 
the  fluid  may  become  xanthochromic  and 
the  entire  lesion  surrounded  by  a neomem- 
brane. Two  theories  have  been  proposed 
to  explain  hygromas.  Primarily  that  it  is 


for  August,  1968 


165 


due  to  traumatic  laceration  of  the  arach- 
noid followed  by  peripheral  pulsations  of 
cerebral  spinal  fluid  with  a secondary  ac- 
cumulation of  fluid;  or  secondarily,  that 
it  is  a primary  effusion  of  fluid  into  the 
subdural  space.  The  exact  mechanism  of 
such  is  not  understood.  The  term  subdural 
hygroma  and  hydroma  are  synonymous.  A 
significant  fact,  however,  is  that  a subdural 
hematoma  and  hygroma  may  co-exist.  With 
minor  differences  symptoms  and  signs  of 
these  two  are  essentially  the  same,  hence 
their  distinction  is  primarily  pathological, 
and  the  following  discussion  applies  to  both 
entities. 

Subdural  hematomas  most  often  occur 
over  the  upper  portion  of  the  parietal  and 
frontal  regions,  and  frequently  may  be 
found  bilaterally.  Size  of  the  hemorrhage 
varies  in  extent  and  amount.  Cerebral  cor- 
tex is  depressed  in  proportion  to  the  quan- 
tity of  accumulated  blood. 

P athology  of  Acute  Subdural  Hematoma 

Fresh  bleeding  beneath  the  dura  almost 
always  occurs  as  a result  of  severe  head  in- 
jury. Often  there  is  an  associated  laceration, 
contusion  and  edema  of  the  brain.  These 
lesions  may  also  occur  secondary  to  a closed 
injury,  at  which  time  there  is  tearing  of 
the  veins  crossing  the  subdural  space  with 
secondary  displacement  of  the  brain  with- 
in the  skull.  They  may  occur  as  a result 
of  a depressed  or  compound  fracture  asso- 
ciated with  laceration  of  the  cerebral  veins 
and  sinuses.  Other  forms  of  hemorrhage 
such  as  subarachnoid,  intracortical,  or 
epidural  may  be  present  simultaneously. 

Although  medical  literature  sporadically 
reports  subdural  hematoma  related  to  de- 
hydration, scurvy,  rupture  of  congenital 
vascular  anomalies,  blood  dyscrasias,  and 
bleeding  associated  with  a brain  tumor,  we 
have  not  observed  any  of  these  phenomena 
in  our  series  of  cases. 

Pathology  of  Chronic  Subdural 
Hematoma 

The  most  characteristic  feature  of  this 
form  is  that  there  is  usually  an  interval 
varying  from  a few  weeks  to  a few  months 
between  the  occurence  of  trauma  and  the 
appearance  of  symptoms  and  signs.  Often 
the  patient  will  have  had  an  incidence  of 
head  trauma  which  cannot  be  recalled,  due 
to  post  traumatic  amnesia. 

Acute  subdural  hematoma  obviously  con- 
sists of  a pool  of  blood  under  the  dura.  The 


collection  of  blood  after  several  weeks  usual- 
ly becomes  completely  encapsulated  by  a 
membrane  of  connective  tissue.  In  this 
early  stage  a capsule  is  not  well  defined. 
It  usually  does  not  become  adherent  to 
the  arachnoid  presumably  because  the 
layer  of  exothelial  cells,  at  the  surface  of 
the  arachnoid,  prevents  attachment.^  These 
cells  do  not  react  to  the  blood  in  the  same 
manner  as  do  the  inner  layers  of  the  dura. 
Small  sinus-like  vessels  are  present  from 
dura  to  capsule.  The  arachnoid  is  usually 
stained  yellow  by  blood  pigments,  and 
there  is  a deposition  of  collagen  fibers 
which  result  in  a tough  outer  membrane. 
The  inner  membrane  is  almost  always  thin- 
ner. The  contents  of  the  subdural  sac  con- 
sist of  either  a dark  red  thick  fluid  or  dark 
yellow  fluid  with  high  protein  content. 
Numerous  red  blood  cells  in  varying  de- 
grees of  disintegration  may  be  observed. 
With  the  passage  of  time  the  breakdown  of 
the  hemoglobin  products  result  in  a fluid 
which  tends  to  become  red-yellow,  then 
ultimately  amber. 

Analysis  of  Cases 

In  the  series  of  76  cases  presented  in  this 
paper  all  were  diagnosed  by  either  subdural 
taps,  ventriculography  or  angiography.  In 
some  patients  more  than  one  diagnostic 
procedure  was  necessary.  All  cases  were 
verified  by  subdural  taps,  burr  holes  or 
craniotomy.  These  cases  have  been  admitted 
on  the  service  of  one  of  us  (L.V.A.)  over 
the  years  1951-1966.  In  the  series  45  pa- 
tients were  boys  and  31  were  girls.  Because 
of  the  differences  in  signs  and  symptoms 
in  infants  and  young  children  when  com- 
pared to  older  children,  the  cases  have  been 
divided  into  two  groups;  the  arbitrary  di- 
viding line  has  been  two  years  of  age. 

Signs  and  Symptoms 

The  findings  which  we  have  recorded 
are  those  noted  on  initial  examination.  In 
evaluating  the  percentage  of  symptoms  and 
signs  it  became  apparent  that  some  of  the 
neurological  observations  appeared  to  be 
different  than  those  commonly  cited  in  the 
literature.  We  were  fortunate  that  refer- 
ring pediatricians  and  family  physicians 
recognized  the  symptomatology  of  subdural 
hematomas  promptly.  Therefore,  patients 
were  admitted  eaily  in  their  clinical 
course. 

In  the  group  of  infants  and  children 


166 


Illinois  Medical  Journal 


under  the  age  of  two  years  there  were  63 
cases.  Of  these  patients,  33  had  bilateral 
hematomas.  We  noted  that  convulsions  oc- 
curred in  38%  of  the  patients,  vomiting 
in  32%,  tension  of  the  fontanelle  in  24%, 
enlarged  head  in  19%,  associated  fracture 
of  the  skull  in  19%,  lethargy  in  13%,  ir- 
ritability in  11%,  retinal  hemorrhage  in 
10%;  hemiparesis,  fever,  anorexia  and  in- 
volvement of  the  extra  ocular  muscula- 
ture occurred  in  less  than  10%  of  our  pa- 
tients. There  is  a variance  with  our  series 
of  patients  when  compared  with  other  ser- 
ies in  the  neurosurgical  literature.  Such 
reports  indicate  that  convulsions  occurred 
in  45%  of  patients,  vomiting  in  40%,  hy- 
perthermia in  40%,  tense  fontanelle  in 
35%,  irritability  in  35%,  enlargement  of 
the  head  in  25%,  retinal  hemorrhages  in 
20%,  lethargy  in  15-20%,  linear  fracture  of 
the  skull  in  15-20%. 

In  those  children  over  two,  this  series  of 
cases  includes  only  13  patients.  Among 
these  one  third  had  bilateral  hematomas. 
Therefore  the  percentages  of  incidence  may 
be  at  variance  with  the  experience  of  other 
neurosurgeons.  We  found  that  in  these  pa- 
tients coma  occurred  in  35%,  lethargy  in 
30%,  headaches  in  50%,  vomiting  in  30%, 
fracture  of  the  skull  in  30%,  papilledema 
in  20%,  hemiparesis  in  20%,  decerebrate 
signs  in  16%,  neck  stiflhiess  in  16%,  and 
convulsions,  sixth  nerve  palsy  and  retinal 
hemorrhages  in  one  percent. 


Laboratory  Studies  in  Infants  and 
Children  Under  Two  Years  Age 

It  was  impressive  to  note  that  anemia  oc- 
curred in  38%;  also,  that  in  some  patients 
the  hemoglobin  was  as  low  as  5.8  grams. 
White  blood  count  demonstrated  a relative 
leucocytosis  in  36%  of  the  cases.  In  one  pa- 
tient the  white  blood  count  was  elevated  to 
43,000  cells  per  cu.  mm.  In  the  very  young 
age  groups  there  was  a predominance  of 
lymphocytes. 

Only  seven  patients  required  spinal 
puncture.  Analysis  of  these  revealed  bloody 
fluid  in  one,  xanthochromia  in  four  and 
clear  fluid  in  two.  Drainage  or  subdural 
taps  were  performed  in  sixty-three  patients, 
and  in  all  of  them  fluid  was  either  bloody 
or  xanthochromatic.  Total  protein  was  ele- 
vated; in  one  case  it  was  1850  milligrams 
percent. 


Laboratory  Studies  in  Children 
Over  Two  years  of  Age 

In  contrast  to  the  above  group,  only  one 
patient  was  anemic,  having  a hemoglobin 
of  only  8.6  grams.  White  blood  count  dem- 
onstrated leucocytosis  in  32%  of  cases,  and 
again  when  contrasted  to  the  younger  age 
group,  the  findings  were  those  of  a pre- 
dominantly polymorphonuclear  cell  in- 
crease. 

Cerebral  spinal  fluid  studies  demonstra- 
ted xanthochromia  in  two  cases,  blood  in 
one.  As  a rule  we  do  not  utilize  lumbar 
puncture  in  suspected  subdural  cases.  In 
three  of  the  patients,  however,  there  was 
some  degree  of  doubt  as  to  the  possibility 
of  a meningitis.  Therefore,  a spinal  punc- 
ture was  performed  as  an  added  investiga- 
tive procedure. 


Diagnostic  Procedures 

Skull  x-rays  were  abnormal  in  50%  of 
the  cases  under  two  years  of  age.  These 
findings  consisted  of  fractures  in  19%  of 
ttiese  infants,  enlargement  of  the  head  in 
18%,  and  calcification  of  the  hematoma  in 
five  percent. 

In  the  older  age  groups  30%  of  the  pa- 
tients demonstrated  fracture  of  the  skull. 


Fig  1.  Subdural  tap  in  an  infant.  Needle  in- 
serted at  lateral  border  of  anterior  fontanelle. 


for  August,  1968 


167 


Other  abnormal  changes  were  not  usually 
detectable.  In  the  series  of  13  patients  we 
found  a skull  fracture  in  twenty-one  per- 
cent. A “growing  fracture”  (a  widening 
fracture  secondary  to  arachnoidal  pulsa- 
tions) was  observed  in  two  patients. 

Cerebral  angiography  is  of  limited  value 
in  the  infant  and  generally  is  not  necessary 
because  of  the  ease  by  which  the  diagnosis 
can  be  established  through  subdural  taps 
(Fig.  1)  and  air  studies  (Fig.  2),  Nonethe- 
less, in  the  older  age  group  cerebral  an- 
giography is  of  considerable  value  in  the 
diagnosis  of  subdural  hematoma  (Fig.  3,4). 

Echoencephalography  may  also  be  of  as- 
sistance in  detecting  the  presence  of  a sub- 
dural hematoma  due  to  a shift  of  the  brain. 
Moreover,  this  procedure  is  a helpful  tech- 
nique in  determining  growth  and  expan- 
sion of  the  blood  clot.  It  should  be  noted, 
however,  that  bilateral  subdural  hemato- 
mas are  exceedingly  difficult  to  differenti- 
ate by  this  technique. 

Electroencephalography  is  of  limited 
value  and  was  performed  in  only  three  of 
the  older  children.  Of  these  three,  two 
demonstrated  bilateral  hypoactivity,  and 
one  was  inconclusive.  We  did  not  use  elec- 


Fig.  3.  Subdural  Hematoma  outlined  by  cere- 
bral angiogram.  Note  avascular  space  between 
cerebral  cortex  and  skull. 


Fig.  2.  Air  study  utilized  to  outline  subdural 
hematoma. 


Fig.  4.  Angiographic  demonstration  of  sub- 
dural hematoma  (early  venous  stage.).  Note 
extent  of  lesion. 


i 


troencephalography  frequently  because  in 
acute  head  injuries,  and  particularly  in 
those  cases  which  have  cephalohematomata 
or  scalp  lacerations,  it  is  very  difficult  and 
at  times  impossible  to  apply  scalp  elec- 
trodes satisfactorily. 

Treatment 

It  has  been  our  policy  to  drain  the  hema- 
toma in  infants  by  means  of  subdural  taps 
at  daily  intervals.  Only  a few  cubic  centi- 
meters of  blood  should  be  removed  in 
order  to  prevent  rapid  shift  of  brain  con- 
tents. ^Vhen  the  taps  are  dry  and  continue 
to  be  so  after  2 or  3 days  we  assume  that, 
in  most  cases,  the  hematoma  has  been  evac- 
uated. 

In  persistent  subdural  hematoma,  i.e. 
those  patients  in  whom  the  taps  continue 
to  reveal  bloody  fluid  after  two  weeks,  we 
perform  a craniotomy  on  the  appropriate 
side.  The  bone  flap  should  be  large  enough 
to  gain  access  to  the  involved  regions.  This 
enables  the  entire  cortex  to  be  visualized, 
and  an  attempt  should  be  made,  not  only 
to  drain  and  irrigate  the  hematoma,  but 
also  to  remove  membranes.  These  are  usu- 
ally stripped  from  the  dura  by  utilizing  a 
curved  periosteal  elevator.  The  membrane 
over  the  cortex  must  be  gently  lifted  from 
the  arachnoid.  Ordinarily  there  is  excellent 
cleavage  and  little  difficulty  is  encount- 
ered. Should  there  be  any  adhesions  it  is  bet- 
ter to  leave  the  adherent  membrane  at- 
tached to  the  arachnoid  rather  than  dam- 
age overlying  cerebral  cortex.  We  are  in 
disagreement  with  those  authors  who  feel 
that  only  drainage,  or  conservative  manag- 
ment,  is  sufficient  to  remove  the  dangers 
of  a subdural  hematoma.  We  believe  that 
a hematoma  is  a potentially  serious  lesion. 
The  mass  should  not  only  be  drained  but 
an  effort  should  be  made  to  remove  any 
constricting  or  potentially  constricting 
membranes  on  the  brain  surface.  We  can 
see  little  advantage  in  leaving  such  a mem- 
brane over  the  cerebral  cortex  and  can  see 
some  harmful  consequences,  such  as:  epi- 
leptogenic focus,  vascular  impairment  to 
cerebral  cortex,  possible  brain  constriction. 

In  the  older  age  group,  diagnosis  and 
management  of  a subdural  hematoma  is 
basically  that  of  removal  of  a mass  lesion. 
Diagnosis  may  be  established  in  one  of  sev- 
eral ways:  echoencephalography,  cerebral 
angiography,  air  studies.  When  the  lesion 
has  been  accurately  outlined  it  is  possible 


to  make  one  or  two  burr  holes  over  the  edge 
of  the  hematoma  and  to  drain  if  in  a liquid 
state.  Burr  holes  may  be  diagnostic  as  well 
as  therapeutic.  If  there  is  a clot,  or  mem- 
brane, we  use  the  same  technique  as  previ- 
ously described  for  infants  and  younger 
children. 

In  a small  number  of  cases,  consisting  of 
both  groups,  we  have  encountered  a per- 
sistent subdural  hygroma  associated  with 
subdural  hematoma.  The  exact  mechanism 
for  formation  of  this  fluid  is  unknown.  Be- 
cause of  continued  compression  of  cortex 
by  the  persistent  fluid  accumulation  there 
is  danger  of  brain  damage.  Therefore  it 
has  been  our  policy  to  insert  a low  pres- 
sure (10  mm)  shunting  system  from  the 
subdural  space  to  the  venous  system  or  per- 
itoneal cavity  to  drain  the  persistent  fluid. 
Our  results  with  such  a procedure  have 
been  excellent. 

Results 

More  than  ninety  percent  of  the  76  pa- 
tients survived  drainage  or  surgery;  81%  of 
these  had  no  sequelae  following  treatment. 
It  should  be  borne  in  mind  that  these  sta- 
tistics are  all  the  more  remarkable  since 
patients  included  seriously  injured  infants 
and  children,  some  of  whom  had  multiple 
trauma. 

The  mortality  rate  was  9.5%  in  this  ser- 
ices.  In  the  group  under  two  years  of  age  4 
patients  (15%)  expired,  three  had  trau- 
matic laceration  of  the  brain  with  extensive 
damage,  and  one  other  patient  died  from 
pneumonitis.  In  the  group  over  two  years 
of  age  three  patients  (20%)  died.  Two  of 
these  had  both  laceration  and  extensive 
trauma  of  the  brain;  the  other  patient  died 
from  septicemic  pneumonitis. 

Sequelae 

In  the  group  under  two  years  of  age  ap- 
proximately eight  percent  developed  symp- 
toms and  signs  of  residual  involvement  of 
the  central  nervous  system.  Some  children 
had  more  than  one  complication.  These 
consisted  of:  hemiparesis  (three  patients), 
cerebral  atrophy  (three),  convulsions  (one), 
sixth  nerve  palsy  (one),  subdural  effusion 
necessitating  shunting  procedure  (two  pa- 
tients). 

In  the  group  over  two  years  of  age,  5 pa- 
tients (36%)  developed  residual  sympto- 
motology  consisting  of  the  following:  hem- 
iparesis in  two,  cerebral  atrophy  in  one, 
convulsions  in  two  patients. 


for  August,  1968 


169 


Follow-ap  Study 

Repeated  observations  have  been  made 
on  the  fifteen  patients  with  sequelae.  It 
has  been  noted  that  in  the  group  under 
two  years  of  age,  out  of  the  three  hemipa- 
retic  patients  two  showed  a definite  im- 
provement, while  one  patient  was  lost  from 
the  clinic  renter.  The  patient  who  had  con- 
vulsions during  hospitalization  has  been 
seizure  free  while  on  medication.  The  child 
with  the  sixth  nerve  palsy  recovered  in 
several  months.  One  of  the  patients  with  a 
shunt  has  been  followed  for  I1/2  years,  and, 
fortunately,  increased  intracranial  pressure 
has  been  adequately  controlled  without 
further  valve  revision.  The  other  patient 
did  not  return  to  the  clinic. 

In  the  age  group  over  two  years  there 
were  two  hemiparetics.  One  improved 
over  the  period  of  a year  and  a half.  The 
other  was  unchanged  at  the  end  of  one 
year,  but,  unfortunately,  could  not  be  eval- 
uated in  the  18  month  period  because  he 
did  not  return  to  the  clinic.  Two  patients 
with  convulsions  were  followed  for  one 
year— one  is  symptom  free  and  continues  on 
anticonvulsants,  the  other  has  had  some 
convulsions  in  spite  of  medication.  The  re- 
maining four  patients  present  no  signifi- 
cant change  in  their  symptomotology. 

Commentary 

Subdural  hematomas  are  found  three 
times  as  frequently  in  infants  and  young 
children  as  they  are  in  the  older  age 
groups.  There  are  several  factors  which 
may  explain  this  increased  incidence.  The 
head  is  proportionately  larger  in  reference 
to  body  size  in  infants  and  young  children. 
This  factor  may  be  conducive  to  greater  in- 
cidence of  head  injury.  It  is  particularly 
true  in  the  patient  learning  to  walk.  The 
skull  is  more  plastic  in  the  infant  and 
young  child  and,  therefore,  greater  stress 
upon  the  cerebral  cortex,  veins  and  sinuses 
probably  is  transmitted  by  an  injury,  when 
compared  with  the  heavier  skull  of  the  old- 
er age  group.  Furthermore,  we  believe  that 
young  children  who  have  less  experience 
in  running  and  walking  will  be  less  able 
to  protect  themselves  from  injury  as  they 
fall. 

Location  of  a subdural  hematoma  is  us- 
ually in  the  parietal  area.  In  our  experi- 
ence 60%  of  all  lesions  were  in  this  region. 
It  is  our  feeling  that  multiple  factors  may 


contribute  to  such  high  incidence.  First  of 
all,  veins  are  delicate,  especially  bridging 
veins  spreading  over  the  vertex  of  the 
brain.  Secondly,  fractures  are  usually  in  the 
frontal-parietal  area,  and  consequently  ex- 
ert a great  deal  of  stress  upon  these  vessels. 
Finally  we  must  consider  that  the  brain 
fits  more  snugly  in  the  lower  half  of  the 
skull  than  it  does  under  the  vertex.  It  is, 
therefore,  conceivable  that  oozing  from 
torn  bridging  veins  would  be  more  limited 
to  the  area  of  the  frontal-parietal  regions 
than  it  would  be  to  the  lower  part  of  the 
brain.  We  believe  that  this  could  be  due  to 
resistance  of  blood  seepage  as  it  accumu- 
lates at  the  site  of  the  torn  vein. 

In  50%  of  the  cases  it  was  noticed  that 
the  subdural  hematomas  were  bilateral. 
Perhaps  shifting  brain  and  the  contre-coup 
theory  explain  torn  veins  at  a distance 
from  the  primary  point  of  impact.  In  some 
of  the  cases  the  hematoma  was  actually 
found  on  the  side  opposite  a fracture! 

It  has  been  common  knowledge  that  in- 
fants present  different  signs  and  symptoms 
than  older  children.  This  is  believed  to  be 
due  primarily  to  head  configuration  of  the 
older  group  and  paucity  of  cartilaginous 
skull.  In  addition,  the  compensatory  mech- 
anism, consisting  primarily  of  large  open 
sinuses,  alters  development  of  increased  in- 
tracranial pressure  in  an  infant  compared 
to  older  children. 

Summary 

Results  are  considered  excellent.  Ap- 
proximately 90%  of  patients  survived  sur- 
gery. Mortality  is  approximately  ten  per- 
cent. It  is  greater  in  the  acute  head  injury, 
which  so  often  has  been  associated  with 
laceration  of  the  brain  and  tears  of  large 
veins  and  sinuses.  Naturally,  such  a head 
injury  is  more  serious  and  the  mortality 
rate  is  higher.  Sequelae  from  head  injuries 
associated  with  subdural  hematoma  are  pri- 
marily the  result  of  brain  compression  and 
associated  injury  from  head  trauma.  These 
findings  consist  of  atrophy  of  the  brain, 
convulsions,  mental  retardation  and  other 
neurological  deficits. 

In  conclusion,  therefore,  prompt  recogni- 
tion of  subdural  hematomas  in  infancy  and 
childhood  is  of  the  utmost  importance.  If 
this  is  accomplished  such  lesions  can  be 
treated  satisfactorily  and  excellent  end  re- 
sults are  obtained. 

(Continued  on  page  204) 


170 


Illinois  Medical  Journal 


Avulsion 

Perineal 


Injury 


A Case  Report  of  Avulsion  of  Skin  of  Penis  and  Scrotum 


Arthur  D.  Poppens^  M.D., 

George  E.  Giffin^  M.D., 

AND  Louis  D.  Tarsinos,  M.D.,  F.A.C.S. 

/Princeton 

Machinery  injuries  of  a very  disabling 
nature  have  become  increasingly  common 
both  in  industry  and  agriculture.  By  virtue 
of  geographic  location,  agriculture  injuries 
are  somewhat  more  common  in  our  com- 
munity than  those  of  an  industrial  nature. 
Many  of  the  injuries  that  are  seen  in  the 
area  involve  trauma  to  various  portions  of 
the  extremities  of  the  patient.  In  particu- 
lar,-crushing  injuries  and  avulsive  injuries 
of  various  kinds  are  common.  Compression 
injuries,  likewise,  are  seen  with  increasing 
frequency  as  various  types  of  feed  grains 
are  compressed  for  purposes  of  decreasing 
space  required  for  storage.  Additional  fac- 
tors in  the  increased  incidence  of  injuries 
has  been  the  advent  of  the  “power  take- 
off” which  is  simply  a power  shaft  from  the 
tractor  to  the  machinery  concerned,  there- 
by eliminating  the  requirement  for  a 
power  source  in  the  machine  itself.  This  is 
a case  of  an  unusual  type  of  injury  which 
resulted  from  involvement  with  such  a 
power  shaft. 

Traumatic  Illness 

Patient  N.N.,  age-49,  was  standing 

astride  a protective  covering  of  a power 


shaft  when  he  slipped  and  fell  so  as  to 
straddle  the  power  shaft.  At  the  same  time 
the  power  shaft  picked  up  a free  edge  of 
the  trouser  leg  on  one  side  and  ripped  off 
this  material  with  great  force  and  also  pul- 
led the  patient  against  the  power  shaft 
with  great  force.  The  continuing  injury 
somehow  caught  the  loose  scrotal  skin  and 
also  the  skin  of  the  penis.  This  rapidly 
avulsed  the  skin  from  the  entire  scrotum 
and  penis  and  produced  a deep  laceration 
of  the  perineum  which  extended  from  an 
area  slightly  above  the  pubis  in  the  lower 
abdomen  down  and  around  the  penis  and 
then  through  the  perineum  into  the  rectal 
muscle  without  penetration  of  the  rectal 
mucosa.  There  were  additional  injuries 
due  to  abrasions  and  contusions  of  the  legs 
and  abdomen  as  well  as  a laceration  of  the 
ear  which  resulted  from  the  patient’s  head 
being  pulled  down  close  to  the  power  shaft. 

The  patient  was  taken  to  the  hospital 
and  suffered  moderate  blood  loss  after  the 
injury  and  during  transportation.  On  ex- 
amination at  the  hospital,  there  were  mul- 
tiple abrasions  and  contusions  of  the 
trunk  and  extremities  as  well  as  a lacera- 
tion behind  the  right  ear  and  a small  lacer- 


Arthur  D.  Poppens,  M.D.,  left,  is  a general  sur- 
geon in  Princeton.  He  is  a graduate  of  North- 
western University  School  of  Medicine  and 
served  his  internship  and  residency  at  Cook 
County  Hospital.  George  E.  Giffin,  M.D.,  ISMS 
Trustee  from  the  2nd  District  in  1967-68,  is 
a graduate  of  the  University  of  Illinois  School 
of  Medicine.  He  served  his  internship  at  St. 
Mary’s  Hospital,  Saginaw,  Mich.,  and  is  Cur- 
rently on  staff  at  Perry  Memorial,  Princeton. 
Louis  D.  Tarsinos,  M.D.,  right,  is  attending 
urologist  at  Perry  Memorial  Hospital 
in  Princeton  and  St.  Margaret’s  Hospital  in 
Spring  Valley.  He  served  his  intemeship  at 
Alexian  Brothers  Hospital,  Elizabeth,  N.J.  and 
a residency  at  Martland  Medical  Center,  New- 
ark, N.J.  He  is  a graduate  of  University  of  Ath- 
ens, Athens,  Greece. 


for  August,  1968 


171 


Fig.  1.  Left  scrotal  contents  placed  under  the  skin  of  the  thigh. 


ation  above  the  right  eye.  There  was  com- 
plete loss  of  the  skin  of  the  scrotum  and 
skin  of  the  proximal  portion  of  the  penis. 
There  was  a small  flap  of  skin  around  the 
coronal  sulcus.  There  was  a deep  lacera- 
tion as  noted  above  in  the  description  of 
the  present  illness.  There  were  in  addition, 
puncture  wounds  of  the  left  thigh,  some 
four  inches  distal  to  the  site  of  perineal 
laceration.  However,  the  penis  and  testicles 
and  cords  were  lying  free  with  no  com- 
promise of  the  vascular  supply  of  the  testi- 
cles. All  wounds  were  very  dirty  and  con- 
tained evidence  of  grass  and  other  debris 
from  the  field. 

The  patient’s  management  consisted  pri- 
marily of  immediate  determination  of  the 
status  of  the  patient’s  blood  count  and  im- 
mediate cleansing  of  the  wounds  and  eval- 
uation of  the  status  of  the  patient.  In  as 
much  as  the  scrotal  and  penile  skin  were 
completely  gone,  it  was  elected  to  trans- 
plant the  testicles  to  the  thigh. 

This  procedure  was  done  and  a few 
loose  sutures  were  used  to  secure  the  testi- 
cles in  position.  A primary  split  thickness 
skin  graft  was  then  elevated  from  the  thigh 
and  used  to  cover  the  penile  shaft.  The 
laceration  which  extended  from  the  supra- 
pubic area  to  the  anus  was  closed  in  stages 
as  this  repair  of  the  penis  was  completed. 
Drainage  was  provided  for  the  entire  area 
through  the  previously  established  trauma- 
tic stab  wound  of  the  left  thigh.  All  addi- 
tional injuries  were  then  treated  and  loose 
dressings  applied  throughout. 

On  admission,  the  patient’s  blood  count 
and  urinalysis  were:  W.B.C.  13,000;  Hemo- 
globin 16.3  gms.;  Hematocrit  45.3%.  Dif- 
ferential showed  52  polys,  4 stabs,  1 eosin, 
42  lymphs,  1 mono;  patient  was  A positive. 

172 


Urinalysis  findings  the  following  day  were 
1 plus  albumin,  1 plus  acetone,  2 to  3 
W.B.C. 


Uncommon  Injury 

Injuries  of  the  scrotal  and  penile  skin 
are  still  uncommon,  though  they  are  be- 
ing encountered  with  increasing  frequency 
as  industry  expands  and  farming  becomes 
more  mechanized.  Scrotal  avulsion  is,  with- 
out exception,  an  industrial  injury.  A 
farmer  straddles  or  leans  against  his  trac- 
tor belt  to  line  it  up  while  starting,  or 
a mechanic  steps  too  close  to  a whirling 
power  belt  or  an  unguarded  set  of  gears. 
Trousers  are  caught,  and  in  an  instant 
they  are  gone,  together  with  most  of  or 
all  of  the  genital  skin,  sometimes  one  or 
both  testes,  and  on  rare  occasions,  the 
penis  itself.  Complete  avulsion  leaves  the 
testes  exposed  and  the  penile  shaft  bare, 
each  of  which  presents  its  own  particular 
problem. 

It  is  imperative  that  the  man  not  be  left 
desexed  if  preventable. 

Whatever  the  type  or  degree  of  penile 
injury,  it  is  of  paramount  importance  that 
everything  possible  be  done  to  preserve 
both  its  structure  and  function.  Sex  stands 
very  high  among  the  most  precious  powers 
of  men  and  its  loss  is  never  taken  lightly. 
The  power  of  useful  erection  and  its  ability 
to  void  in  a manly  fashion  are  functions 
of  utmost  importance  and  their  preserva- 
tion should  be  the  prime  purpose  in  the 
management  of  all  penile  injuries. 

The  purpose  of  this  paper  is  to  present 
and  emphasize  the  successful  preservation 
of  both  the  testicles  and  penis,  the  restora- 
tion of  urination  and  sexual  ability,  and 
the  cosmetic  results  of  the  plastic  repair. 

Illinois  Medical  Journal 


L 


Fig.  3.  Skin  graft  to  the 
base  of  the  penis  after 
complete  healing.  Notice 
the  minimal  scarring  on 
the  dorsal  aspect  of  the 
penis  and  donor  areas  on 
thighs. 


Fig,  4.  Complete  healing 
of  the  perineum  after  re- 
moval of  the  scrotal  con- 
tents. The  penis  can  be 
retracted  upwards  with- 
out any  difficulty.  This 
will  provide  a normal 
erection. 


Fig.  5.  This  picture  illus- 
trates a normally  appear- 
ing penis  after  a skin 
graft  done  for  complete 
avulsion  of  the  penis  and 
the  scrotum.  The  pa- 
tient had  a satisfactory 
anatomical  andfunc- 

tional  result.  Comilient 

The  patient  presented  here  showed  a 
good  recovery  from  his  injuries.  The 
wounds  healed  primarily  and  the  skin  graft 
of  the  penile  shaft  was  accepted  in  its  en- 
tirety. There  is  continuing  tenderness  of 
the  testicles  in  their  new  position  in  the 
thigh  but  the  patient’s  potency  is  restored 
and  he  states  that  he  is  able  to  undertake 
normal  sexual  relations  with  ejaculation. 
A certain  amount  of  expected  psychic  ef- 
fect has  resulted  and  the  patient  has  con- 
siderable anxiety  and  mild  phobias  about 
his  general  condition.  He  has  episodes  of 
lower  abdominal  pain  which  seem  best  to 
be  related  to  some  tension  on  the  sperma- 
tic cord.  His  physical  status  is  very  good 
and  it  is  anticipated  that  further  improve- 
ment will  occur  in  his  psychic  state. 


for  August,  196S 


173 


Results  in  an  Urban 
Private  Psychiatric  Practice 


By  Paul  Miller,  M.D. /Chicago 


Dr.  PIPP— the  Psychiatrist  in  Private 
Practice— is  more  of  an  enigma  to  his  fel- 
low physicians  than  any  other  medical  spe- 
cialist. The  reason  is  that  most  non-psychi- 
atric physicians  have  not  directly  observed 
Dr.  PIPP’s  work,  nor  have  they  been  able 
to  review  the  outcome  of  psychotherapy, 
since  no  Dr.  PIPP  has  ever  published  a des- 
cription of  all  his  patients  and  the  results 
of  their  treatment  over  a period  of  several 
years. 

This  report  is  the  first  description  of  all 
the  patients  of  a typical  Dr.  PIPP.  Two  re- 
cent studiesi-2  indicate  that  the  author  is 
similar  to  the  “average”  urban  psychiatrist 
in  private  general  psychiatric  practice,  who 
typically  spends  30-35  hours  a week  seeing 
private  patients,  sees  about  33  different  in- 
dividuals each  month,  sees  most  of  his  pa- 
tients in  once-a-week  psychotherapy,  uses 
drugs  for  a selected  minority  of  patients, 
does  not  see  neurological  patients,  and 
spends  his  other  professional  time  in  teach- 
ing, in  research,  and  in  public  clinics  and 
hospitals. 

This  author  has  collected  data  in  52  dif- 
ferent areas  for  each  patient  since  he  began 
private  practice  in  1960.  Information  has 
been  transferred  to  IBM  punchcards.  Data 
presented  have  been  chosen  for  their  in- 
terest to  the  general  medical  reader;  they 
represent  only  a fraction  of  all  data  col- 
lected. 

The  Patients 

During  1960-1964  the  author  saw  a total 
of  157  patients.  Of  these,  139  (89%)  were 
evaluated  for  psychiatric  treatment.  The 

Table  1 

Sources  of  Referral  of  157  Patients 
Medical  84% 

Non-psychiatric  MD  (42%) 

Psychiatrist  (32%) 

Medical  clinic  (10%) 

Non-medical  16% 

Clergyman  (4%) 

Lawyer  (4%) 

Former  patient  of  author  (4%) 

Self-referred  student  of  author  (2%) 

Non-medical  psychotherapist  (1%) 

College  mental  health  center  (1%) 


remaining  18  (11%)  were  referred  for  other 
services,  including  counseling  about  a spe- 
cific situation  (such  as  divorce),  advice 
about  a disturbed  relative,  and  determina- 
tion of  legal  competency.  Table  1 lists  the 
sources  of  their  referral  (no  psychiatric  pa- 
tients are  “walk-ins”).  Table  2 indicates 

the  disposition  of  the  139  patients  referred 
for  psychotherapy.  Table  3 summarizes  the 
basic  characteristics  of  patients  referred  for 
psychotherapy. 

Table  2 

Disposition  of  139  Referrals  for  Psychotherapy 
Psychotherapy  Not  Recommended  9% 

Psychotherapy  Recommended,  Patient  Refused  12% 

Psychotherapy  Recommended,  Patient  Accepted  79% 

Treated  by  the  author  (68%) 

Referred  to  another  psychotherapist  (11%) 

Table  3 

Basic  Characteristics  of  139  Patients  Referred 


for  Psychotherapy 


Age 

Mean 

35.2  years 

Range 

14-78  years 

Distribution 

14-19 

12% 

20-29 

27% 

30-39 

31% 

40-49 

14% 

50-59 

10% 

60-69 

5% 

70-78 

1% 

Sex 

Male 

47% 

Female 

53% 

Religion 

Protestant 

41% 

Catholic 

27% 

Jewish 

20% 

None 

12% 

Activity 

Practicing 

46% 

Non-practicing 

54% 

Marital  status  of  116  adults 

Never 

married 

22% 

Married  and  living  with  spouse  59% 

Once  married  but  now  living  alone  19% 

The  marital  status  of  adult  patients  was 
unstable:  for  every  five  patients,  only  three 
were  married  and  living  with  their  spouse: 
one  had  not  married,  and  the  other— al- 
though married  in  the  past— was  not  living 
with  a spouse. 


174 


Illinois  Medical  Journal 


Table  5 


Table  4 

Social  Class  Factors  (No.  = 139) 
Social  Class 


Class  1. 

13% 

Class  II. 

24% 

Class  III. 

41% 

Class  IV. 

15% 

Class  V. 

4% 

Undetermined 

3% 

Head  of 

Education 

Household 

Patient 

Graduate  degree 

14% 

11% 

College  degree 

29% 

25% 

Completed  1-3  years  of  college 

22% 

29% 

High  school  graduate 

16% 

16% 

Completed  2-3Vi  years  of  high  school  12% 

17% 

Completed  8-9  years 

1% 

1% 

Undetermined 

6% 

Head  of 

1% 

Occupation 

Household 

Patient 

Higher  executive;  major  professiona 
Manager;  proprietor;  lesser 

1 19% 

12% 

professional 

24% 

9% 

Administrative  personnel;  small  busi 

1- 

nessman;  minor  professional 

30% 

20% 

Clerk;  salesman;  technician 

14% 

13% 

Skilled  manual  employee 

5% 

1% 

Semi-skilled  employee 

2% 

1% 

Unskilled  employee 

1% 

1% 

Undetermined 

5% 

0% 

Student 

0% 

16% 

Housewife  unemployed  outside  home  0% 
Unemployed  and  not  a student  or 

22% 

a housewife 

0% 

5% 

Table  4 summarizes  social  class  factors. 
The  “Two  Factor  Index  of  Social  Posi- 
tion”^ was  the  scale  used;  it  yields  five  so- 
cial classes,  using  the  two  factors  of  the 
education  and  the  occupation  of  the  head 
of  the  household.  The  table  shows  that  the 
upper  classes  were  over-represented  and  the 
lower  classes  were  under-represented.  Both 
patients  and  heads  of  households  were  well 
educated  and  -were  high  occupational 
achievers.  Table  5 lists  the  annual  income 
of  the  heads  of  households  of  patients.  The 
median  income  of  ^7900  was  approximate- 
ly the  same  as  the  median  income  of  fami- 
lies in  Chicago. 

Initial  Phychiatric  Evaluation 

The  remainder  of  the  Tables  describe  the 
94  patients  who  undertook  psychotheraj^y 
with  the  author. 

Table  6 gives  the  initial  psychiatric  diag- 
nosis. All  patients  referred  for  psycho- 
therapy had  a diagnosable  mental  disorder, 
a finding  that  refutes  critics^  ® who  say  that 
most  highly  trained  psychotherapists  treat 
“garden-variety  distress  or  unhappiness” 


Annual  Income  of  Head  of  Household 
(No.  = 139) 


0-$3500 

4% 

$3600-5000 

12% 

$5100-7500 

30% 

$7600-10,000 

24% 

$10,000  and  up 

26% 

Undetermined 

4% 

Table  6 

laitial  Psychiatric  Diagnosis  (No.= 

94) 

Psychoneurotic  Disorders 

32% 

Personality  Disorders 

45% 

Personality  trait  disturbance  (25%) 

Personality  pattern  disturbance 

(16%) 

Sociopathic  personality  disturba 
Schizophrenic  Reactions 

nee  (4%) 

23% 

Table  7 

Symptom  Problem  Areas  (No.  = 94) 
Primary  Secondary 


Area 

Area 

Area 

Total 

Marital  Conflict 

18% 

16% 

34% 

Depression 

17% 

17% 

34% 

Confusion  of  Self-Identity 

11% 

22% 

33% 

Lack  of  Impulse  Control 

20% 

4% 

24% 

Somatic  Complaints 

9% 

9% 

18% 

Sexual  Difficulties 

9% 

9% 

18% 

Disturbed  Interpersonal 
Relations 

6% 

10% 

16% 

Nonspecific  Dissatisfaction 
with  Life 

2% 

7% 

9% 

Difficulty  with  Parents 

4% 

4% 

8% 

Anxiety 

4% 

2% 

6% 

and  “therefore,  have  less  time  for  that  simi- 
lar number  of  truly  neurotic  and  psychotic 
patients  who  need  their  specialized  skills.”^ 
Most  physicians  are  familiar  with  psycho- 
neurosis and  schizophrenia  but  know  less 
about  personality  disorder.  It  is  “character- 
ized by  developmental  defects  or  pathologic 
trends  in  the  personality  structure.  . . . 
manifested  by  a lifelong  pattern  of  action 
or  behavior,  rather  than  by  mental  or  emo- 
tional symptoms.”^  In  general  it  is  more 
severe  than  psychoneurosis  and  less  severe 
than  schizophrenia. 


Paul  Miller,  M.D.,  is 
Assistant  Professor  of 
Neurology  and  Psychia- 
try, Northwestern  Uni- 
versity Medical  School 
and  is  also  engaged  in 
the  private  practice  of 
psychiatry.  He  received 
his  M.D.  from  Northwest- 
ern University,  having 
taken  his  pre-med  at  De- 
Pauw.  His  internship 
was  served  at  Henry  Ford  Hospital,  Detroit, 
and  his  residency  was  at  Michael  Reese  Hos- 
pital. 


for  August,  1968 


175 


Organic  disease  is  not  represented,  be- 
cause patients  with  known  brain  disease 
are  rarely  referred  to  this  author  by  his 
colleagues;  if  they  are,  the  author  imme- 
diately refers  them  to  a neurologist. 

Table  7 details  the  symptom  problem 
areas.  After  completing  the  diagnostic  sur- 
vey (a  minimum  of  two  interviews),  the 
author  chose  which  areas  were  the  first  and 
second  areas  of  patient  problems. 

Table  8 

Grades  of  Anxiety  and  Depression  (No.  = 94) 


Anxiety 

None  0% 

Slight  2% 

Some  16% 

Moderate  22% 

Moderately  severe  40% 
Severe  12% 

Disabling  8% 

Depression 

None  2% 

Slight  5% 

Some  17% 

Moderate  26% 

Moderately  severe  28% 
Severe  13% 

Disabling  9% 


Table  8 records  grades  of  anxiety  and 
tiepression  among  patients.  The  process  of 
rating  levels  of  affect  from  a clinical  inter- 
view has  been  established  as  reliable  and 
valid. Although  grades  of  anxiety  were 
slightly  higher  than  depression,  patients 
complained  of  much  more  depression  than 
they  did  of  anxiety  (Table  7).  Probably 
depression  is  the  more  painful  subjective 
experience.  One  study®  found  that  depres- 
sion is  basically  the  same  as  anxiety  with 
the  added  dimensions  of  strong  feelings  of 
lielplessness  and  hopelessness.  It  is  these 
added  feelings  which  make  depression  more 
painful  to  the  patient. 

The  Process  of  Psychiatric  Treatment 

As  a psychodynamically  (or  “psychoana- 
lytically”)  oriented  psychotherapist,  the 
author  views  his  work  as  follows.  Pie  and 
the  patient  meet  at  regular  times.  The  pa- 
tient discusses  his  problems  and  the  thera- 
pist comments  on  them.  This  provides  the 
patient  with  a learning  opportunity  to  see 
both  his  abilities  and  his  limitations  more 
objectively,  to  view  his  major  relations  and 
his  work  in  broader  perspective,  to  see 
choices  where  he  saw  only  one  uncontroll- 
able course  of  action  previously,  and  to  ex- 
ercise the  choices  that  will  yield  maximum 
benefit  to  him.  In  addition  to  talking,  the 
patient  behaves  in  the  psychotherapy  rela- 


tion: he  reenacts  his  characteristic  roles,  ex- 
pectations, and  self-defeating  (“neurotic”) 
or  grossly  distorting  (“psychotic”)  styles  of 
life.  The  therapist  observes  the  non-verbal 
behavior  and  communicates  verbal  insights 
and  emotional  responses  that  structure  the 
therapeutic  relation  .so  that  it  expo,ses  rather 
than  gratifies  or  reinforces  the  patient’s 
usual  self-defeating  roles  and  attitudes. 
From  his  learning  in  therapy,  the  patient 
can  apply  his  new  knowledge  to  the  rest  of 
his  life. 

Table  9 details  timing  and  place  of  psy- 
chotherapy. All  of  the  14  patients  seen 
three  or  more  times  a week  were  initially 
hospitalized.  After  discharge,  only  two  re- 
(juired  continuation  of  this  frequency  as 


outpatients.  Most  patients  (77%)  were  seen 

as  outpatients  only. 

Tahle  9 

Timing  and  Place  of  Psychotherapy  (No.  = 94) 

Number  of  Psychotherapy 

Sessions 

3-10 

19% 

n-25 

26% 

26-50 

12% 

51-75 

13% 

76-100 

12% 

101  + 

18% 

Duration  in  Months 

1-  2 

22% 

3-  6 

28% 

7-12 

11% 

13-18 

17% 

19-24 

6% 

25  + 

16% 

Primary  Frequency  of  Sessions 

Once  every  2 weeks 

6% 

Once  a week 

57% 

Twice  a week 

22% 

3-5  times  a week 

15% 

Place 

Outpatient  only 
Inpatient  and  out- 

77% 

patient 

16% 

Inpatient  only 

7% 

Table  10  lists  the  concomitant  use  of 
drugs  with  psychotherapy.  The  majority 
(58%)  received  no  drugs;  of  these  who  did, 
all  had  discontinued  them  by  the  time  psy- 
chotherapy terminated. 

Outcome  of  Psychotherapy 

These  evaluations  have  been  made  by 
the  author,  based  on  what  the  patients  said 
about  themselves  and  also  on  the  author’s 
observation  of  what  had  occurred  objec- 
tively in  the  patients’  lives.  Table  11  lists 
four  criteria  for  measuring  change  in  psy- 
chotherapy: symptoms,  character  organiza- 
tion, self-esteem,  and  psycho,social  comfort. 


176 


Illinois  Medical  Journal 


Table  10 

Use  of  Drugs  with  Psychotherapy  (No.  = 94) 


None  58% 

Minor  Tranquilizers  (Non-Phenothiazines)  10% 

Major  Tranquilizers  (Phenothiazines)  16% 

Antidepressants  16% 

Alone  (6%) 

With  tranquilizers  (10%) 


The  relief  of  symptoms  is  the  patient’s 
primary  motive  for  consulting  the  psychia- 
trist. By  this  criterion,  psychotherapy  was 
helpful:  72%  improved  moderately  or 

markedly.  Only  2 became  worse:  both 
were  schizophrenics,  a syndrome  which  oc- 
casionally has  an  inexorable  decline. 

Character  organization  may  be  defined 
in  many  ways.  For  purposes  of  reliable 
measurement,®  it  is  defined  as  the  individ- 
ual’s psychological  traits  and  social  roles 
which  are  acceptable  and  desirable  to  the 
self.  This  contrasts  with  symptoms,  which 
are  always  perceived  as  alien  and  undesir- 
able. Hence,  the  patient  is  much  less  moti- 
vated to  change  his  character  than  to  change 
his  symptoms. 

The  following  case  history  illustrates  the 
contrast  between  character  organization  and 
symptoms.  A 50  year  old  married  male  con- 
sulted me  because  he  was  suffering  from 
symptoms  of  lack  of  energy,  difficulty  in 
his  work,  episodes  of  “nervousness,”  and 
spells  of  “feeling  blue.”  I diagnosed  his 
primary  symptom  area  as  a moderate  de- 
pression and  his  secondary  symptom  area 
as  somatic  complaints.  As  he  described  his 
life,  it  became  obvious  that  he  rigidly  or- 
ganized all  of  it.  He  worked  at  his  execu- 
tive job  “according  to  the  book.”  He  ran 
his  home  “like  a tight  ship:”  he  issued  di- 
rectives to  his  wife  and  daughter,  posting 
them  on  the  bulletin  board  each  morning. 
He  never  relaxed  or  played;  his  spare  time 
was  spent  in  watching  a little  television  and 

Table  11 

Outcome  of  Psychotherapy  According  to 
Specific  Criteria  (No.  = 94) 

Char-  Psycho- 

acter  social 


Symp- 

Organi- 

Self- 

Com- 

toms 

zation 

Esteem 

fort 

-j-3  Markedly  Improved 

33% 

10% 

20% 

37% 

+ 2 Moderately  Improved 

39% 

20% 

23% 

21% 

+ 1 Mildly  Improved 

15% 

23% 

27% 

27% 

0 No  Change 

11% 

45% 

25% 

14% 

— 1 Mildly  Worse 

1% 

2% 

3% 

0% 

— 2 Moderately  Worse 

1% 

0% 

2% 

1% 

— 3 Markedly  Worse 

0% 

0% 

0% 

0% 

Percentage  That  Improved 
Markedly  or  Moderately 

72% 

30% 

43% 

58% 

sleeping.  The  success  of  his  occasional  va- 


cation was  measured  in  how  accurately  he 
kept  his  traveling  schedule  and  how  de- 
tailed he  recorded  his  expenses.  These  psy- 
chological traits  and  social  roles  supplied 
the  basis  for  a character  diagnosis  of  a com- 
pulsive personality  trait  disturbance.  The 
patient  wished  to  change  only  his  symp- 
toms which  were  distressing  him;  he  ad- 
mired his  entire  style  of  life,  although  it 
distressed  his  wife  and  daughter  and  caused 
him  difficulty  in  his  job. 

It  soon  became  obvious  to  the  patient 
and  to  me  that  his  symptoms  were  the 
eventual  payoff  to  a lifetime  of  rigidity. 
His  adolescent  daughter  was  currently  re- 
belling against  him  and  seeking  to  estab- 
lish more  freedom  in  her  own  life.  This 
made  him  very  angry,  but  he  soon  realized 
that  he  also  envied  it,  as  he  had  experienced 
the  same  conflict  in  his  adolescence  only 
to  capitulate  to  his  rigid  parents  and  settle 
into  his  adult  compulsivity.  Within  two 
months  he  became  more  flexible  in  his  at- 
titudes and  behavior,  with  improvements 
in  his  relations  both  at  home  and  in  his 
job.  At  that  point  his  symptoms  disap- 
peared; they  had  not  returned  three  years 
later.  He  was  rated  as  “markedly  improved” 
in  symptoms  and  “moderately  improved” 
in  character  organization. 

Self-esteem  and  psychosocial  comfort  are 
dimensions  that  have  been  found  meaning- 
ful in  measuring  change  in  psychotherapy.^® 
Self-esteem  is  how  well  or  badly  one  thinks 
of  oneself.  Ninety-one  per  cent  of  these  pa- 
tients had  a negative  self-esteem  prior  to 
beginning  psychotherapy.  At  the  end,  59% 
had  a positive  self-esteem.  Psychosocial 
comfort  is  the  patient’s  estimate  of  his  ease 
in  social  situations  and  relations.  Whereas 
97%  were  on  the  negative  side  prior  to 
psychotherapy,  60%  were  on  the  positive 
side  at  the  end  of  psychotherapy. 

The  overall  outcome  presented  in  Tables 
12  and  13  is  based  on  the  results  from  Table 
11.  It  has  been  computed  as  follows;  the 
results  for  each  of  the  four  criteria  were 
rank  ordered,  ranging  from  -f-3  for  “mark- 
edly improved”  through  zero  for  “no 
change”  to  —3  for  “markedly  worse.”  The 
algebraic  sum  for  these  criteria  yielded  the 
following  categories: 


^9  to  +12: 
+5  to  + 8: 
+ 1 to  + 4: 
0 ; 
—1  to  — 4: 


markedly  improved 
moderately  improved 
mildly  improved 
no  change 
worse. 


for  Avgust,  19bS 


177 


Table  12 


Outcome  of  Psychotherapy  According  to 
Diagnosis 


, Percentage 
That  Improved 


Markedly 

Moderately 

Mildly 

No 

Markedly  or 

Improved 

Improved 

Improved  Change  Worse 

Moderately 

Psychoneurotic  Disorders  (No.  = 30) 

50% 

43% 

7% 

0% 

0% 

93% 

Personality  Disorders  (No.  = 42) 

14% 

24% 

41% 

21% 

0% 

38% 

(Personality  trait  disturbance)  (No.  = 23) 

(26%) 

(31%) 

(31%) 

(12%) 

(0%) 

(57%) 

(Personality  pattern  disturbance)  (No.=  15) 

(0%) 

(13%) 

(47%) 

(40%) 

(0%) 

(13%) 

(Sociopathic  personality  disturbance)  (No.  = 4) 

(0%) 

(25%) 

(75%) 

(0%) 

(0%) 

(25%) 

Schizophrenic  Reactions  (No.  = 22) 

45% 

27% 

14% 

0% 

14% 

72% 

Total  (No.  = 94) 

33% 

31% 

23% 

10% 

3% 

64% 

Table  12  shows  that  the  three  diagnostic 
categories  responded  with  “markedly  im- 
proved” or  “moderately  improved”  results 
in  the  following  proportions:  psychoneuro- 
tics, 93%;  schizophrenics,  72%;  and  per- 
sonality disorders,  38%.  The  relatively  poor 
response  of  personality  disorders  is  striking. 
There  are  several  possible  explanations. 
Most  patients  whose  symptom  problem 
areas  were  “lack  of  impulse  control”  and 
“disturbed  interpersonal  relations”  (the 
two  symptom  problems  areas  least  respon- 
sive—Table  13),  occurred  mainly  in  per- 
sonality disorders.  Another  factor  was  rigid- 
ity: personality  disorders  are  a “lifelong 
pattern”  and  are  fixed  and  rigid  by  adult- 
hood. The  Standard  Nomenclature  states 
that  the  subtype,  personality  pattern  dis- 
turbance, “can  rarely  if  ever  be  altered  . . . 
by  any  form  of  therapy.”®  This  study  indi- 
cates that  although  personality  disorders  do 
respond  to  psychotherapy,  they  are  less  re- 
sponsive than  psychoneurotics  or  schizo- 
phrenics. 

Table  13  lists  the  outcome  of  psycho- 
therapy according  to  symptom  problem 
areas.  The  primary  and  secondary  symptom 
problem  areas  (Table  7)  were  added  to- 


gether to  produce  the  results.  Somatic  com- 
plaints were  most  responsive,  a finding 
which  should  encourage  physicians  to  con- 
sider psychiatric  referral  for  those  patients 
who  have  no  organic  lesion  to  account  for 
their  physical  symptoms.  Depression,  con- 
fusion of  self-identity,  marital  conflict,  and 
sexual  difficulties  all  responded  with 
marked  or  moderate  improvement  for  65% 
of  the  patients. 

The  symptoms  of  lack  of  impulse  con- 
trol and  disturbed  interpersonal  relations 
do  less  well.  To  participate  in  psycho- 
therapy requires  an  ability  to  control  one’s 
impulses,  to  stop  behaving  erratically,  and 
to  consider  one’s  behavior  objectively.  The 
habit  of  “acting  out,”  such  as  the  alcoholic 
continuing  to  drink,  may  be  extremely  dif- 
ficult to  curtail.  If  the  patient  has  dis- 
turbed interpersonal  relations,  he  will  ex- 
press that  difficulty  in  psychotherapy.  This 
hampers  its  effectiveness. 

Three  symptoms  listed  in  Table  7— non- 
specific dissatisfaction  with  life,  difficulty 
with  parents,  and  anxiety— are  not  included 
in  Table  13  because  the  number  of  cases 
was  too  small  to  yield  reliable  results. 

(Continued  on  page  202) 


Table  13 


Outcome  of  Psychotherapy  According 
to  Symptom  Problem  Areas  (No, =94) 


Markedly 

Improved 

Moderately 

Improved 

Mildly  No 

Improved  Change  Worse 

Percentage 
That  Improved 
Markedly  or 
Moderately 

Somatic  Complaints  (No.  = 15) 

27% 

53% 

13% 

7% 

0% 

80% 

Depression  (No.  = 34) 

35% 

38% 

21% 

6% 

0% 

73% 

Confusion  of  Self-Identity  (No.  = 34) 

44% 

26% 

18% 

6% 

6% 

70% 

Marital  Conflict  (No.  = 34) 

35% 

29% 

24% 

6% 

6% 

64% 

Sexual  Difficulties  (No.=  17) 

41% 

24% 

24% 

11% 

0% 

65% 

Lack  of  Impulse  Control  (No.  = 24) 

17% 

29% 

42% 

8% 

4% 

46% 

Disturbed  Interpersonal  Relations  (No. = 14) 

29% 

14% 

21% 

36% 

0% 

43% 

Total  (No.  = 172) 

34% 

31% 

23% 

9% 

3% 

65% 

178  Illinois  Medical  Journal 


THE  VIEW  BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Diagnostic  Radiology,  Cook  County  Hospital, 
and  Clinical  Professor  of  Radiology,  Chicago  Medical  School 


This  infant  presented  at  birth  with  con- 
genital cataracts  and  a murmur  consistent 
with  patent  ductus  arterosis. 


WHATS  YOUR  DIAGNOSIS? 

1.  Congenital  lues. 

2.  Hypophosphatasia. 

3.  Rubella  syndrome  in  infants. 


(Answer  on  page  210) 


for  August,  1968 


179 


Medical  Management  Of  Obese  People: 
Timely  Observations 

By  Frank  L.  Bigsby^  M.D.  and  Cayetano  Muniz,  M.D. /Chicago 


The  American  Medical  Association  re- 


cently issued  the  following  statement  of 
policy: 

“The  practice  of  physicians  concerned 
with  weight  reduction  is  a subject  of  in- 
creasing medical  interest.” 

“There  is  no  ethical  nor  legal  ruling 
which  would  prevent  a physician  from 
limiting  his  practice  to  the  treatment  of 
obesity  but  this  is  not  a recognized  speci- 
alty. Since  obesity  may  be  only  a sign, 
many  disciplines  of  medicine  may  be  in- 
volved in  proper  treatment.” 

“Any  physician  particularly  concerned 
with  the  treatment  of  obesity  should  rec- 
ognize that  his  practice  and  the  care  of 
patients  should  follow  all  professional 
and  ethical  rules  governing  the  practice 
of  medicine.  A physician  should  not  ad- 
vertise his  services;  he  should  not  exploit 
the  patient  in  any  way.  The  use  of  drugs 
must  be  carefully  controlled  by  the  phy- 
sician.” 


“The  treatment  of  obesity  cannot  be 
isolated  from  concern  for  co-existing  dis- 
eases such  as  diabetes  and  heart  disease, 
and  requires  very  definite  diagnostic 
skills  and  close  supervision  of  the  patient. 


Frank  L.  BJttshy,  M.D.,  left,  is  a graduate  of 
Tulane  \Jniversity  Sciioul  of  McOv«i|^g  a sen- 

. a a M. 


o^cciai  *«verest 


eral  practitioner  ~ clini- 
cal aspects  of  and  disturber 

^Hion.  He  served  ki^hiternship  at  Kansas  City 
® *\sidency  at  Barnes  Hos- 
bt.  Louis.  Cayet^o  Muniz,  M.D.,  right. 

n a special  interest 

tL  I’^eived  his  M.D.  from 

Sfha  *'"a*’®**^  Havanaychool  of  Medicine, 
Middl  served  a residence  in  psychiatry  at 
Middletown  State  Hospital,  ^iddletown,  N.Y. 


It  is  vitally  important  that  physicians 
working  in  this  area  have  a thorough 
knowledge  of  all  aspects  of  internal 
medicine.  The  methods  which  a physi- 
cian uses  in  this  area  should  be  based  on 
all  knowledge  of  human  physiology  and 
metabolism  and  on  current  information 
concerning  the  patient’s  responses  to 
weight  reduction.  There  are  health  haz- 
ards in  weight  reduction  and  these 
should  be  thoroughly  understood  and 
appreciated.” 

The  statement  is  undoubtedly  endorsed 
by  every  physician.  It  is  hoped  that  the 
opinions  voiced  will  result  in  positive  ac- 
tion by  concerned  physicians  and  that  the 
past  tendency  to  treat  weight  rather  than 
people  will  be  reversed. 

An  important  step  in  successfully  treating 
people  is  the  realization  that  the  physician’s 
prime  goal  is  to  initiate  a long  term  dietary 
regimen  and  then  employ  every  ethical, 
truthful,  and  healthful  means  at  his  dispo- 
sal to  prevent  the  patient  from  prematurely 
breaking  off  the  program. 

Clearly,  the  weapons  at  our  disposal  to 
promote  long  term  dieting  are  inadequate. 
The  naive  attitude  that  the  physician 
should  merely  admonish  the  patient  to 
push  away  from  the  table  and  perhaps  to 
increase  energy  expenditure  is  excellent 
advice  for  cooperative  patients.  Unfortu- 
nately, there  are  from  20  to  40  million  peo- 
ple (the  figures  vary)  unwilling  or  unable 
to  do  this.  Is  this  attitude  consistent  with 
the  statement  of  policy  issued  by  the  Amer- 
ican Medical  Association  that,  since  obesity 
may  be  only  a sign,  many  disciplines  of 
medicine  may  be  involved  and  that  the 
treatment  of  obesity  cannot  be  isolated 
from  concern  for  coexisting  diseases?  Dy- 
suria,  frequency,  urgency  and  tenesmus 
niiijr  oymptorYx:  of  acute  cystitis.  Should 
the  physician  advise  this  patient  to  go 
home  and  stop  urinating? 

Thousands  of  physicians  having  insuffi- 
cient time  to  devote  to  the  problem  know 
that  a pep  talk  with  a calorie  chart  is  inef- 


180 


Illinois  Medical  Journal 


fective  so  they  supplement  the  chart  with 
hastily  scribbled  prescriptions  for  diuretics 
and  anorexiants,  perhaps  with  a periodic 
injection  of  a mercurial.  Is  this  practice  con- 
sistent with  the  principles  issued  by  the 
Medical  Association? 

The  “fat  doctor”  currently  in  the  head- 
lines is  guilty  of  drug  abuse  in  treating 
weight  rather  than  people.  It  is  an  accepted 
fact  that  the  weakness  of  supportive  medi- 
cation in  a dietary  program  is  that  there 
may  be  a total  loss  of  effectiveness  within  a 
four  to  six  week  period.  This  is  particular- 
ly true  when  the  dietary  program  is  off- 
handedly and  briefly  presented,  when  both 
physician  and  patient  rely  solely  on  medi- 
cation for  results.  With  early  loss  of  drug 
effectiveness  the  only  alternative  is  escala- 
tion of  dosage  to  dangerous  levels.  This 
practice  clearly  flaunts  every  principle  out- 
lined in  the  AMA  statement. 

To  effectively  overcome  the  above  short- 
comings the  physician  should  employ  every 
acceptable  method  to  keep  the  patient  in  a 
dieting  frame  of  mind;  the  mood  to  diet 
must  be  sustained  indefinitely  (a  good  defi- 
nition of  motivation):  this  allows  medica- 
tion to  support  a regimen  in  a safe,  health- 
ful and  controlled  manner. 

The  only  intelligent  way  to  treat  obese 
people  is  to  treat  the  people  and  not  their 
obesity.  An  attempt  must  be  made  to  un- 


derstand the  patient.  Clearly,  prescribing  a 
diet  is  ineffective  unless  motivation  is  suf- 
ficient to  keep  him  on  it  indefinitely:  im- 
proving motivation  depends  upon  improv- 
ing insight  into  the  true  nature  of 
the  problem.  Improving  insight  is  impos- 
sible without  developing  an  excellent  pa- 
tient-doctor relationship. 

How  can  rapport,  insight,  and  motiva- 
tion be  improved?  Surface  or  superficial 
psychotherapy  is  the  one  logical  method 
that  merits  universal  consideration.  It  con- 
tains four  elements:  1)  aeration  and  venti- 
lation—encoursiging  the  patient  to  talk  free- 
ly about  overweight  and  the  problems  it 
produces;  2)  explanatory  therapy— pxowid- 
ing  a judicious  explanation  of  causes  of 
overeating,  refuting  mistaken  ideas  about 
other  phases  of  obesity;  3)  manipulative 
therapy— pre?,crihmg  a long  term,  prudent 
diet  to  produce  gradual  weight  loss,  a diet 
that  can  be  maintained  the  many  years  that 
may  be  required  to  learn  to  say  “no”  per- 
mantly;  4)  supportive  therapy  (a  poor 
fourth  in  importance)— the  intelligent  and 
controlled  use  of  medication. 

Finally,  the  success  of  this  program  re- 
quires special  knowledge,  time,  interest, 
and  proper  personnel.  In  this  sense  alone 
the  management  of  obese  people  may  some- 
day be  considered  a medical  specialty. 


Internal  Bleeding 

The  use  of  selective  celiac  and  superior  mesenteric  arteriography  in  the 
diagnosis  of  acute  gastrointestinal  bleeding  is  a valuable  diagnostic  pro- 
cedure. Because  the  diagnosis  rests  on  demonstration  of  contrast  medium 
outside  the  vascular  bed,  in  the  lumen  of  a hollow  organ,  it  is  mandatory 
that  the  patient  be  actively  bleeding  at  the  time  of  examination.  Bleeding 
of  0.5  ml  per  minute  can  be  demonstrated  if  the  contrast  medium  is  injected 
selectively  into  the  appropriate  visceral  artery.  In  this  small  series  of  four 
patients  arteriography  accurately  localized  the  site  of  bleeding.  In  actively 
bleeding  patients,  arteriography  should  precede  barium  studies  because  the 
barium  in  the  intestine  may  obscure  the  extravasated  contrast  medium. 
Barium  studies  can  follow  arteriography  immediately  when  the  point  of 
bleeding  has  not  been  identified. 

Arteriography  is  most  helpful  in  demonstrating  arterial  bleeding,  but  can 
also  disclose  venous  abnormalities  such  as  varices.  Arteriography  is  also  use- 
ful in  chronic  cases  in  which  barium  studies  failed  to  localize  the  site  and 
cause  of  bleeding.  Lesions  such  as  aneurysms  of  abdominal  vessels,  arterio- 
venous malformations,  and  traumatic  ruptures  of  viscera  may  be  best  dem- 
onstrated by  this  method.  (Angiographic  Localization  of  Unknown  Acute 
Gastrointestinal  Bleeding  Sites.  Edward  Mallinckrodt.  Radiology  (Aug.) 
1967;  89:244-249.) 


for  August,  1968 


181 


''will  it  ease  the  pain?'' 

Mylanta  helps  relieve  ulcer  pain  with  the  two  most  widely 
prescribed  antacids:  aluminum  and  magnesium  hydroxides. 

will  it  help  "my  gassy  stomach"? 

Mylanta  also  contains  simethicone:  for  concomitant  relief 
of  G.l.  gas  distress. 

"will  this  one  taste  O.  K.?" 

The  prolonged  acceptance  of  Mylanta  was  recently 
confirmed  in  87.5%  of  104  patients  — after  a total  of  20,459 
documented  days  of  therapy.*  *Danhof,  i.  e.:  Report  on  tiie. 


in 

peptic 

ulcer: 


antacid 


solved  by 


aluminum  and  magnesium  hydroxides  p/us  simethicone 


Composition:  Each  Mylanta  chewable  tablet  or  teaspoonful 

(5  ml.)  contains:  magnesium  hydroxide,  200  mg.;  aluminum  hydroxide, 

dried  gel,  200  mg.;  simethicone,  20  mg.  Dosage:  One  or  two  tablets  (well 

chewed  or  allowed  to  dissolve  in  the  mouth)  or  one 

or  two  teaspoonfuls  to  be  taken  between  meals  and  at  bedtime. 


Division/Pasadena,  Calif. 
ATLAS  CHEMICAL  INDUSTRIES,  INC. 


182 


Illinois  Medical  Journal 


Opinions  and  Reports  on  Ethical  Relations 


Payment  of  Physician  for  Services 
Performed  by  Intern  Under  His 
Direction  or  Supervision 

The  Council  agreed  that  when  a physi- 
cian assumes  responsibility  for  the  services 
rendered  to  a patient  by  a resident  or  an 
intern,  the  physician  may  ethically  bill  the 
patient  for  services  which  were  performed 
under  the  physician’s  personal  observation, 
direction  and  supervision.  (Judicial  Coun- 
cil; Council  on  Medical  Service,  1965) 

Charging  Penalty  for  Over-due  Accounts 

Since  the  practice  of  medicine  is  a profes- 
sion and  not  a business,  the  practices 
adopted  by  businessess  are  not  necessarily 
suitable. 

It  is  not  in  the  best  interest  of  the  public 
or  the  profession  to  charge  a penalty  if 
fees  for  professional  services  are  not  paid 
within  a prescribed  period  of  time,  nor  is 
it  proper  to  charge  a patient  a flat  collec- 
tion fee  if  it  becomes  necessary  to  refer  the 
account  to  an  agency  for  collection.  (Judi- 
cial Council,  1962) 

Bill  for  Respiratory  Services  Provided 
by  Lay  Organization 

It  is  not  ethical  for  a physician  to  bill 
a patient  for  respiratory  services  provided 
by  a lay  organization.  A physician  should 
limit  his  income  to  services  he  actually 
renders  to  the  patient.  A physician  should 
not  collect  for  services  he  does  not  render. 
(Judicial  Council,  1962) 

Rebates  from  Sale  of  Medicines 
or  Appliances 

It  should  be  well  known  by  this  time 
that  the  traditional  interpretation  of  the 
Principles  of  Medical  Ethics  by  the  various 
Judicial  Councils  in  the  history  of  the  As- 
sociation has  been  that  the  doctor  may  re- 
ceive no  profit  whatever  from  his  patient 
other  than  payment  for  rendered  medical 
services.  Hence  it  should  be  apparent  that 
no  rebate  of  any  kind,  in  any  form  or  from 
any  source  can  be  accepted.  This  applies 
also  to  rebates  coming  from  agents  or  own- 
ers of  optical  companies.  They  are,  in  every 
case,  absolutely  unethical.  (House  of  Dele- 
gates, 1947) 


Rebates  and  Commissions 

The  acceptance  of  rebates  on  prescrip- 
tions and  appliances  or  of  commissions 
from  those  who  aid  in  the  care  of  patients 
is  unethical.  (Principles  of  Medical  Ethics, 
1955  Edition,  Chapter  I,  Section  9.) 

Fee  Splitting  Defined 

By  the  term  secret  splitting  of  fees  is 
meant  the  sharing  by  two  or  more  men  in 
a fee  which  has  been  given  by  the  patient 
supposedly  as  the  reimbursement  for  the 
service  of  one  man  alone.  By  secrecy  is 
meant  that  the  division  of  the  fee  is  done 
without  the  knowledge  of  the  patient  or 
some  representative  of  the  family.  It  in- 
cludes those  cases  in  which  the  term  assist- 
ant is  used  as  a subterfuge  to  obtain  a part 
of  the  fee  which  otherwise  could  not  be 
rightfully  claimed.  The  term  commission 
refers  to  those  rebates,  “rake  offs,”  or  pro 
rata  moneys  sent  for  referring  patients  or 
favors  received  and  not  for  medical  and 
surgical  services  rendered. 

The  Judicial  Council  recommends  for 
adoption  by  the  House  of  Delegates  the 
following  resolutions: 

Resolved,  That  any  member  of  the 
American  Medical  Association  found 
guilty  of  secret  fee  splitting  or  of  giving 
or  receiving  commissions  shall  cease  to 
he  a member  of  the  American  Medical 
Association. 

Resolved,  That  the  House  of  Delegates 
of  the  American  Medical  Association 
recommends  to  each  constituent  body 
that  it  endeavor  through  the  action  of 
its  various  county  societies  to  reform  the 
various  abuses  of  lodge  practice  in  their 
separate  communities  in  order  that  the 
lodges  may  give  an  adequate  service  to 
its  members  and  an  honorable  remun- 
eration to  the  medical  men,  (House  of 
Delegates,  1912) 

Fee  Splitting  is  Giving  or  Receiving 
A Commission 

The  Judicial  Council  holds  to  the  opin- 
ion that  a division  of  a fee  constitutes  a 
giving  and  receiving  of  a commission. 
(House  of  Delegates,  1929) 


for  August,  1968 


183 


A service  of  the  Public  Relations  and  Economics  Division 


Hospital  Planning 
Proposal  Stirs  Debate 
in  Illinois 


ISMS  Malpractice 
Program  Off  To 
Flying  Start 


ISMS  Gets  Many 
Appeals  on  Usual/ 
Customary  Fees 


A proposed  statement  of  the  American  Hospital  Associa- 
tion on  areawide  planning  review  has  stirred  controversy  in 
Illinois.  The  proposal  would  commit  hospitals  to  areawide 
health-planning  agency  approval  as  a condition  for  reim- 
bursement of  capital  development  costs.  Backers  argue  that 
the  Government  otherwise  would  refuse  to  allot  reimburse- 
ment funds,  and  would  impose  arbitrary  controls  on  hos- 
pital expansions.  Opponents  contend  that  the  planning 
agencies  would  not  understand  the  unique  needs  of  hos- 
pitals, and  would  hamper  a hospital’s  private  funding  ar- 
rangements. The  Assembly  of  the  Illinois  Hospital  Associa- 
tion has  expressed  “reservations”  to  the  AHA  statement, 
which  reportedly  is  being  reworded.  The  ISMS  Executive 
Committee  has  asked  the  society’s  Hospital  Relations  Com- 
mittee to  weigh  the  issue.  A major  debate  is  expected  when 
the  AHA  House  of  Delegates  meets  next  month  in  Atlantic 
City,  N.  J. 

The  ISMS-sponsored  malpractice  insurance  program  has 
started  in  high  gear.  More  than  75  applications  and  250  in- 
quiries had  been  made  by  July  1,  just  a week  after  avail- 
ability of  the  insurance  was  announced.  The  response  was 
reported  by  Parker,  Aleshire  8c  Company,  9933  N.  Lawler, 
Skokie,  111.,  60076,  administrator.  ISMS  will  directly  super- 
vise and  control  the  program,  in  conjunction  with  the  ad- 
ministrator and  underwriter  (Employers’  Group  of  Insur- 
ance Companies,  Boston).  Coverage  up  to  $1,000,000  is 
available,  regardless  of  age  or  type  of  specialty.  In  an  effort 
to  discourage  nuisance  claims  and  stabilize  premium  rates, 
firm  steps  will  be  taken  to  improve  the  legal  climate  in  the 
malpractice  field.  A Board  of  Trustees  report  at  the  AMA 
convention  last  June  noted  that  malpractice  insurance  rates 
have  risen  10  to  50  per  cent  in  20  states  this  year  because  of 
the  rising  incidence  and  size  of  claims. 

Appeals  representing  some  500  physicians  have  been 
handled  by  the  ISMS  Committee  on  Usual  and  Customary 
Fees  since  its  establishment  two  years  ago.  The  complaints 
generally  were  that  the  Illinois  Department  of  Public  Aid 
had  reduced  or  delayed  fee  payments.  A physician  having 
such  a complaint  can  carry  his  appeal  through  the  follow- 
ing steps:  (1)  to  Robert  G.  Wessel,  chief  of  the  Division  of 
Medical  Administration,  Illinois  Department  of  Public  Aid, 


184 


Illinois  Medical  Journal 


HEW  Sets  Regional 
Meet  on  Health- 
Care  Costs 


1035  West  Outer  Park  Drive,  Springfield;  (2)  to  his  county 
medical  society  if  no  understanding  is  reached  with  the 
IDPA  headquarters;  (3)  to  his  ISMS  district  trustee  or  com- 
mittee, and  (4)  to  the  ISMS  Usual  and  Customary  Fees 
Committee,  which  meets  periodically  with  IDPA  officials. 

Leaders  from  the  health  community,  insurance,  labor 
and  general  public  in  five  states,  including  Illinois,  will 
take  part  in  a Regional  Conference  on  Health  Care  Costs 
Oct.  17  and  18  in  Cleveland.  The  Department  of  Health, 
Education  and  Welfare  is  conducting  such  conferences  to 
review  various  health-cost  plans  and  stimulate  interest  at 
the  local  level.  Attendance  will  be  by  invitation.  The  con- 
ference advisory  committee  includes  Dr.  Charles  L.  Hud- 
son, Chicago,  director  of  the  AMA  division  of  health  serv- 
ices. 


An  Illinois  resolution  on  disaster  medical  care  was  adop- 
ted, with  minor  changes,  at  the  AMA’s  San  Francisco  con- 
vention. It  calls  on  Governors  and  other  officials,  both  state 
and  local,  to  plan  adequate  protection  of  medical  person- 
nel, hospital  equipment  and  patients  during  civil  disorders. 
“Medical  personnel  must  be  free  to  treat  patients  without 
interference  and  without  fear  of  injury  to  patients,  or  dam- 
age to  the  facilities  in  which  they  work,”  the  resolution 
states. 

Illinois  ranked  below  the  national  average  last  December 
in  the  percentage  of  population  receiving  money  in  the  As- 
sistance to  the  Aged,  Blind  or  Disabled,  Aid  to  Dependent 
Children  and  General  Assistance  programs.  The  newly  re- 
leased HEW  figures  listed  Illinois  as  24th  among  the  50 
states,  and  sixth  among  the  10  most  populous  states— well 
below  California  and  New  York. 

Hospital  Costs  The  average  cost  of  a day’s  care  in  a U.S.  general  hos- 

Rise  15%  in  One  Year  pital  was  $58.06  last  year— up  15  per  cent  from  the  year  be- 
fore. Salaries  of  hospital  employees  accounted  for  $36.30, 
or  more  than  62  per  cent,  of  last  year’s  daily  expense  bill. 
The  figures,  released  by  the  Health  Insurance  Institute, 
were  based  on  an  AHA  study  of  656  hospitals.  Overall,  the 
nation’s  community  hospitals  spent  $12.6  billion  on  pay- 
rolls, equipment,  services,  supplies  and  employee  fringe 
benefits  during  1967— up  $2.1  billion  from  the  year  before. 

By  DON  B.  FREEMAN 

Psycho-Social  Aspects  of  Smoking 

A clear  cut  smoker’s  personality  has  not  emerged  from  the  results  so  far 
published.  While  smokers  differ  from  non-smokers  in  a variety  of  character- 
istics, none  of  the  studies  has  shown  a single  variable  which  is  found  solely 
in  one  group  and  is  completely  absent  in  another.  Nor  has  any  single  vari- 
able been  verihed  in  a sufficiently  large  proportion  of  smokers  and  in  suf- 
ficiently few  non-smokers  to  consider  it  an  “essential”  aspect  of  smoking. 

The  overwhelming  evidence  points  to  the  conclusion  that  smoking— its 
beginning,  habituation,  and  occasional  discontinuation— is  to  a large  extent 
psychologically  and  socially  determined.  This  does  not  rule  out  physiologi- 
cal factors,  especially  in  respect  to  habituation,  nor  the  existence  of  predis- 
posing constitutional  or  hereditary  factors.  (Smoking  and  Health.) 


AMA  Adopts  Illinois 
Idea  on  Disaster 
Medical  Care 


Illinois  Below  U.  S. 
Average  in  Per  Capita 
Public  Aid 


for  August,  1968 


185 


Do  you  have  patients 
who  try  to  hide  anger 
behind  charm? 


Jwu  see  many  depressed  patients  who  hide 
their  real  anxieties  behind  a smoke  screen  of 
pretense.  The  more  they  try  to  conceal  reality, 
the  more  entrenched  the  disturbances  become. 
The  role  they  assume  is  not  adequate  to 
suppress  their  inner  turmoil.  Unchecked,  the 
turmoil  finds  expression  in  other  symptoms. 

They  want  your  help  and  Aventyl  HCl  can 
help  you. 

Whether  depression  is  open  or  secretive, 
Aventyl  HCl  assists  in  relieving  the  symptoms 
and  the  state  of  depression  itself.  It  may  aid 
in  removing  the  emotional  distortions  and, 
in  lifting  the  depression,  help  patients  face, 
accept,  or  change  their  life  patterns.  S0032X 


Eli  Lilly  and  Company,  Indianapolis,  Indiana  46206 


Helps  remove  the  symptoms, 
lift  the  depression, 
and  release  the  patient 


Aventyl*  HCl 

Nortriptyline*^Hydrochloride 


(See  last  page  for  prescribing  information.) 


OBITUARIES 


*Dr.  C.  M.  Barr,  Percy,  a veteran  of  56 
years  of  Illinois  medical  service,  died  June 
9 at  the  age  of  92.  He  was  a member  of 
the  ISMS  Fifty-Year  Club. 

*Dr.  John  Franklin  Beyerle,  Kewanee, 
72,  died  June  26,  He  was  a member  of  Mo- 
hammed Shrine  of  Peoria,  Kewanee  Ma- 
sonic Blue  Lodge,  Veterans  of  Foreign 
Wars,  Henry  County  Medical  Society  and 
on  the  staffs  of  Kewanee  Public  and  St. 
Francis  Hospitals. 

*Dr.  Edward  J.  Clancy,  Santa  Barbara, 
Calif.,  a practicing  physician  in  Chicago  for 
27  years,  died  June  22  at  the  age  of  55.  He 
was  battalion  surgeon  for  the  1st  Marine 
Division  during  the  Guadalcanal  Cam- 
paign in  World  War  II. 

*Dr.  George  A.  Darmer,  an  Aurora  physi- 
cian for  more  than  50  years,  died  June  12. 
He  was  a member  of  the  American  College 
of  Surgeons,  Academy  of  Ophthalmology 
and  Otolaryngology,  ISMS  Fifty-Year  Club 
and  an  emeritus  member  of  the  staffs  of 
Copley  Memorial  and  St,  Joseph  Mercy 
Hospitals. 

Dr.  Othello  Ennis,  Chicago,  died  July  2 
at  the  age  of  67.  He  was  a member  of  the 
Provident  Hospital  medical  staff. 

*Dr.  William  I.  Fishhein,  Lincolnwood, 
director  of  the  Bureau  of  Health  Services, 
the  Chicago  Board  of  Health,  died  May  30 
at  the  age  of  67. 

*Dr.  Robert  L.  French,  Oak  Park,  chief 
radiologist  in  Oak  Park  Hospital  for  42 
years,  died  June  14  at  the  age  of  79. 

*Dr.  Garnett  M.  Frye,  Peoria,  died  May 
27  at  the  age  of  62.  He  was  past  president 
of  St.  Francis  Hospital  medical  staff,  Peoria 
Medical  Society  and  on  the  boards  of  St. 
Francis,  Methodist  and  Proctor  Hospitals. 
*Dr.  Samuel  L.  Governale,  Chicago,  69, 
died  in  St.  Bernard’s  Hospital  where  he 
had  formerly  been  a staff  member  and  chief 
of  surgery. 


Dr.  Ewald  E.  Hermann,  a physician  and 
surgeon  in  Highland,  died  May  22  at  the 
age  of  73.  He  was  a member  of  the  Inter- 
national College  of  Surgeons,  a former 
president  of  the  Highland  Chamber  of 
Commerce  and  Madison  County  Medical 
Society. 

^Dr.  Holger  N.  Hoegh,  Chicago,  died 
June  11  at  the  age  of  70. 

*Dr.  William  D.  Jack,  79,  who  practiced 
medicine  in  Chicago  for  more  than  50 
years,  died  July  2.  He  was  governor  and 
a trustee  of  Henrotin  Hospital,  a member 
of  ISMS  Fifty-Year  Club. 

*Dr.  Glenn  S.  Nelson,  67,  a physician  in 
the  Chicago  area  for  40  years,  died  July  2. 
*Dr.  Alfred  Nienow,  Argo,  79,  a physician 
and  surgeon  in  the  Argo-Summit  area  for 
more  than  40  years,  died  May  16. 

*Dr.  Irving  B.  Richter,  Chicago,  55,  a 
pediatrician  and  faculty  member  of  the 
University  of  Illinois  Medical  School,  died 
June  24. 

Dr.  Albert  J.  Roemisch,  Chicago,  83,  a 
former  Blue  Island  health  commissioner 
for  38  years,  and  a police  surgeon,  died 
May  29. 

*Dr.  Donald  T.  Rolnick,  Hines,  40,  a 
urologist,  died  June  24.  He  was  on  the 
staff  at  Michael  Reese  Hospital. 

*Dr.  Seymour  R.  Steinhorn,  Winnetka, 
a psychiatrist  on  the  staff  of  Michael  Reese 
Hospital,  died  May  31. 

Dr.  Anna  Sorna  VanPaing,  La  Grange, 
a physician  and  surgeon  in  the  Chicago 
area  for  46  years,  died  June  8 at  the  age 
of  88. 

*Dr.  Thomas  F.  P.  Walsh,  Chicago,  80, 
died  May  31  in  Mercy  Hospital  where  he 
was  a 50  year  staff  member.  He  was  also 
a member  of  ISMS  Fifty-Year  Club. 

^Indicates  membership  in  the  Illinois  State  Medi- 
cal Society. 


Togetherness 

Each  characteristic  and  institution  of  suburban  life  testifies  that  the 
“lonely  crowd”  is  everywhere.  The  suburbanite  does  not  live  in  a house 
that  expresses  his  individuality  or  blends  landscape  and  architecture.  In- 
stead, he  either  builds  a house  that  expresses  the  values  of  the  real  estate 
experts  or  settles  in  a large  housing  development  of  quarter-acre  parcels.  His 
house,  as  much  like  his  neighbor’s  as  possible,  is  crammed  with  mechanical 
conveniences  that  reflect  a preoccupation  with  consumption.  Arranged  for 
entertainment,  these  houses  are  built  to  encourage  family  and  neighborhood 
sociability.  They  are  erected  as  symbols  of  material  well-being  and  “to- 
getherness,” the  new  social  ethic  in  practice.  (Suburbia  and  Suburban  Man, 
Carter,  Robert  M.,  GP  (Mar.)  1968;  37:3;122-128.) 


for  August,  1968 


189 


MEETim  MEMOS 


Aug.  31-Sept.  2— The  Pulmonary  Circula- 
tion, A Satellite  Conference  of  the  Con- 
gress of  the  International  Union  of  Physi- 
ological Sciences.  To  be  held  in  Chicago, 
the  conference  is  sponsored  by  the  Univ. 
of  Chicago,  Michael  Reese  Hospital,  the 
Chicago  Heart  Ass’n.,  and  the  Tubercu- 
losis Institute  of  Chicago  and  Cook  Co. 
Reports  of  new  medical  research  will  be 
made  by  22  medical  scientists  from  six 
countries;  in  addition,  51  doctors  from  16 
countries  will  discuss  these  reports. 

Sept.  7-11  —The  Second  International  Con- 
gress of  the  Transplantation  Society  will 
meet  in  New  York  City  at  the  Americana 
Hotel.  More  than  2,000  members  and  guests 
from  around  the  world  are  expected.  The 
scientific  program  will  feature,  among  other 
things,  sessions  on  bone  marrow  transplan- 
tation, and  cancer  and  pregnancy  in  their 
relationship  to  transplantation.  A full  day 
will  be  devoted  to  the  transplantation  of 
organs,  including  kidney,  heart,  liver, 
lung,  and  others.  Body  rejection  will  be 
covered  at  length. 

Sept.  9-1 1 —San  Francisco  is  the  site  of  the 
Continuation  Course  in  Clinical  Electro- 
encephalography. It  is  a basic  review  of 
the  applications  of  EEC  to  clinical  medi- 
cal practice.  Inquiries  about  the  course 
should  be  directed  to  Dr.  Klass,  EEC 
Course  Director,  Mayo  Clinic,  Rochester, 
Minn.  55901. 

Sept.  9-13— The  Third  International  Con- 
gress of  Phlebology  is  scheduled  to  be  held 
in  Amsterdam,  the  Netherlands.  The  con- 
gress is  held  in  conjunction  with  the  In- 
ternational Society  of  Lymphology.  The 
venous  system  of  the  lower  limb,  congeni- 
tal abnormalities  of  the  venous  and  lym- 
phatic systems,  and  varicose  conditions  of 
the  lower  limb  are  the  main  subjects  to  be 


covered.  Round  table  conferences  on  perti- 
nent therapeutic  problems  are  planned. 
Sept.  16-20— The  Cook  County  Graduate 
School  of  Medicine  is  sponsoring  the  Eifth 
Sumner  L.  Koch  Hand  Surgical  Sympo- 
sium. The  Department  of  Surgery  of  North- 
western University  Medical  School  is  also 
sponsoring  this.  “Reconstruction  of  the  In- 
jured Hand”  will  be  the  theme  of  the  main 
address. 

Sept.  20-27— To  be  held  in  New  York 
City,  at  the  Hilton  Hotel,  the  9th  Inter- 
national Congress  of  Neurology  and  the 
4th  International  Congress  of  Neurological 
Surgery  will  meet  jointly  as  the  World 
Congresses  of  Neurological  Sciences.  Atten- 
dees from  40  countries  are  expected.  Scien- 
tific sessions  for  each  group  as  well  as  joint 
sessions  are  scheduled.  Several  related 
groups  will  hold  meetings  at  the  same 
time:  the  Eulton  Society,  the  International 
League  Against  Epilepsy,  the  International 
Multiple  Sclerosis  Society,  the  Interna- 
tional Society  for  Research  in  Stereoen- 
cephalotomy. Major  themes  for  the  meet- 
ings are  epilepsy  and  cerebral  vascular  dis- 
ease. 

Sept.  23-Oct.  4— The  Department  of  Oto- 
laryngology of  the  Illinois  Eye  and  Ear  In- 
firmary and  the  University  of  Illinois  Col- 
lege of  Medicine  will  conduct  a postgradu- 
ate course  in  Laryngology  and  Broncho- 
esophagology.  Attendance  is  limited  to  15. 
It  will  be  held  at  the  Infirmary.  There  are 
to  be  demonstrations,  practice  in  broncho- 
scopy, diagnostic  and  surgical  clinics,  and 
didactic  lectures. 

Sept.  26-28— The  Skirvin  Hotel,  Oklahoma 
City,  is  the  meeting  site  for  the  Central 
Association  of  Obstetricians  and  Gynecolo- 
gists. 


CBS  To  Acquire  W.  B.  Saunders  Company 


Columbia  Broadcasting  System,  Inc.,  and 
W.  B.  Saunders  Company  have  agreed  on 
terms  by  which  CBS  will  acquire  the  assets 
and  business  of  the  medical  publishing 
firm.  The  announcement  was  made  by  Wil- 
liam S.  Paley,  CBS  chairman,  and  Frank 
Stanton,  president,  and  by  Lawrence  Saun- 
ders, W.  B.  Saunders  Company  chairman, 
and  Harry  R.  Most,  president. 

Organized  in  1888,  W.  B.  Saunders  Com- 


pany is  a leading  publisher  in  the  medical 
field,  with  headquarters  in  Philadelphia.  It 
will  operate  as  a division  of  the  CBS/Holt 
Group,  whose  president  is  Alfred  C.  Ed- 
wards. In  addition  to  publishing  books  and 
magazines  for  the  general  reader,  the 
Group  develops  and  distributes  education- 
al materials  and  systems  for  schools  and 
colleges  in  this  country  and  abroad. 


190 


Illinois  Medical  Journal 


“Will  I ever 
catch  up  on 
my  work?” 


Mebaraf®  usually  calms  the  anx^ 
ious  patient  without  the  degree 
of  languor,  or  decrease  in  alert- 
ness often  caused  by  other  bar- 
biturates J Mebaral  is  particuJaily 
valuable  In  treating  anxiety-ten- 
sion states  when  ntinimai  hypnot- 
ic action  is  desired.^  Its  sedative 
action  is  prolonged^  and  pre- 
dictable. 


Contraindication : Large  doses  are 
contraindicated  in  patients  with 
nephritis. 

Warning:  May  be  habit  forming. 


Precautions:  As  with  other  barbi- 
turates, caution  is  advisable  dur- 
ing use  in  debilitated  and  senile 
patients  and  In  patients  with  pul- 
monary disease. 


Adverse  reactions:  Although 
Mebaral  is  generally  well  tolerated 
over  long  periods,  the  possibility 
of  idiosyncrasy  to  barbiturates  (as 
manifested  by  drowsiness,  ver- 
tigo, and  cutaneous  eruptions) 
should  be  considered. 


Dosage:  Adults,  for  daytime  seda- 
tion—Va  gr.  (32  mg.),  % gr.  (50  mg.) 
and,  at  times,  1V2  gr.  (100  mg.), 
three  or  four  times  daily. 


References:  1.  Musser,  Ruth  D.,  and  Shub- 
kagel,  Betty  L.:  Pharmacology  and  Therapeu- 
tics, ed.  3,  New  York,  Macmillan  Company, 
1965,  p.  363.  2.  Council  on  Drugs,  American 
Medical  Association:  New  Drugs  1965,  Chi- 
cago. American  Medical  Association,  1965, 
p.  157.  3,  Modell,  Walter  (Ed.):  Drugs  in  Cur- 
rent Use  1966,  New  York,  Springer  Publishing 
Company,  1966,  p.  77. 

Winthrop  Laboratories 
New  York,  N.  Y.  1 001 6 


ILLINOIS  ASSOCIATION 

OF  THE  PROFESSIONS 


lAP  was  organized  to 

. provide  the  organizational  machinery 
whereby  the  combined  strength  and  coun- 
sel of  all  professions  can  be  utilized  for  the 
advancement  of  professional  ideals  and  the 
promotion  of  professional  welfare. 

. strengthen  the  traditional  rights, 
privileges,  and  responsibilities  of  each  pro- 
fession. 

“.  . . devise  ways  and  means  of  better 
utilizing  the  professional  knowledge  and 
skills  of  its  members  for  the  benefit  of  so- 
ciety and  attempt  to  create  the  kind  of  re- 
lations between  the  professions  which  will 
most  effectively  accomplish  this  objective. 
“.  . . serve  its  members  as  one  practical 
medium  of  communication  between  the 
professions  and  legislative  bodies. 

“.  . . supplement  efforts,  programs  and 
services  of  the  individual  state  professional 
societies. 

“.  . . benefit  the  individual  member  by 
helping  him  protect  and  perpetuate  the  in- 
dividual privileges  and  responsibilities  of 
the  professional  person. 

“.  . . serve  as  a medium  of  communication 
between  the  professions.” 


The  difference  between  a trade  and  a pro- 
fession is  that  the  trader  frankly  carries  on 
his  business  primarily  for  the  sake  of  pecu- 
niary gain,  while  the  members  of  a profes- 
sion profess  an  art,  their  skill  in  which  they 
place  at  the  public  service  for  a remuner- 
ation, adequate  or  inadequate,  but  which 
is  truly  an  end  in  itself. 


Annual  Meeting  of  lAP 

The  fifth  annual  meeting  of  the  Illinois 
Association  of  the  Professions  is  scheduled 
for  October  10-11,  1968  at  the  Ambassador 
Hotel  in  Chicago.  Under  the  chairmanship 
of  Marvin  Mindes,  J.D.,  the  Annual  Meet- 
ing Committee  is  planning  an  outstanding 
professional  meeting. 

The  registration  form  will  be  mailed  to 
the  entire  membership  of  the  eight  profes- 
sions holding  membership  in  lAP.  This  an- 
nouncement in  early  September  will  in- 
clude the  complete  program. 


Opposes  Laymen  on  Professional 
Boards 

The  Michigan  Association  of  the  Pro- 
fessions has  strongly  opposed  packing  of 
professional  boards  with  laymen.  A series 
of  bills  have  been  introduced  in  the  Michi- 
gan legislature  permitting  a lay  person  to 
serve  on  the  licensing  and  regulation 
boards  of  the  several  professions. 

In  opposition  to  this  legislation,  MAP 
stated  “How  could  a layman  be  expected 
to  understand  such  responsibilities  and 
their  relative  importance  unless  he  had 
been  intimately  involved  by  having  him- 
self practiced  the  profession. 


Illinois  Water  Resources 

The  report  “Water  for  Illinois— A Plan 
for  Action”  is  largely  the  result  of  studies 
made  by  professional  engineers  who  have 
long  advised  public  policy  makers  that  the 
technology  is  available  to  control  air  and 
water  pollution  and  provide  adequate 
water  supplies  and  recreation  development 
if  the  funds  are  provided. 

The  billion  dollar  bond  issue  to  be  sub- 
mitted to  the  voters  of  Illinois  involves  a 
twelve  year  action  program  and  is  suppor- 
ted by  the  ISPE  who  is  encouraging  its 
membership  to  explain  and  discuss  the  is- 
sue with  voters  in  their  communities. 


192 


Illinois  Medical  Journal 


That’s  why  Abbott  offers 
you  a pill  plus  a program. 


The  Product 


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15  mg.  Methamphetamine  Hydrochloride, 

90  mg.  Sodium  Pentobarbital 


FRONT  SIDE 


FRONT  SIDE 


The  Program 

Weicrht  Control  Booklet^'^’"'^''^^^'^ 

rreigiu  K^onu  m stand  why  they  are  overweight,  and  what  they  can 

do  about  it.  The  booklet  stresses  the  importance  of 
changing  lifelong  eating  habits  and  explains  how  this 
can  be  done,  sensibly,  comfortably — and  perma- 
nently. There  is,  also,  a comprehensive  list  of  foods 
showing  their  caloric  content. 


Food  Diary 


i 


Designed  to  help  the  overweight  patient  follow 
your  eating  instructions.  Space  is  provided  for 
breakfast,  lunch,  supper,  and  even  snacks.  By  writ- 
ing down  everything  that’s  eaten  each  day,  the 
patient  is  constantly  reminded  that  she’s  trying  to 
change  her  eating  habits.  And  you  are  furnished 
with  a written  record  of  how  well  she’s  doing. 


I 

Picture  Menu  Booklet 


\ 


A large  (10"  x 10")  booklet  which  features  appetiz- 
ing lunch  and  dinner  menus  for  every  day  of  the 
week.  The  meals  are  depicted  in  full  color  and  the 
correct  portion  size  so  that  the  dieter  can  see  the 
amount  of  food  that’s  recommended.  Patients  are 
pleasantly  surprised  to  learn  that  each  day’s  meals 
add  up  to  only  1,000  calories.  soi444 


Ask  Your  Abbott  Man  For  Free  Supplies 


Please  see  Brief  Summary 
on  next  page. 


Brief  Summary 
DESOXYN®Gradumet® 

Methamphetamine  Hydrochloride 
in  Long-Release  Dose  Form 

DESBUTAC 10  Gradumet 

10  mg.  Methamphetamine  Hydrochloride, 

60  mg.  Sodium  Pentobarbital 

DESBUTAL  15  Gradumet 

15  mg.  Methamphetamine  Hydrochloride, 

90  mg.  Sodium  Pentobarbital 

Indications:  Desoxyn  and  Desbutal 
are  used  orally  as  appetite  suppres- 
sants, for  reduction  of  mild  mental 
depression,  and  to  help  in  manage- 
ment of  psychosomatic  complaints 
or  neuroses.  Desoxyn,  when  ad- 
ministered parenterally,  may  be 
used  as  a vasopressor  agent  or  ana- 
leptic. 

Contraindications : Methampheta- 
mine (in  Desoxyn  and  Desbutal) 
is  contraindicated  in  patients  tak- 
ing a monoamine  oxidase  inhibitor. 
Do  not  use  pentobarbital  (in 
Desbutal)  in  persons  hypersensi- 
tive to  barbiturates. 

Precautions,  Side  Effects:  Observe 
caution  in  patients  with  hyperten- 
sion, cardiovascular  disease,  hyper- 
thyroidism, old  age,  or  those 
sensitive  to  sympathomimetic 
drugs.  Prolonged  usage  may  lead 
to  tolerance  or  psychic  dependence. 
Careful  supervision  is  necessary  to 
avoid  chronic  intoxication  and 
drug  dependence. 

Amphetamine  side  effects  such 
as  headache,  excitement,  agitation, 
palpitation  or  cardiac  arrhythmia 
usually  may  be  controlled  by  re- 
ducing the  dose.  Paradoxically- 
induced  depression  is  an  indication 
to  withdraw  the  drug.  Pentobarbi- 
tal (in  Desbutal)  may  cause  skin 
rash.  Nervousness  or  ex- 
cessive sedation  with 
Desbutal  is  often  transient. 


Environmental  Pollution 
Due  T o Insecticides 

Insecticides  on  our  food  or  in  the  air 
may  enter  man  and  cause  many  prescribed 
drugs  to  be  ineffective  or  even  harmful.  A 
great  many  such  modern  hazards  face  us  in 
our  increasing  exposure  to  pollution  of  the 
environment  by  radiation,  chemical  agents, 
and  pesticides. 

For  more  than  20  years,  the  University 
of  Chicago  Toxicity  Laboratory  has  devo- 
ted itself  exclusively  to  research  in  locating, 
exposing,  and  controlling  modern  environ- 
mental poisons.  Operating  with  a 20  to  25 
man  staff,  it  has  made  a number  of  impor- 
tant and  often  unnerving  discoveries. 

One  such  discovery  was  that  insecticides, 
aerosol  solvents,  and  perhaps  many  other 
environmental  elements  taken  into  the 
body  from  the  air,  by  contact  with  skin,  or 
by  mouth  can  stimulate  the  liver  to  pro- 
duce abnormally  high  levels  of  certain 
enzymes.  “These  enzymes,”  said  Dr.  Ken- 
neth DuBois,  Director,  “cause  increased  de- 
toxification of  drugs,  which  may  render 
the  drugs  therapeutically  ineffective  at  the 
dosage  levels  that  are  normally  used.” 

Tests  in  the  Toxicity  Laboratory  have 
demonstrated  conclusively,  for  example, 
that  the  effects  of  the  frequently  used 
sedatives  such  as  the  barbiturates  are 
counteracted  by  DDT.  “Such  a counterac- 
tion has  generally  been  written  off  by  phy- 
sicians as  a natural  resistance  in  the  pa- 
tient to  the  drug  being  used,”  he  said. 

If  the  physician  knew  that  such  a reac- 
tion is  taking  place  as  a result  of  stimula- 
tion of  detoxification  by  environmental 
chemicals,  he  could  increase  the  dose  of  the 
sedative  and  thereby  obtain  effective  treat- 
ment, Dr.  DuBois  said. 

DDT  and  other  persistent  pesticides  pose 
some  special  problems.  These  problems 
have  recently  been  acknowledged  by  the 
government’s  lowering  of  the  allowable  lev- 
el of  DDT  in  food. 

The  problem,  according  to  Dr.  DuBois, 
centers  around  the  need  for  insecticides  to 
maintain  high  agricultural  production,  but 
pesticide  residues  in  the  atmosphere  and 
the  soil  are  constantly  rising. 


801444 


196 


Illinois  Medical  Journal 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  an  effort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  phy- 
sicians, the  Journal  is  publishing  synopses 
submitted  to  the  Physicians  Placement 
Service  concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  who  know  of  any  out-of-state 
physicians  seeking  an  Illinois  residence  are 
asked  to  notify  the  placement  service. 

Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addition- 
al physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave., 
Chicago  60601. 

EDWARDS  COUNTY:  Albion;  popu- 
lation: 2,000  and  10,000  in  trade  area.  Ur- 
gent need  for  a second  physician.  Only  phy- 
sician is  age  56.  Nearest  hospitals  at  Fair- 
field  and  Mt.  Carmel,  16  and  18  miles. 
Evansville,  Ind.  50  miles.  One  prescription 
drug  store.  Twelve  protestant  churches, 
grade  and  high  schools.  Agricultural  com- 
munity. For  further  information  contact: 
Huldah  M.  Orr,  Secretary,  Edwards  County 
Health  Improvement  Association,  Albion. 
Phone:  618-445-2905. 

EFFINGHAM  COUNTY:  Beecher  City; 
population:  500.  Community  without  a 
physician  for  5 years,  when  only  physician 
retired.  Nearest  at  Effingham,  15  miles, 
and  Cowden,  six  miles.  Nearest  hospital 
15  miles.  Decatur  60  miles.  No  drug  store 
at  this  time.  Community  will  provide  a 
building  for  a physician  or  loan  money. 
Three  protestant  churches,  grade  and  high 
schools.  Adequate  recreational  facilities.  Ac- 
tive Masonic  Lodge.  For  further  informa- 
tion contact:  Rev.  S.  Burkett  Milner,  Box 
355,  Beecher  City.  Phone:  618-487-4241. 

FAYETTE  COUNTY:  St.  Peter;  popu- 
lation: 400.  Trade  area,  2,000.  Located  on 
state  route  185.  Town  without  a resident 
physician  for  many  years.  Nearest  at  Far- 
ina, six  miles  and  Vandalia,  18  miles.  Near- 
est hospital  at  Vandalia,  103  beds.  Chicago 
and  Eastern  Illinois  Railroad.  Office  and 
housing  will  be  provided  by  Business  Men’s 


Association  in  accordance  with  doctor’s 
wishes.  Financial  assistance.  Agricultural 
community.  Evangelical  Lutheran  Church. 
Public  and  parochial  schools.  Bus  to  high 
school,  six  miles.  New  sewer  system.  For 
further  information  contact: 

O.  J.  Gluesenkamp,  St.  Peter 
A.  D.  Hotz,  St.  Peter 
FAYETTE  COUNTY:  Vandalia;  popu- 
lation: 5,500.  Opening  in  Moore  Clinic;  2 
GPs,  need  for  a third.  Ultra-modern  103 
bed  hospital.  New  high  school  and  new 
swimming  pool.  Several  industries.  Located 
on  Kaskaskia  River,  60  miles  from  St. 
Louis.  County  seat  of  Fayette  County;  pop- 
ulation: 28,000.  New  clinic  building,  3 
blocks  from  hospital.  Three  consultation 
rooms,  ten  examining  rooms,  office,  recep- 
tionist office,  waiting  rooms.  Large  parking 
lot.  For  details  contact: 

S.  W.  Moore,  M.D. 

D.  H.  Rames,  M.D.,  Vandalia 
Phone:  283-0945  or  283-1209 
FORD  COUNTY:  Melvin;  population: 
550.  Trade  area,  3,000.  Town  without  a 
physician  since  1961.  Nearest  hospital  at 
Gibson  City,  1 1 miles;  35  miles  from  Cham- 
paign. Office  of  former  physician  available 
if  desired.  Agricultural  community. 
Churches:  Catholic,  Lutheran,  Methodist. 
Grade  and  high  schools.  Active  Lions  Club, 
Masonic  Lodge,  VFW,  American  Legion, 
etc.  Country  club  with  golf  and  swimming 
facilities.  Contact  the  President,  Melvin 
State  Bank,  the  Administrator,  Gibson 
City  Community  Hospital,  the  Superin- 
tendent of  Schools,  or  James  Arnold,  Presi- 
dent, Melvin  Lions  Club. 

FORD  COUNTY:  Paxton;  population: 
5,000.  Four  physicians,  ages  86,  59,  47,  and 
32.  Last  three  associated  in  Paxton  Clinic, 
established  in  1947.  If  new  physician  estab- 
lishes solo  practice,  a GP  is  preferable;  if 
he  prefers  to  associate  with  Clinic,  surgeon 
or  obstetrician  would  be  acceptable,  if  will- 
ing to  do  some  GP.  No  investment  neces- 
sary at  first;  opportunity  for  partnership 
after  one  year.  Fully  accredited  40  bed  hos- 
pital. Thirty  miles  from  Champaign.  Three 
prescription  drug  stores.  Churches:  Protes- 
tant, Catholic.  Grade  and  high  schools.  Lo- 
cal country  club  with  golf  and  swimming. 
Contact:  S.  B.  Furby,  M.D.,  or  Gene  Noble, 
M.D.  at  217-379-2361. 


for  August,  1968 


197 


early  relief  from 


f At  the  recommended  Norpramin 
I {desipramine  hydrochloride) 
i dosage  level— initially  150  mg. 

! per  day— symptomatic 
improvement  may  often 
begin  within  two  to  five 
days.  As  depression  subsides, 

I daytime  activity  improves. . . 
i mood  fluctuations  lessen . . . 

I sleep  is  sounder.  Fast  onset  of 
action  and  usually  mild  side 
effects  are  significant  reasons 
for  Norpramin’s  use  in 
depression  of  any  type . . .any 
degree  of  severity. 


lAKESlOE 


L 


IN  BRIEF: 

INDICATIONS:  In  mental  depression  of  any 
kind— neurotic  or  psychotic. 
CONTRAINDICATIONS:  Glaucoma,  urethra!  or 
ureteral  spasm,  recent  myocardial  infarction, 
severe  coronary  heart  disease,  epilepsy. 
Should  not  be  given  within  two  weeks  of  treat- 
ment with  a monoamine  oxidase  inhibitor. 
RELATIVE  CONTRAINDICATIONS:  (1)  Patients 
With  a history  of  paroxysmal  tachycardia.  (2) 
Patients  receiving  concomitant  therapy  with 
thyroid,  anticholinergics  or  sympathomimet- 
ics  may  experience  potentiation  of  effects  of 
these  drugs.  (3)  Safety  in  pregnancy  has  not 
been  established.  (4)  Perform  liver  function 
studies  in  patients  suspect  of  having  hepatic 
disease. 

PRECAUTIONS:  (1)  Desipramine  hydrochloride 
should  not  be  substituted  for  hospitalization 
when  risk  of  suicide  or  homicide  is  consider- 
ed grave.  Suicidal  ingestion  of  large  doses 
may  be  fatal.  (2)  If  serious  adverse  effects 
occur,  reduce  dosage  or  alter  treatment.  (3) 
In  patients  with  manic-depressive  illness  a 
hypomanic  state  may  be  induced.  (4)  Discon- 
tinue drug  as  soon  as  possible  prior  to  elec- 
tive surgery. 


ADVERSE  EFFECTS:  The  following  side  effects 
have  been  encountered;  dry  mouth,  constipa-. 
tion,  dizziness,  palpitation,  delayed  urination, - 
agitation  and  stimulation  ("jumpiness,”  “ner- 
vousness,” “anxiety,”  “insomnia”)  bad  taste, 
sensory  illusion,  tinnitus,  sweating,  drowsi- 
ness, headache,  hypotension  (orthostatic), 
flushing,  nausea,  cramps,  weakness,  blurred  I 
vision  and  mydriasis,  rash,  tremor,  allergy 
(general),  altered  liver  function,  ataxia  and 
extrapyramidal  signs,  agranulocytosis. 

Additional  side  effects  more  recently  reported 
include:  seizures,  eosinophilia,  confusional 
states  with  hallucinations,  purpura,  photosen- 
sitivity, galactorrhea,  gynecomastia,  and  im- 
potence. Side  effects  which  could  occur  (an- 
alogy to  related  drugs)  include  weight  gain, 
heartburn,  anorexia,  and  hand  and  arm  pares- 
thesias. 

DOSAGE:  Optimal  results  are  obtained  at  a 
dosage  of  50  mg.  t.i.d.  (150  mg. /day). 

SUPPLIED:  NORPRAMIN  (desipramine  hydro- 
chloride) tablets  of  25  mg.;  bottles  of  50,  500 
and  1,000;  and  tablets  of  50  mg.  in  bottles  of 
30,  250,  and  1,000. 


LAKESIDE  LABORATORIES,  INC.  Milwaukee,  Wisconsin  53201 


improvement  often 
begins  in  2 to  5 days 


See  package  insert  for  complete  prescribing  information. 


IHA  Explains  Emergency  Service 
Rules  to  Member  Hospitals 


The  current  publicity  about  hospital 
emergency  services  has  stimulated  many 
questions  about  what  is  and  what  is  not 
legally  acceptable  practice  on  “house  staff’ 
coverage.  The  Illinois  Department  of  Reg- 
istration and  Education  advises  that 
they  are  now  getting  many  such  questions 
from  hospitals  across  the  state.  The  follow- 
ing, which  has  been  cleared  with  the  De- 
partment of  R&E,  the  IHA  legal  counsel, 
and  other  authoritative  sources,  is  an  at- 
tempt to  answer  some  of  these  questions. 

ECFMG  Certification.  The  Educational 
Council  for  Foreign  Medical  Graduates 
certification  does  not  qualify  anyone  to 
practice  medicine  in  Illinois.  ECFMG  is  no 
more  or  no  less  than  a voluntary 
screening  mechanism  for  graduates  of  for- 
eign medical  schools,  aliens  or  native  born 
Americans,  who  wish  to  continue  their 
medical  education  in  the  ETnited  States. 
(Class  A Canadian  Medical  Schools  and 
their  graduates  are  treated  as  American.) 
As  such,  it  provides  a very  useful  service  to 
teaching  institutions  considering  applicants 
for  residencies.  In  large  part,  this  is  why  it 
was  established.  Physicians  may  enter  the 
United  States  without  ECFMG  certifica- 
tion, and  those  with  this  certifica- 
tion need  not  function  in  a medical  setting 
after  their  arrival.  The  ECFMG  certifica- 
tion has  no  legal  status  as  a consideration 
for  issuing  a temporary  certificate  of  regis- 
tration in  Illinois. 

Temporary  Certificates  of  Registration. 

The  only  persons  authorized  to  practice 
medicine  in  Illinois  are  holders  of  a full 
license  or  temporary  certificates  of  regis- 
tration. The  authorization  to  practice 
medicine  with  a temporary  certificate  is 
on  a very  clearly  defined  and  delimited 
basis.  To  receive  such  a certificate  the  ap- 
plicant must  establish  that  he  is  accepted 
for  residency  of  specialty  training  in  an 
Illinois  hospital  approved  for  this  purpose 
by  the  Department  of  R8cE.  (NOTE: 
These  approvals  coincide  with  the  AMA- 
approved  list).  He  receives  such  a certifi- 
cate for  one  year  only,  though  it  is  subject 
to  renewal.  Though  the  certificate  is  is- 
sued to  the  physician  by  name,  it  must  be 


kept  in  the  care  and  custody  of  the  hos- 
pital. The  hospital  is  required  to  return 
the  certificate  to  R8cE  when  the  physician 
completes  his  training  period  or  leaves  for 
some  other  reason.  The  Department  of 
R&E  is  explicit  on  the  point  that  the  cer- 
tificate is  only  valid  for  the  hospital  which 
accepted  the  physician  for  residency  train- 
ing. Without  another  approval  process,  he 
is  not  authorized  to  practice  medicine  in 
any  other  setting. 

Employment  of  holders  of  ECFMG  and/ 
or  temporary  certificates.  There  is  no  law 
against  a hospital  employing  a physician 
who  has  no  more  than  an  ECFMG  certifi- 
cation or  has  been  issued  a temporary  cer- 
tificate or  registration  at  another  hospital. 
The  only  prohibition  is  against  employing 
and  using  him  as  a physician  or  presenting 
him  to  the  public  as  such.  According  to 
Frank  R.  Petrone,  Chief,  Technical  Advis- 
or of  the  Department  of  R&E,  “These  indi- 
viduals can’t  do  anything  more  in  the  pa- 
tient care  setting  than  any  other  unlicensed 
person  can  do.”  Such  a person  can  be  em- 
ployed as  an  “orderly”  or  as  a “technician” 
but,  as  a protection  to  the  hospital  and  the 
public,  there  must  be  clear  understandings 
with  the  physician  himself  and  by  the  hos- 
pital’s medical  staff  that  he  must  function 
in  the  hospital  under  medical  supervision. 
This  means,  among  other  things,  that  he 
cannot  independently  perform  any  diag- 
nosis or  institute  any  course  of  treatment. 
In  1964,  Mr.  Petrone  issued  interpretations 
under  the  Medical  Practice  Act  stating 
that  unauthorized  practice  of  medicine  in 
these  situations  is  a criminal  offense  by  the 
individual  involved.  The  hospital  admini- 
strator or  chief  of  staff  who  assigns  such 
individual  to  illegal  medical  practice  also 
may  subject  himself  to  the  criminal  offense 
of  aiding  or  abetting  the  unlicensed  prac- 
tice of  medicine. 

Emergency  Room  Statute.  Under  state 
law  (Chapter  Ill-i/g,  Sec.  86,  111.  Rev.  Stat.) 
no  general  hospital  can  refuse  to  give 
emergency  medical  treatment  to  an  appli- 
cant “in  case  of  injury  or  acute  medical  con- 
dition where  the  same  is  liable  to  cause 
death  or  severe  injury  or  serious  illness.” 


200 


Illinois  Medical  Journal 


There  is  no  requirement  that  these  cases 
be  admitted  as  inpatients  nor  is  there  any 
prohibition  against  referring  them  to  an- 
other institution.  However,  the  judgment 
about  the  patient’s  condition  is  necessarily 
a medical  one,  and  in  Illinois  only  licensed 
physicians  are  qualified  to  make  these 
judgments.  We  repeat  a statement  made 
by  our  IHA  legal  counsel,  Harry  L.  Kinser, 
four  years  ago  (IHA  Document,  “Hospital 
Emergency  Service  Under  Illinois  Law,’’ 
May  19,  1964): 

“My  conclusion  is  that  an  Illinois  hos- 
pital must  furnish  emergency  room  serv- 
ice; that  the  governing  board  must  pro- 
vide how  this  is  to  be  done  and  must 
adopt  a system  which  will  make  a phy- 
sician at  all  times  available;  that  a mem- 
ber of  the  medical  staff  must  comply 
with  such  requirements  or  incur  the  risk 
of  losing  his  staff  privileges  and  facing 
a charge  that  would  jeopardize  his  sta- 
tus as  a licensed  physician.’’ 

Medical  Licensure  Verification.  I n t h e 


IHA  document  cited  above,  we  recom- 
mended that  every  hospital  arrange  for 
routine  verification  of  current  licensure  of 
every  physician  practicing  medicine  at  that 
hospital  including  residents  and  out-of- 
state  physicians  who  occasionally  admit 
patients  or  provide  professional  consulta- 
tion. 

This  may  be  done  easily  at  the  time  staff 
privileges  are  annually  reviewed.  The  De- 
partment of  R&E  advises  us  that  they  are 
always  prepared,  by  letter  or  by  telephone, 
to  verify  a given  license  number.  The  De- 
partment tells  us  that  it  plans  soon  to  do 
another  survey  under  which  hospitals  are 
asked  to  report  the  licensure  numbers  of 
all  physicians  on  their  staffs.  We  suggest 
that  this  is  an  appropriate  time  for  hospi- 
tals to  become  current  on  this  information. 

NOTE:  The  Medical  Practice  Act,  in- 
cluding Rule  VIII  (Temporary  Certifi- 
cates of  Registration)  and  Rule  IX  (Lim- 
ited License  to  Practice  in  State  Hospitals) 
appears  on  page  551  of  the  October,  1967, 
issue  of  the  Illinois  Medical  Journal,  the 
annual  reference  issue. 


New  Cellular  Component 
Found  in  Red  Blood  Formation 


Scientists  at  The  University  of  Chicago 
have  found  a new  cellular  component  that 
arises  during  the  process  of  red  blood  cell 
formation. 

The  component  was  found  by  Martin 
Gross,  a graduate  student,  and  Eugene 
Goldwasser,  Professor  of  Biochemistry. 
Their  work  was  done  in  The  Argonne 
Cancer  Research  Hospital,  which  is  oper- 
ated by  the  University  for  the  U.S.  Atomic 
Energy  Commission. 

The  new  component  was  described  in  a 
paper  Gross  delivered  at  the  52nd  annual 
meeting  of  the  Federation  of  American  So- 
cieties for  Experimental  Biology.  It  is  a 
very  large  RNA  that  is  formed  as  a result 
of  the  action  of  the  hormone,  erythropoie- 
tin, on  the  cells  from  which  mature  red 
blood  cells  are  derived.  Erythropoietin, 
which  is  produced  mainly  in  the  kidneys, 
appears  to  be  the  primary  factor  for  trig- 
gering the  conversion  of  the  primitive  cells 
in  marrow  to  red  blood  cells. 

The  large  RNA  formed  as  a result  of 
erythropoietin  action  is  many  times  larger 
than  any  other  RNA  occurring  in  normal 


animal  cells.  It  is  present  in  such  minute 
amounts  that  it  can  be  detected  only  by 
using  radioactive  tracers  to  tag  it  when  it 
is  formed. 

A recent  refinement  of  method  showed 
Gross  and  Goldwasser  that  earlier  tech- 
niques had  been  causing  the  breakdown  of 
these  large  RNA  molecules,  making  them 
appear  much  simpler  than  they  are.  The 
function  of  this  “monster”  RNA  has  not 
yet  been  established,  but  finding  it  has 
forced  these  investigators  to  re-examine 
their  concepts  concerning  the  biochemical 
mechanisms  underlying  cellular  differen- 
tiation. 

“We  now  realize,”  Goldwasser  said,  “that 
the  process  of  converting  unspecialized 
cells  to  specialized  ones  involves  switching 
on  the  sythesis  of  a large  variety  of  new 
RNA  types.  This  realization  is  forcing  on 
us  a need  for  new  concepts  in  this  field.” 

Such  detailed  information  on  how  red 
blood  cells  are  formed  might  lead  ulti- 
mately to  an  understanding  of  the  chemi- 
cal process  by  which  primitive  cells  are  con- 
verted to  cells  with  specialized  function. 


for  August,  1968 


201 


anticostive^ 

hematinic 


PERITIMC* 

Hematinic  with  Vitamins  and  Fecal  Softener 

A tablet^day  provides: 

• Elemental  Iron  (as  Ferrous  Fumarate) . 100  mg 

• Dioctyl  Sodium  Sulfosuccinate  ( to  _ 

counteract  constipating  effect  of  iron)  100  mg 


Vitamin  Bi 7.5  mg 

Vitamin  B2 7.5  mg 

Vitamin  Ba 7.5  mg 

Vitamin  B12 50  mcgm 

Vitamin  C 200  mg 

Niacinamide 30  mg 

Folic  Acid 0.05  mg 

Pantothenic  Acid 15  mg 


Bottles  of  60 

anticostive,  adj.  {anti  opposed  to 
4-  costive  causing  constipation.) 
Against  constipation.  (Now  isn’t 
that  a good  idea  in  an  iron-contain- 
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Urban  Private 
Psychiatric  Practice 

(Continued  from  page  178) 

SUMMARY 

The  results  with  all  157  patients  seen  in 
a general  psychiatric  private  practice  in  an 
urban  area  during  a four  year  period 
(1960-1964)  are  reviewed.  The  “average” 
patient  was  35  years  old,  middle  or  upper- 
middle  class,  overtly  depressed  as  well  as 
anxious,  with  multiple  symptoms  that  dis- 
rupted all  major  areas  of  his  life.  Psycho- 
therapy consisted  of  a median  of  35  ses- 
sions over  a median  period  of  six  months. 
The  majority  (58%)  received  no  drugs. 
Overall  results  were:  markedly  improved, 
33%;  moderately  improved,  31%;  mildly 
improved,  23%;  no  change,  10%  and 
worse,  3%. 

Psychoneurotics  and  schizophrenics  did 
best;  personality  disorders  did  worst.  The 
most  responsive  symptom  areas  were  soma- 
tic complaints,  depression,  confusion  of  self- 
identity,  martial  discord,  and  sexual  diffi- 
culties, in  that  descending  order. 

References 

1.  Bahn,  Anita  K.:  Conwell,  Margaret;  and  Hur- 
ley, Peter:  Survey  of  Private  Psychiatric  Prac- 
tice, Arch.  Gen.  Psychiat.  12:295-302  (March) 
1965. 

2.  Lockman,  Robert  F.:  Nationwide  Study  Yields 
Profile  of  Psychiatrists,  Article  in  Psychiatric 
News  (January)  1966. 

3.  Hollingshead,  August  B.,  and  Redlich,  Fritz 
C.:  Social  Class  and  Mental  Illness,  New  York: 
John  Wiley  and  Sons,  1958. 

4.  Matarazzo,  Joseph  D.:  Psychotherapeutic  Proc- 
esses, An.  Rev.  Psychol.  16:181-224,  1965. 

5.  Schofield,  William.  Psychotherapy:  the  Pur- 
chase of  Friendship,  Englewood  Cliffs,  N.J.: 
Prentice-Hall,  1964. 

6.  Committee  on  Nomenclature  and  Statistics  of 
the  American  Psychiatric  Association:  Diag- 
nostic and  Statistical  Manual.  Mental  Disorders, 
Washington,  D.C.:  American  Psychiatric  Asso- 
ciation, 1952. 

7.  Hamburg,  David;  Sabshin,  Melvin  A.;  Board, 
Frank  A.;  and  Grinker,  Roy  R.:  Classification 
and  Rating  of  Emotional  Experiences,  AMA 
Arch.  Neur.  Psychiat.  79:415-426  (April)  1958. 

8.  Luborsky,  Lester:  Clinicians’  Judgment  of  Men- 
tal Health,  Arch.  Gen.  Psychiat.  7:407-417  (De- 
cember) 1962. 

9.  Grinker,  Roy  R.;  Miller,  Julian;  Sabshin,  Mel- 
vin; Nunn,  Robert;  and  Nunnally,  Jum  C.; 
The  Phenomena  of  Depressions,  New  York; 
Hoeber  Medical  Division,  1961, 

10,  Frank,  Jerome:  Persuasion  and  Healing.  A 
Comparative  Study  of  Psychotherapy,  Balti- 
more: The  Johns  Hopkins  Press,  1961. 


202 


Illinois  Medical  Journal 


for  topical  antibiotic  therapy  with  minimum 
risk  of  sensitization 


Caution:  As  with  other  antibiotic  products,  prolonged  use  may 
result  in  overgrowth  of  nonsusceptible  organisms,  including 
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Supplied  in  V2  oz.  and  1 oz.  tubes. 

Complete  literature  available  on  request  from  Professional 
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Subdural  Hematomas 
in  Infants  and  Children 

(Continued  from  page  170) 

References 

1.  Christensen,  E.,  and  Husby,  J.:  Chronic  Sub- 
dural Hematoma  in  Infancy.  Acta  Neurol. 
Scand.  39:223-342.  1963. 

2.  Bowman,  C.  E.,  and  Kahn,  E.A.:  Subdural 
Hematoma  in  Infants.  South.  Surg.  11:164-172, 
1942. 

3.  Ford,  F.R.:  Diseases  of  the  Nervous  System  in 
Infancy,  Childhood  and  Adolescence.  C.C. 
Thomas.  1960. 

4.  Gardner,  W.J.:  Traumatic  Subdural  Hematoma 
with  Particular  Reference  to  the  Latent  Inter- 
val. Arch.  Neurol.  Psychiat.  27:847-858,  1932. 

5.  Greenfield,  J.G.,  and  Russell,  D.S.:  Traumatic 
Lesions  of  the  Central  and  Peripheral  Nervous 
System.  Chapter  7 in  Greenfield’s  Neuropath- 
ology. The  Williams  and  Wilkins  Co.  Balti- 
more, 1963. 

6.  Hendrick,  E.B.,  Harwood-Hash,  D.C.F.,  and 
Hudson,  A.R.:  Head  Injury  in  Children.  Clini- 
cal Neurosurg.  Vol.  11,  Baltimore.  The  Williams 
and  Wilkins  Co.,  1964. 

7.  Ingraham,  F.D.,  and  Heyl,  H.L.:  Subdural 
Hematoma  in  Infancy  and  Childhood.  J.A.M.A. 
112:198-204,  1939. 

8.  Ingraham,  F.D.  and  Matson,  D.D.:  Neurosur- 
gery of  Infancy  and  Childhood,  Springfield, 
C.C.  Thomas.  1961. 

9.  Lanzara,  G.,  and  Delgaudio,  A.:I1  Traumatismi 
Cranio-Cerebrali  Nell  Infanzia,  Minerva  Chir. 
30:260-275.  1964. 

10.  McKissock,  W.,  Richardson,  A.,  and  Bloom, 
W.H.:  Subdural  Hematoma.  Lancet.  1:1365- 
1369,  1960. 

11.  Pia,  H.W.:  Die  Traumatichen  Hirblutingen 
des  Kindersalter.  Acta  Neurochir.  11:583-600, 
1964. 

12.  Putnam,  T.J.,  and  Cushing,  H.:  Chronic  Sub- 
dural Hematoma— Its  Pathology,  its  Relation  to 
Pachymeningitis  Hemorrhagica  and  its  Surgical 
Treatment.  Arch.  Surg.  11:329-393,  1925. 

13.  Shulman,  K.,  and  Ransahoff,  J.:  Subdural  Hem- 
atoma in  Children.  The  Fate  of  Children  with 
Retained  Membranes.  J.  Neurosurg.  18:175-181, 
1961. 

14.  Svien,  H.J.,  and  Gelety,  J.E.:  On  the  Surgical 
Management  of  Encapsulate  Subdural  Hema- 
toma. J.  Neurosurg.  21:172-177,  1964. 

15.  Tondury,  G.D.:  Das  Subdurale  Hamatom  und 
Hygrom  in  Kindesalter.  Schweiz.  Arch  Neurol. 
Neurochir.  Psychiat.  99:299-312,  1967. 

This  study  was  supported  by  a grant  from  the 

Spastic  Paralysis  Research  Foundation. 


“Health  on  Wheels,”  a 14-minute  black 
and  white  film  depicts  the  basic  principles 
applied  in  mobile  multi-phasic  chronic 
disease  screening.  Screening  techniques, 
types  of  educational  approaches,  reporting 
systems  and  follow-up  are  all  demonstra- 
ted. It  has  recently  been  released  through 
the  International  Film  Bureau,  332  S. 
Michigan  Ave.,  Chicago,  60604.  Purchase 
and  rental  inquiries  may  be  addressed  to 
the  Bureau. 


204 


Illinois  Medical  Journal 


Abstracts  of  Board  Actions 

(Continued  from  page  138) 

CONSIDERATION  GIVEN  TO  SERVICES  TO  IDPA  RECIPIENTS 

The  Advisory  Committee  to  IDPA  report  involved  a decision 
relative  to  telephoning  a pharmacy  or  other  vendor  to  pre- 
scribe or  order  medications,  medical  supplies  or  sick  room 
needs  for  a public  aid  recipient  ; also,  the  situation  rela- 
tive to  podiatrists  participating  in  the  care  of  public  aid 
recipients  was  discussed.  The  Department  of  Public  Aid  was 
asked  to  seek  the  scientific  advice  of  physicians  and  the 
legal  advice  of  attorneys  familiar  with  the  Podiatry  Act  and 
the  Medical  Practice  Act  before  proceeding  further  with  the 
implementation  of  the  law  requiring  IDPA  to  pay  podiatrists 
directly  for  their  services  without  prior  referral  by  a 
physician. 

MEDICAL  SERVICE  FOR  CONVENTION 

By  official  action,  the  chairman  of  the  Board  was  author- 
ized to  offer  to  man  a first  aid  station  in  cooperation  with 
Chicago  Medical  Society  (including  ambulance  and  hospital 
facilities)  for  the  Democratic  Convention  to  be  held  in  Chi- 
cago in  August.  An  offer  was  to  be  made  to  the  Democrat  Na- 
tional Committee  and  if  the  idea  was  acceptable  and  practi- 
cal, it  would  be  developed. 

MATERNAL  AND  PERINATAL  MORTALITY  STUDY 

Dr.  Stewart  Abel  appeared  before  the  Board  to  discuss  the 
Maternal  and  Perinatal  Mortality  Study.  In  1964  Dr.  Edward 
Dorr  (deceased)  was  interested  in  the  problem  of  standard- 
izing records  of  maternal  perinatal  deaths  throughout  the 
country.  The  original  committee  in  Illinois,  where  a pilot 
study  was  made,  included  Dr.  Abel  and  Dr.  Dorr,  Dr.  Robert 
Hartman,  and  Dr.  Philipsborn,  who  was  chairman  of  the  ISMS 
Committee  on  Perinatal  Mortality  (no  longer  in  existance). 
Since  private  funds  were  not  available  for  the  original 
study,  the  project  lay  dormant  for  the  past  three  years.  Dr. 
Abel  asked  that  the  entire  project  be  revived,  and  the  study 
be  done  in  Illinois  so  that  one  state  would  have  considered 
the  problem  on  a "trial  basis." 

LISTING  OF  BOARD  ACTIVITIES 

By  official  action  the  Board  was  asked  to  set  up  a priority 
list  of  activities,  using  as  a source  for  information  on 
which  to  base  such  actions  a committee  composed  of  past 
presidents  of  the  society.  This  group,  through  the  Executive 
Committee,  would  make  interim  reports  at  least  every  six 
months. 

CONSTITUTIONAL  CONVENTION  SUPPORTED 

The  Board  approved  support  for  the  calling  of  a Constitu- 
tional Convention  which  will  appear  on  the  November  ballot, 
and  so  recommended  to  the  House  of  Delegates,  which  con- 
curred. 


for  August,  1968 


205 


What  can  be  done 
for  Susan  Jane 
To  stop  the  runs 
and  crampy  pain? 

Parepectolin  for  quick  relief  of  acute  diarrhea 
. . . soothes  colicky  pain  with  paregoric 
. . .consolidates  fluid  stools  with  pectin 
, . . adsorbs  irritants  with  kaolin,  and  protects 
intestinal  mucosa 


In  children,  Parepectolin  may  be  used  to  control 
diarrhea  promptly  and  prevent  dehydration, 
until  etiology  has  been  determined.  In  some 
cases,  Parepectolin  may  be  all  the  therapy 


Each  fluid  ounce  of  creamy  white  suspension  contains: 

Paregoric  (equivalent) (1.0  dram)  3.7  ml. 

Contains  opium  (%  grain)  15  mg.  per  fluid 


ounce. 

warning:  may  he  habit  forming 

Pectin (2%  grains)  162  mg. 

Kaolin  (specially  purified) ....  (85  grains)  5.5  Gm. 
(alcohol  0.69%) 

Usual  Children’s  Dose:  One  or  two  teaspoonfuls 
three  times  daily. 


WILLIAM  H.  RORER,  INC. 

Fort  Washington,  Pa. 


8 

RO^ER 

R 


Practice  of  Medicine 

(Continued  from  page  118) 

cate  may  not  practice  medicine  in  any  de- 
gree in  a hospital  in  Illinois  unless  he  is 
within  one  of  the  categories  outlined  above. 

Offenses  Listed 

An  unlicensed  person  who  commits  any 
of  the  following  acts  regardless  of  whether 
the  same  be  committed  within  or  without 
a hospital  is  guilty  of  practicing  medicine 
without  a license— a criminal  offense: 

1.  Hold  himself  out  to  the  public  as  be- 
ing engaged  in  the  diagnosis  or  treat- 
ment of  ailments  of  human  beings. 

2.  Suggest,  recommend  or  prescribe  any 
form  of  treatment  for  the  palliation, 
relief  or  cure  of  any  physical  or  men- 
tal ailment  of  a person  with  the  in- 
tention of  receiving  therefor,  either 
directly  or  indirectly,  any  fee,  gift,  or 
compensation  whatsoever. 

3.  Diagnosticate  or  attempt  to  diagnos- 
ticate any  ailment  or  supposed  ailment 
of  another. 

4.  Operate  upon,  profess  to  heal,  pre- 
scribe for,  or  otherwise  treat  any  ail- 
ment, or  supposed  ailment  of  another. 

5.  Maintain  an  office  for  examination  or 
treatment  of  persons  afflicted,  or  al- 
leged or  supposed  to  be  afflicted,  by 
any  ailment. 

6.  Attach  the  title  Doctor,  Physician,  Sur- 
geon, M.D.,  or  any  other  word  or  ab- 
breviation to  his  name,  indicative  that 
he  is  engaged  in  the  treatment  of  hu- 
man ailments  as  a business. 

(Section  24  Medical  Practice  Act.  [Chp. 

91„  Sec.  16i,  1967  Rev.  Stat.]) 

Manifestly,  the  enforcement  of  the  Medi- 
cal Practice  Act  with  respect  to  the  elimi- 
nation of  unlicensed  persons  practicing 
medicine  in  a hospital  is  dependent  upon 
co-operation  by  responsible  persons  within 
the  hospital.  It  should  be  noted  that  lack 
of  co-operation  or  failure  to  meet  respon- 
sibilities can  in  a proper  case  be  translated 
into  criminal  liability  and  disciplinary  ac- 
tion resulting  in  revocation  or  suspension 
of  a license  to  practice  medicine  as  follows: 

1.  The  unlicensed  person  practicing  me- 
dicine is  committing  a criminal  of- 
fense. 

2.  A hospital  administrator  who  assigns 
an  unlicensed  person  to  duties  which 

(Continued  on  page  212) 


206 


Illinois  Medical  Journal 


Clinics  for  Crippled  Children 


Twenty-eight  clinics  for  Illinois’  physi- 
cally handicapped  children  have  been 
scheduled  for  September  by  the  University 
of  Illinois,  Division  of  Services  for  Crippled 
Children.  This  includes  twenty-one  general 
clinics  providing  diagnostic,  orthopedic, 
pediatric,  speech  and  hearing  examination 
along  with  medical,  social,  and  nursing 
service.  There  will  be  four  special  clinics 
for  children  with  cardiac  conditions  and 
rheumatic  fever,  and  three  for  children  with 
cerebral  palsy.  Clinicians  are  selected  from 
among  private  physicians  who  are  certified 
Board  members.  Any  private  physician 
may  refer  to  bring  to  a convenient  clinic 
any  child  or  children  for  whom  he  may 
want  examination  or  consultative  services. 

September  4 Rock  Island  Cerebral  Palsy 
—Foundation  for  Crippled  Children  & 
Adults,  3808  Eighth  Avenue 

September  4 Carmi— Carmi  Township 
Hospital 

September  4 Jacksonville— Holy  Cross 
Hospital 

September  4 Hinsdale— Hinsdale  Sani- 
tarium 

September  5 Sterling— Community  Gen- 
eral Hospital 

September  5 Effingham  General— St.  An- 
thony Memorial  Hospital 

September  5 Peoria  Cerebral  Palsy  (a.m.) 
—Zeller  Zone  Center 

September  10  East  St.  Louis— Christian 
Welfare  Hospital 

September  10  Peoria  General— Children’s 
Hospital 

September  1 1 Champaign-Urbana— Mc- 
Kinley Hospital 

September  11  Joliet— St.  Joseph's  Hospital 

September  12  Macomb— McDonough  Dis- 
trict Hospital 


September  12  Anna— First  Christian 
Church 

September  12  Springfield  General— St. 
John’s  Hospital 

September  13  Chicago  Heights  Cardiac— 
St.  James  Hospital 

September  17  Alton  General— Alton  Me- 
morial Hospital 

September  18  Evergreen  Park— Little 
Company  of  Mary  Hospital 

September  19  Decatur— Decatur  8c  Ma- 
con Co.  Hospital 

September  19  Rockford— Rockford  Me- 
morial Hospital 

September  19  Sparta— First  Baptist 
Church  Educational  Building 

September  19  Elmhurst  Cardiac— Me- 
morial Hospital  of  DuPage  County 

September  24  Belleville— St.  Elizabeth’s 
Hospital 

September  24  Peoria  General— Children’s 
Hospital 

September  25  Centralia— St.  Mary’s  Hos- 
pital 

September  25  Springfield  Cerebral  Palsy 
(p.m.)— Diocesan  Center 

September  25  Elgin— Sherman  Hospital 

September  26  Effiingham  Rheumatic 
Fever  8c  Cardiac— St.  Anthony  Memorial 
Hospital 

September  27  Chicago  Heights  Cardiac— 
St.  James 

The  Division  of  Services  for  Crippled 
Children  is  the  official  state  agency  estab- 
lished to  provide  medical,  surgical,  correc- 
tive, and  other  services  and  facilities  for 
diagnosis,  hospitalization  and  after-care  for 
children  with  crippling  conditions  or  who 
are  suffering  from  conditions  that  may  lead 
to  crippling. 


Vascular  Changes  in  Arthritis 

The  synovial  overgrowth  produces  the  destructive  changes  of  rheumatoid 
arthritis  in  the  digits  and  is  the  predominant  factor  in  the  condition.  Oc- 
clusive digital  artery  disease  predominates  in  rheumatoid  arthritis  and  starts 
in  the  digital  arteries  of  the  extremities.  Vasculitis  accounts  for  some  of  the 
polyneuropathy  in  rheumatoid  arthritis  and  probably  all  of  the  deminerali- 
zation. It  is  hoped  that  more  interest  will  be  shown  in  the  vascular  changes 
in  arthritic  conditions.  (Radiographic  Changes  in  Rheumatoid  Arthritis  in 
the  Digits,  T.  R.  Marshall,  Radiology,  (Jan.)  1968,  90:121-123.) 


for  August,  1968 


207 


Tuberculosis?  Influenza? 
Pneumonia?  Leukemia? 
Hodgkin's  Disease?  Syphilis? 
Systemic  Fungal  Diseases? 
Chronic  Chest  Diseases? 
or 

HISTO? 

(Histoplasmosis— “The  Masquerader”) 


A new  aid  in  differential  diagnosis 

HISTOPLASMIN,TINE  TEST 

(Rosenthal) 

The  LEDERTINE'''ht  Applicator  with  the  Blue  Handle 

Precautions— Nonspecific  reactions  are  rare,  but 
may  occur.  Vesiculation,  ulceration  or  necrosis 
may  occur  at  test  site  in  highly  sensitive  persons. 
The  test  should  be-used  with  caution  in  patients 
known  to  be  allergic  to  acacia,  or  to  thimerosal 
(or  other  mercurial  compounds). 


Ask  your  representative  for  details  or  write  Medical  Advisory  Dept., 
Lederle  Laboratories,  Pearl  River,  New  York  1 0965.  406-8 


2 ways  Doctor... 

you  can  help  achieve 
TOTAL  REHABILITATION 
in  your  handicapped  patients. . . 

DIRECT  THEM  TO  EMPLOYMENT  OPPOR- 
TUNITY— by  referring  them  to  the  Gover- 
nor's Committee  on  Employment  of  the 
Handicapped. 

BECOME  AN  ACTIVE  FORCE  FOR  EQUAL 
EMPLOYMENT  OPPORTUNITY  IN  YOUR 
COMMUNITY:  Join  your  Local  Council  on 
Employment  of  the  Handicapped. 

For  complete  information  write  . . . 
Louis  A.  Sabella 
Executive  Dir.— Governor’s  Committee 
on  Employment  of  the  Handicapped 
Frank  J.  Jirka,  M.D.,  Chairman 
188  W.  Randolph  St.  / Chicago,  III.  60601 
(AC  312)  372-3437 


Approve  New  Curriculum 
in  Medical  Dietetics 

The  University  of  Illinois  Board  of 
Trustees  has  approved  authorization  of  the 
establishment  of  a curriculum  in  Medical 
Dietetics  within  the  School  of  Associated 
Medical  Sciences  at  the  University’s  Medi- 
cal Center  Campus  in  Chicago. 

The  proposed  curriculum,  which  would 
lead  to  the  degree  of  Bachelor  of  Science 
in  Medical  Dietetics,  must  now  be  ap- 
proved by  action  of  the  Illinois  State  Board 
of  Higher  Education.  The  curriculum  had 
been  endorsed  by  Dr.  Joseph  S.  Begando, 
Chancellor  for  the  Medical  Center  Cam- 
pus, the  Medical  Center  Campus  Faculty 
Senate  and  University  Executive  Vice  Pres- 
ident and  Provost  Lyle  H.  Lanier. 

According  to  a University  sp>okesman  the 
proposed  program,  which  emphasizes  the 
biological  and  physical  sciences  and  the 
application  of  nutritional  principles,  rep- 
resents a relatively  new  approach  to  the 
field  of  dietetics. 

In  addition  to  incorporating  the  latest 
developments  in  nutritional  science,  the 
program  would  integrate  the  classroom  in- 
struction with  immediate  practical  appli- 
cation to  patient  needs. 

The  entire  curriculum,  it  was  empha- 
sized, is  based  on  detailed  studies  which  in- 
dicate that  the  number  of  dieticians  ex- 
pected to  be  available  by  1970  will  be  far 
below  projected  needs  These  studies  also 
point  up  the  need  in  hospitals  for  profes- 
sional specialists  in  the  field  of  applied 
nutrition. 

Minimum  requirements  for  admission 
are  60  semester  or  90  quarter  hours,  at 
least  a 3.0  (C)  average  and  certain  prere- 
quisite courses.  Requirements  for  gradua- 
tion with  the  B.S.  degree  in  Medical  Die- 
tetics include  general  education  sequences 
in  the  biological,  physical  and  social  sci- 
ences and  in  the  humanities. 

* * * 

Widows  of  veterans  of  all  wars  on  the 
pension  rolls  of  the  Veterans  Administra- 
tion, who  are  blind  or  helpless  enough  to 
require  regular  aid  and  attendance,  or  who 
are  patients  in  nursing  homes,  are  entitled 
to  receive  $50  a month  more  than  their 
regular  pension  payment. 


208 


Illinois  Medical  Journal 


Describe  Insertion  of  Balloon 
in  Heart  to  Aid  Cardiac  Victims 


A balloon  inserted  into  the  heart  to  help 
victims  o£  heart  failure  was  described  re- 
cently, at  the  University  of  Chicago. 

The  device  was  one  of  several  mechanical 
assistances  to  the  heart  discussed  by  Dr. 
James  R.  Jude,  head  of  the  Division  of 
Thoracic  and  Cardiovascular  Surgery,  Uni- 
versity of  Miami  School  of  Medicine. 

At  a conference  on  aggressive  manage- 
ment of  coronary  artery  disease  sponsored 
by  The  University  of  Chicago  School  of 
Medicine  and  The  American  College  of 
Cardiology,  Dr.  Jude  described  the  process 
of  inserting  and  using  the  balloon. 

A double-passage  catheter,  or  tube,  with 
the  deflated  balloon  attached  is  inserted  in 
a patient  with  a failing  heart  through  an 
incision  in  the  groin,  he  said.  It  is  then 
manipulated  into  the  heart.  At  regulated  in- 
tervals coinciding  with  the  beat  of  the 
heart,  the  balloon  is  allowed  to  contract  or 
expand.  It  is  filled  with  helium  or  nitro- 
gen to  displace  blood  so  the  weakened  heart 
can  function  on  reduced  pressure. 


The  balloon  has  been  used  up  to  24 
hours  in  a single  heart  attack  victim  by 
Dr.  Adrian  Kantrowitz  in  New  York,  said 
Dr.  Jude. 

He  added  that  there  might  be  some  value 
in  using  such  a method  periodically  to  re- 
lieve the  pressure  on  a victim  of  heart 
failure. 

Dr.  Jude  also  described  a variation  on 
the  pacemaker  which  has  been  used  suc- 
cessfully. Pacemakers  are  devices  implant- 
ed by  surgery  into  the  body  with  electrodes 
attached  to  the  heart  wall.  The  pacemaker 
provides  periodic  electrical  shocks  that 
keep  a weak  heart  beating  regularly. 

Since  many  people  with  heart  problems 
require  this  stimulation  but  do  not  require 
it  constantly,  the  newer  pacemaker  has  a 
switch  which  permits  the  user  to  turn  it  on 
and  off. 

Such  a unit,  according  to  Dr.  Jude,  also 
reduces  the  possibility  of  self-electrocution 
and  requires  less  frequent  surgery  to  re- 
place the  pacemaker  battery. 


Vacation  trip.... 


Motion  sickness? 


This  time  it’ll  be  different.  Emetrol  taken  before  the 
trip  begins  will  usually  prevent  nausea  and  vomiting. 
Emetrol  is  effective  and  safe... most  helpful  where  safe- 
ty is  most  important.  It  acts  locally— not  systemically. 


Emetrol® 

phosphorated  carbohydrate 

WILLIAM  H.  RORER,  INC*.  solution 

Fort  Washington,  Pa.  emesis  control 


\~T~ 

RORER 

R 


for  August,  1968 


209 


THE  VIEW  BOX 


Does  The 

Psychiatric  Hospital 
Serve  Medicine? 

Some  treatment  facilities  seem  to  pro- 
vide an  unusual  measure  of  aid  and  com- 
fort to  other  disciplines,  with  the  doctor’s 
role  apparently  subsumed  in  a kind  of 
miscellany  of  therapeutic  activity. 

This  is  not  the  case  at  North  Shore 
Hospital.  In  policy  and  in  practice,  the 
doctor  creates  the  program  and  treatment 
regime,  drawing  upon  relevant  aspects  of 
the  existing  milieu  to  structure  his  pa- 
tient’s day. 

While  obviously  beneficial  and  entirely 
necessary  in  patient  management,  the 
therapeutic  environment  must  be  astutely 
scaled  to  specific  patient  needs,  as  inter- 
preted by  the  attending  physician. 

Patients  referred  to  the  hospital  by  the 
general  practitioner  and  other  medical 
specialists  are  cared  for  by  the  hospital’s 
own  psychiatric  staff  which,  at  the  same 
time,  provides  continuity  of  care  for  all 
patients. 

Hospital  administration  and  medical 
responsibility  are  under  one  and  the  same 
person  at  this  hospital:  the  superinten- 
dent and  psychiatrist-in-chief.  Conse- 
quently, patient  welfare,  and  nothing  else, 
defines  hospital  organization  and  the 
therapeutic  programs. 

The  private  psychiatric  facility,  as  com- 
pared to  other  institutions  and  units  of 
care,  remains  especially  suited  to  the 
treatment  of  a wide  range  of  mental  dis- 
ease entities.  This  is  true  in  those  in- 
stances where  the  patient  is  ambulatory, 
in  need  of  relative  freedom,  and  where 
an  appropriate  diversity  of  activity  is  in- 
dicated. Those  conditions  of  daily  living, 
in  other  words,  which  are  required  for 
the  therapeutic  rehearsal  of  recovery  are 
uniquely  available  in  such  a hospital. 

The  remotivation  programs  for  the 
medicare  patients,  the  class  rooms  for  the 
adolescents,  the  patient  library,  the  out- 
door and  indoor  games  and  parties,  all 
of  these  professionally  organized  activities 
make  up  the  hospital  day— but  again  with 
sharp  medical  emphasis.  Through  weekly 
staffings,  written  orders,  and  discussions 
with  staff  the  doctor  remains  entirely  in 
command. 

The  hospital,  in  fulfilling  its  medical 
commitments,  stands  ready  to  offer  con- 
sultation on  office  and  home  emergencies. 
In  short,  it  is  here  (in  a strikingly  beau- 
tiful section  of  the  North  Shore)  to  serve 
doctors  by  keeping  faith  with  the  profes- 
sion of  medicine. 

Telephone  or  write  to  Charles  H. 
Jones,  MD— Superintendent  and  Psychia- 
trist-in-Chief,  North  Shore  Hospital,  225 
Sheridan  Road,  Winnetka,  Illinois  60093 
—Telephone  (312)  446-8440. 


(Continued  from  page  179) 

DIAGNOSIS:  Rubella  syndrome  in  infants. 

The  roentgenographic  features  in  the 
long  bones  are  considered  pathognomonic 
by  some  observers.  In  the  newborn  these 
changes  consist  of  a poorly  defined  provi- 
sional zone  of  calcification  and  coarsening 
of  the  metaphyseal  trabecula  with  longitu- 
dinal areas  of  radiolucency  and  sclerosis. 
All  of  the  metaphyseal  areas  are  involved 
but  especially  prominent  is  the  region  of 
the  proximal  tibia  and  distal  femoral  epi- 
physis. The  shafts  of  the  bones  are  essen- 
tially normal.  If  the  infant  survives  and 
grows  satisfactorily  the  metaphyseal  trabe- 
cular pattern  returns  to  normal  and  con- 
comitant with  this  the  provisional  zone  of 
calcification  shows  an  increase  in  density 
and  smoothness.  The  rapidity  and  com- 
pleteness of  the  regressive  bone  changes  ap- 
pear to  correlate  closely  with  the  clinical 
well  being  of  the  infant.  In  those  infants 
who  thrive  and  maintain  normal  growth, 
the  bones  appear  normal  at  one  to  three 
months  except  for  residual  growth  disturb- 
ance lines.  Those  babies  that  do  not  de- 
velop normally  may  show  persistance  of  the 
irregular  growth  plate  and  altered  trabe- 
culation  of  the  metaphysis,  but  the  provi- 
sional zones  of  calcification  become  dense 
and  may  even  be  unusually  thick  and  scle- 
rotic. 

Congenital  heart  disease  commonly  oc- 
curs in  infants  whose  mothers  have  had  ru- 
bella during  the  first  trimester  of  their 
pregnancy.  The  most  common  cardiac  ano- 
maly associated  with  rubella  is  patent  duc- 
tus arteriosis.  The  second  most  common 
lesion  was  pulmonary  artery  branch  steno- 
sis. 

Reference : 

Singleton,  E.,  Rudolph,  A.J.,  Rosenberg,  H.S.,  and 
Singer,  D.B.  The  Roentgenographic  Manifestations 
of  the  Rubella  Syndrome  in  Newborn  Infants.  Am. 
J.  Roentgenology,  Rad.  Ther.,  and  Nucl.  Med.  97 
(1):82-91. 


The  Veterans  Administration  system  of 
166  hospitals  provides  the  most  complete 
cross-index  of  diagnoses  and  operations  in 
existence  for  study  by  medical  research  per- 
sonnel. 


210 


Illinois  Medical  Journal 


^pecia 


LJ  S. 


eruice 


IN 


PROFESSIONAL  LIABILITY  INSURANCE 


/• 

iJ  a hian  mah 


k of  didtinction 


Professional  Protection  Exclusively  since  1899 




CHICAGO  OFFICE:  Tom  J.  Hoehn  and  E.  M.  Brvier,  Reprasentalives 
55  Eo$t  Washington  Street,  Room  1334,  Chicago  60602  Telephone:  312-782-0990 

MOUNT  PROSPECT  OFFICE:  Theodore  J.  Pandak,  Representative 
709  Hacicborry  Lane  (P.  O.  Box  105)  Mount  Prospect  60056  Telephone:  312-259-2774 

ST.  CHARLES  OFFICE:  Joseph  C.  Kunches,  Representative 
1220  Wing  Avenue,  St.  Charles  60174  Telephone:  312-5S4-0920 

SPRINGFIELD  OFFICE:  William  J.  Nattermann,  Representative 
1124  South  Fifth  Street,  Springfield  62703  Teleohone:  217-544-2251 


ifaitnuit 


— :rwr 


Nervous 

Geriatrics 


Mental 

Custodial 


Est.  1909 

RESTHAVEN 

This  modernly  equipped  institution  located  in  the  beautiful  Fox  River  Valley  35 
miles  west  of  Chicago,  cooperates  with  physicians  to  the  fullest  extent. 

It  provides  accommodations  for  100  patients  in  single  and  double  rooms.  Rest- 
haven  accepts  patients  by  referral  and  direct  admission. 

RESTHAVEN  HOSPITAL,  600  VILLA  ST.,  ELGIN,  ILL. 

Phone:  SH  2-0327 


Long  Term 
and  Short 
Term  Care 


Day  Care 
and  Mental 
Health  Clinic 


for  August,  1968 


211 


COOK  COUNTY 
Graduate  School  of  Medicine 
CON'I'INIJING  EDUCATION  COURSES 

STARTING  DATES— 1968 

SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Pari  I,  August  12 
SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  Part  1,  Sopt. 
9 A 16. 

SPECIALTY  REVIEW  COURSE  IN  THORACIC  SURGERY, 
Sept.  16 

PATHOLOGY  REVIEW  COURSES  FOR  SPECIALTIES,  Re- 
quest  Dates 

SURGERY  OF  HEAD  AND  NECK,  One  Week,  September  16 
SURGERY  OF  THE  HAND,  One  Week,  September  16 
PEDIATRIC  SURGERY.  One  Week,  September  30 
PROCTOSCOPY  A VARICOSE  VEINS,  One  Week,  September  9 
FIHEROPTIC  CULDOSCOPY  A PELVIC  PERITONEOSCOPY, 
Sept,  to 

SURGICAL  A RADIATION  Rx  OF  GYN.  MALIGNANCIES,  Sept.  0 
ADVANCES  IN  GYNECOLOGY  A OBSTETRICS,  One  Week, 
Sept.  16 

VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Sept. 
23 

DIAGNOSTIC  RADIOLOGY,  One  Week,  September  16 
RADIOISOTOPES,  One  or  Two  Weeks,  First  Monday  Each 
Month 

BASIC  ELECTROCARDIOGRAPHY,  One  Week  October  7 
ANESTHESIA,  Inhalation,  Endotrachaol,  Roglonal,  Request 
Datos 

Information  concerning  numerous  other 
continuation  courses  available  t*l)on  request. 

IT  ACHING  FACUI/IY 
Attending  Staff  of 
Cook  County  Hospital 

Add  re.ssi 

RliGISIRAK,  707  .^uth  Wood  Street, 
(diica/(o,  IllinoiH  60612 


/ "V 

ASSOCIATE  IVIEmCAL 
DIKECTOK 

AnHiHlanl  To 
Sr.  Vico  ProHidonl 
Motlical  Diroclor 


We  rue  .seeking  an  M.I).  to  act  as 
liaison  between  rnir  RLUK  CROS.S- 
BLUE  SmKI.l)  Elans  and  Medical  As- 
.sociations,  Medical  Societies  and  Doo 
lors.  You  will  also  consult  in  the  ad- 
judication of  clilliculi  claim  setlleinenls 
and  assist  in  the  over-all  administra- 
tion oi  the  Medical  division. 

Illinois  licensing  i.s  not  necc.ssary. 
The  position  does  rc‘C|nirc!  some  mc'cl- 
ical  administration  c’X|)erienc:e.  'This 
is  a nnic|ue  opj>ortunity  for  the  indi- 
vidual .selected  both  in  tc-rms  of  per- 
.soiml  advancement  and  corporate  rcc- 
ogniiion.  Upon  rc'ceiju  of  a complete 
icsume  we  will  consider  recpic'sis  for 
addiiional  iidoi ination. 

Addre.ss  lo: 

Mr.  I,.  E.  Kri/ka 

m.iii:  CHoss — lu.iiK 

'12.')  North  Michigan  Ave, 
Chicago,  Illinois  (JOtifM) 

An  equal  opportunity  otnployer 


Practice  of  Medicine 

(Continued  from  page  206) 

involve;  his  jirat.l icing  rncrdicinc  may 
suhjccL  hirnscdl  to  the  crirninal  offense 
of  aiding  and  abetting  such  nnlicen.scd 
pt:rson  to  illegally  )>rac;tic:e  medicine, 
and  the  same  may  he;  true  of  a hospital 
chief  of  staff  or  department  head  if 
in  the;  nature  of  his  duties  he  is  di- 
rcrctly  rc;sj)onsihle  lor  a.ssignitig  such 
duties  to  the  unlicensed  pc;rson. 

A licensed  doc  tor  may  have  his  license 
suspc'ndcrcl  or  revokc'd  if  he  has  profes- 
sional connection  or  association  with 
anothc-r  who  is  illegally  practicing 
mc;dicine.  A chief  of  staff  who  know- 
ingly allows  such  person  to  illegally 
prac;tic;e  mc;dicine,  or  in  a proper  case, 
any  ineinher  of  the  mcrclical  staff  of  a 
hospital  may  subject  himself  to  dis- 
ciplinary ac:tion  against  his  license. 

'1.  A licensccl  doctor  may  have  his  li- 
cense suspended  or  revokc'cl  for  un- 
ethical or  unj)rofe.ssional  conduct  of  a 
charac  tet  likedy  to  dcc:eive,  defraud  or 
harm  the  ))uhlic. 

A nicMuhc'r  of  the  medical  staff  of  a 
hospital  may  j)lace  himself  within  such 
concluc  t if  he  neglects,  fails  or  refuses 
to  fulfill  his  rc*s|)on.sihilities  while  on 
c inergencry  room  call. 


University  of  Illinois  Medical 
('enter  Accepts  $448^1 61 
in  (r  rants 

rite  IJnivetsity  of  Illinois  Mctlical  Ceri- 
tc;r  accepted  an  overall  total  of  .fd'18,161  in 
re.search  and  training  grants  for  the  month 
of  June.  Out  of  M giants  listed,  11  grants 
totaling  .1-129, 622  were  from  the  United 
.Statc;s  Public  Health  Service. 

'rite  funds  wc-re  alloc:ated  as  follows: 
.IhOO  (iracluate  Gollege  and  $4-17, .561  Col- 
Ic'ge  of  Mc*clicinc.  M’he  largest  single  grant, 
.f!  I I 1 ,082,  was  awaicleci  to  Dr.  Cieorge  E. 
Miller,  |)tole.s.sor  of  mcrclicine  and  Director 
of  the  ()ffic:e  of  Kesearch  in  Medical  Edu- 
cation by  the  Unitccl  States  Public  Health 
Servic;e  for  “ The  Efficicuit  Use  of  Medical 
Manpower.” 

riirc'e  c|uartc‘rs  of  a million  veterans  re- 
ceive hosj)ital  treatment  each  year  in  the 
166  Veterans  Administration  lIo.spitaIs. 


212 


Illinois  MrHiral  Journal 


) 


BLUE  SHIELD 


D 

LI\ 


FOR 


PUBLISHED  MONTHLY  BY:  BLUE  SHIELD  PLAN  OF  ILLINOIS  MEDICAL  SERVICE  • 425  NORTH  MICHIGAN  AVENUE  • CHICAGO.  ILLINOIS  60690 


Vol.  2 No.  9 


September,  1968 


New  National  Account  Card 


BLUE  SHIELD® 

IDENTIFICATION  CARD 


1 UNIT  a .1 

SUBSCRIBER  E 

XYZ 

m. 

L. 

_L 

66 

ABCO  PRODUCTS 


Blue  Shield  s new  National  Account  ID  Card  will 
be  seen  more  frequently  in  physicians’  offices 
throughout  the  country  as  more  large  national  or- 
ganizations purchase  Blue  Shield  coverage  for  their 
employees. 

This  new  Blue  Shield  identification  card  looks 
different  from  the  type  issued  by  the  Blue  Shield 
Plan  of  Illinois  Medical  Service.  It  carries  the  words 
“Blue  Shield  Identification  Card”  and  “National 
Account”  across  the  top. 

National  Account  ID  Cards  are  given  to  the 
employees  of  large  national  organizations  that  have 
purchased  Blue  Shield  coverage  under  a central 
certification  system. 

The  National  ID  Card,  as  used  in  connection 
with  central  certification,  eliminates  the  necessity 
to  reissue  ID  Cards  when  employees  move  from 
one  Blue  Shield  Plan  area  to  another. 

Central  certification  is  an  administrative  system 
developed  by  Blue  Shield  to  help  speed  payments 
to  physicians  and  to  provide  them  and  their  office 
assistants  with  a means  of  identifying  eligible  sub- 
scribers from  outside  the  local  area. 

Medical  and  hospital  benefits  for  employees  of 
centrally-certified  groups  are  uniform  regardless  of 
where  the  individual  employee  may  be  located. 

When  you  provide  professional  services  to  a pa- 
tient carrying  a National  Account  ID  Card,  your 
office  assistant  should  be  instructed  to  file  the  claim 
with  the  Illinois  Blue  Shield  Plan. 

This  is  particularly  important  when  your  patient 
has  a “usual  and  customary”  Blue  Shield  program, 
for  it  will  enable  us  to  make  proper  payment  to 
you,  using  Illinois  definitions  of  “usual  and  custo- 
mary” charge  patterns. 


AAedical  Assistants 
AAeetings  Underway 

The  fall  dinner  meetings  for  medical  assistants 
got  off  to  a good  start  August  28  at  Pheasant  Run 
Lodge  in  St.  Charles,  Illinois. 

As  part  of  the  ongoing  Professional  Relations 
program,  the  Blue  Shield  Plan  of  Illinois  Medical 
Service,  for  eleven  years,  has  sponsored  dinner 
meetings  for  medical  assistants  in  the  area  it  serves 
to  help  keep  them  abreast  of  changes  in  Blue  Shield 
benefit  structures,  procedures,  and  methods,  and 
to  help  them  carry  out  their  responsibilities  more 
effectively  for  their  physician-employers. 

Following  dinner,  the  program  includes  a pres- 
entation of  our  new  Blue  Shield  65  plan  and  allows 
time  for  questions  to  be  answered  by  members  of 
our  Blue  Shield  staff  from  our  Medicare,  Blue 
Shield,  and  Major  Medical  Departments. 

All  medical  assistants  will  be  invited  to  attend 
one  of  the  scheduled  meetings  and  should  return 
promptly  the  reservation  form  they  receive  with 
their  invitations. 

Dinners  are  served  at  6:30  P.M.  and  meetings 
adjourn  promptly  at  9:00  P.M.  The  following  din- 
ner meetings  have  been  scheduled: 


September  25 

McHenry  County  Club 

September  26 

Waukegan  Inn 

October  2 

Oak  Park  Arms 

October  3 

Lords — Wheeling 

October  16 

O’Tooles — Shoreland  Hotel 

October  17 

O’Tooles — Shoreland  Hotel 

October  23 

Park  Ridge  Inn 

October  30 

Hyatt  House 

October  31 

Hyatt  House 

November  6 

Neilson’s  Nordic 

November  7 

Halleran’s  Restaurant 

November  13 

Knickerbocker  Hotel 

November  14 

Knickerbocker  Hotel 

For  additional  details,  please  write  or  telephone 
Mrs.  Loretta  O’Donnell,  Special  Representative, 
Professional  Relations,  Blue  Shield  Plan,  425  North 
Michigan  Avenue,  Chicago,  Illinois  60611 — MO  4- 
7100,  extension  580.  


ASK  BLUE  SHIELD 


• • • ABOUT  MEDICARE 


The  following  information  was  excerpted  from  an  important  communication  on  custodial  care  received 
from  the  Social  Security  Administration. 

Physician  and  Hospital  Responsibilities 

In  order  for  an  extended  care  facility  to  provide  the  care  a patient  needs,  it  must  know  promptly  at 
admission  what  the  condition  of  the  patient  is  and  what  treatment  it  is  expected  to  provide.  At  the  same 
time,  the  patient  and  the  facility  need  to  know  whether  Medicare  will  pay  for  the  services.  In  doubtful 
cases  there  is  a need  for  prompt  decisions  on  coverage.  Otherwise,  denial  of  a claim  may  mean  a patient 
owes  a large  sum  that  is  likely  to  cause  a serious  problem  to  him  and  the  facility.  This  possibility  exists 
when  the  level  of  care  is  not  clearly  covered  and  the  facility  furnishes  the  intermediary  with  only  the  in- 
formation required  by  the  regular  billing  procedures.  Thus,  in  doubtful  cases,  the  procedure  outlined  in 
Section  V should  be  employed.  (Section  V has  to  do  with  certain  forms  to  be  sent  to  Blue  Cross,  as  inter- 
mediary, by  the  extended  care  facility.) 

The  attending  physician  customarily  plans  in  advance  for  the  needs  of  his  patient,  including,  where 
appropriate,  transfer  from  a hospital  into  an  extended  care  facility.  The  hospital  can  and  should  aid  in 
this  planning  process.  In  the  case  of  such  a transfer,  the  preferred  approach  to  the  provision  of  patient 
care  information  is  as  follows: 

A.  While  the  patient  is  in  the  hospital,  a medical  information  summary  may  be  prepared  which  would 
include  physician  s orders  for  the  patient’s  care  in  the  facility,  a profile  of  the  patient’s  condition,  and 
the  services  expected  to  be  needed. 

B.  This  summary  should  be  submitted  by  the  hospital  to  the  facility  prior  to  the  time  of  the  transfer  of 
the  patient. 

C.  If  the  summary  is  to  be  incorporated  into  a form,  it  may  be  incorporated  into  a standard  form 
agreed  to  by  the  intermediary  and  the  providers  of  service.  (Blue  Cross  is  developing  such  a form 
which  will  be  delivered  to  extended  care  facilities). 

When  this  information  has  not  been  submitted  in  advance  as  indicated  above,  alternate  approaches 
should  be  used  to  supply  the  needed  information.  In  every  instance,  good  patient  care  requires  the  extend- 
ed care  facility  to  have  available  by  the  time  of  admission,  in  writing,  the  required  patient  care  informa- 
tion. The  written  data  may  in  some  instances  be  preceded  by  telephone  orders  which  would  make  possi- 
ble advance  preparation  for  care. 

The  State  agency,  the  intermediary,  and  the  extended  care  facility  should  do  all  they  can  to  encourage 
hospitals  to  transfer  this  medical  information  to  the  facility  by  the  time  of  admission. 


ANNOUNCEMENT 

The  Civil  Service  Commission  will  enroll  fed- 
eral employees  in  Illinois  Blue  Shield’s  superior 
“Usual  and  Customary”  program  efiFective  Jan- 
uary 1,  1969. 

Until  then,  federal  employees  in  the  state  will 
continue  to  be  protected  by  Blue  Shield’s  indem- 
nity certificate. 


NOTICE 

To  help  speed  Medicare  payments,  physicians 
in  the  counties  of  Cook,  DuPage,  Kane,  Lake 
and  Will  may  obtain  a supply  of  SSA  1490  Re- 
quest for  Payment  forms  with  their  name  im- 
printed on  them  by  writing  to  Government  Con- 
tracts Division,  Blue  Cross-Blue  Shield,  300 
North  State  Street,  Chicago,  Illinois  60690. 


(This  is  not  an  advertisement) 


f 

That’s  why  Abbott  offers 
you  a pill  plus  a program. 


The  Product 


For  smooth  appetite 
control  plus  mood 
elevation 


DESOXYKGradumet 

Methamphetamine  Hydrochloride 
in  Long-Release  Dose  Form 


5 mg.  10  mg.  15  mg. 


For  patients  who  can’t  DESBUTAL  10  Gradumet 

take  plain  amphetamine  10  mg.  Methamphetamine  Hydrochloride, 

60  mg.  Sodium  Pentobarbital 


FRONT  SIDE 


DESBUTAL  15  Gradumet 

15  mg.  Methamphetamine  Hydrochloride, 

90  mg.  Sodium  Pentobarbital 


FRONT  SIDE 


The  Program 


Weight  Control  Booklet 


Specifically  written  to  help  your  patients  under- 
stand why  they  are  overweight,  and  what  they  can 
do  about  it.  The  booklet  stresses  the  importance  of 
changing  lifelong  eating  habits  and  explains  how  this 
can  be  done,  sensibly,  comfortably — and  perma- 
nently. There  is,  also,  a comprehensive  list  of  foods 
showing  their  caloric  content. 


inf 

rmttroflinff 
tfnirr  trcifjftt 


Food  Diary 


Designed  to  help  the  overweight  patient  follow 
your  eating  instructions.  Space  is  provided  for 
breakfast,  lunch,  supper,  and  even  snacks.  By  writ- 
ing down  everything  that’s  eaten  each  day,  the 
patient  is  constantly  reminded  that  she’s  trying  to 
change  her  eating  habits.  And  you  are  furnished 
with  a written  record  of  how  well  she’s  doing. 


Picture  Menu  Booklet 


Please  see  Brief  Summary 
on  next  page. 


A large  (10"  x 10")  booklet  which  features  appetiz- 
ing lunch  and  dinner  menus  for  every  day  of  the 
week.  The  meals  are  depicted  in  full  color  and  the 
correct  portion  size  so  that  the  dieter  can  see  the 
amount  of  food  that’s  recommended.  Patients  are 
pleasantly  surprised  to  learn  that  each  day’s  meals 
add  up  to  only  1,000  calories.  eoi444 


Ask  Your  Abbott  Man  For  Free  Supplies 


Brief  Summary 
DESOXYN®Gradumef 

Methamphetamine  Hydrochloride 
in  Long-Release  Dose  Form 

DESBUTAI!  10  Gradumet 

10  mg.  Methamphetamine  Hydrochloride, 

60  mg.  Sodium  Pentobarbital 

DESBUTAL 15  Gradumet 

15  mg.  Methamphetamine  Hydrochloride, 

90  mg.  Sodium  Pentobarbital 

Indications:  Desoxyn  and  Desbutal 
are  used  orally  as  appetite  suppres- 
sants, for  reduction  of  mild  mental 
depression,  and  to  help  in  manage- 
ment of  psychosomatic  complaints 
or  neuroses.  Desoxyn,  when  ad- 
ministered parenterally,  may  be 
used  as  a vasopressor  agent  or  ana- 
leptic. 

Contraindications:  Methampheta- 
mine (in  Desoxyn  and  Desbutal) 
is  contraindicated  in  patients  tak- 
ing a monoamine  oxidase  inhibitor. 
Do  not  use  pentobarbital  (in 
Desbutal)  in  persons  hypersensi- 
tive to  barbiturates. 

Precautions,  Side  Effects:  Observe 
caution  in  patients  with  hyperten- 
sion, cardiovascular  disease,  hyper- 
thyroidism, old  age,  or  those 
sensitive  to  sympathomimetic 
drugs.  Prolonged  usage  may  lead 
to  tolerance  or  psychic  dependence. 
Careful  supervision  is  necessary  to 
avoid  chronic  intoxication  and 
drug  dependence. 

Amphetamine  side  effects  such 
as  headache,  excitement,  agitation, 
palpitation  or  cardiac  arrhythmia 
usually  may  be  controlled  by  re- 
ducing the  dose.  Paradoxically- 
induced  depression  is  an  indication 
to  withdraw  the  drug.  Pentobarbi- 
tal (in  Desbutal)  may  cause  skin 
rash.  Nervousness  or  ex- 
cessive sedation  with 
Desbutal  is  often  transient. 


NEW 

PHARMACEUTICAL 
SPECIALTIES 
by  Paul  deHaen 


For  detailed  information  regarding  indica- 
tions, dosage,  contraindications,  and  adverse 
reactions,  refer  to  the  manufacturer’s  package 
insert  or  brochure. 

Single  Chemicals — Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products — Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products — Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms — Of  a previously  introduced 
product. 


DUPLICATE  SINGLE  PRODUCTS 

DYNAPEN  Antibiotic-Penicillin  R 

Manufacturer:  Bristol  Laboratories 

Nonproprietary  Name:  Sodium  Dicloxacillin 

Monohydrate 

Indications:  Infections  due  to  penicillinase-pro- 
ducing staphylococci,  streptococci,  pneumococ- 
ci, and  also  penicillin-sensitive  staphylococci. 

Contraindications:  Hypersensitivity  to  penicillin. 

Dosage:  Adults  and  children  over  88  lbs. — 125  to 
250  mg.  q6h.  Children  under  88  lbs. — 12.5  to 
25  mg. /kg. /day  in  divided  doses,  q6h. 

Supplied:  Capsules — 125  and  250  mg.,  bottles  of 
24  and  100.  Powder  for  Oral  Suspension — 62.5 
mg./ 5 cc.,  bottles  of  80  cc. 

MYOCON  Granucaps  Vasodilator-Coronary  R 

Manufacturer:  S.J.  Tutag  Company 

Nonproprietary  Name:  Nitroglycerin 

Indications:  Management  of  angina  pectoris.  Not 
intended  for  immediate  relief  of  anginal  at- 
tacks. 

Contraindications:  Early  myocardial  infarction, 
severe  anemia,  glaucoma,  increased  intracra- 
nial pressure. 

Dosage:  One  capsule  ql2h.,  may  be  increased  to 
q8h.  For  oral  use,  not  sublingual. 

Supplied:  Capsules,  sustained  release — 2.5  mg. 


COMBINATION  PRODUCTS 


GOURMASE  Enzyme-Digestive  R 

Manufacturer:  Rowell  Laboratories 
Composition:  a-amylase  20  mg. 

Pepsin  150  mg. 

Pancreatin  525  mg. 

Ox  bile  extract  100  mg. 


Indications:  Digestive  disturbances  due  to  over- 
eating, age,  illness,  surgery,  pregnancy,  or  ner- 
vous indigestion. 

Contraindications:  Hypersensitivity  to  any  of  the 
ingredients. 

Dosage:  1 to  2 capsules  tid,  with  meals. 

Not  for  children  under  6 yrs. 

Supplied:  Capsules — bottles  of  100,  500,  and  1,000. 

(Continued  on  page  246) 


801444 


224 


Illinois  Medical  Journal 


In 

TllCr  ulcer: 

antacid 


solved  by 

Mylanta 

aluminum  and  mt  magnesium  hydroxides  p/us  simethicone 


Will  it  ease  the  pain?' 

Mylanta  helps  relieve  ulcer  pain  with  the  two  most  widely 
prescribed  antacids:  aluminum  and  magnesium  hydroxides. 

win  it  help  gassy  stomach''? 

Mylanta  a/so  contains  simethicone:  for  concomitant  relief 
of  G.l.  gas  distress. 

'Will  this  one  taste  O.  K.?" 

The  prolonged  acceptance  of  Mylanta  was  recently 
confirmed  in  87.5%  of  104  patients -after  a total  of  20,459 
documented  days  of  therapy  .*  *Danhof,  I.  E.:  Report  on  file. 


I 

,1 


Composition:  Each  Mylanta  chewable  tablet  or  teaspoonful 

(5  ml.)  contains:  magnesium  hydroxide,  200  mg.;  aluminum  hydroxide, 

dried  gel,  200  mg.;  simethicone,  20  mg.  Dosage:  One  or  two  tablets  (well 

chewed  or  allowed  to  dissolve  in  the  mouth)  or  one 

or  two  teaspoonfuls  to  be  taken  between  meals  and  at  bedtime. 


Division/Pasadena,  Calif. 

\TLAS  CHEMICAL  INDUSTRIES,  INC. 


for  September,  1968 


225 


2.  V, 


Editor 

T.  R.  Van  Dellen,  M.D. 

Managing  Editor 
Richard  A.  Ott 


Executive  Administrator 

Roger  N.  White 

Director  of  Business  Services 
Roland  I.  King 


STAFF 


Medical  Progress  Editor 

Harvey  Kravitz_,  M.D. 

Publications 

jACOii  E.  Reisch,  M.D., 

Chairman 

J.  Ernest  Breed,  M.D. 

Editorial 

Edwin  F.  Hirsch,  M.D. 

Chairman 

James  H.  Hutton,  M.D. 

Samuel  A.  Levinson,  M.D. 


Advertising  Manager 
John  A.  Kinney 

Committee 

Darrell  H.  Trumpe,  M.D. 
Warren  W.  Young,  M.D. 
Board 

Charles  Mrazek,  i\ED. 
Clarence  J.  Mueller,  M.D. 
Frederick  Steigmann,  M.D. 
Frederick  Stenn,  M.D. 
Arkell  M.  Vaughn,  A ED. 


ILLINOIS  state  medical  SOCIETY 


360  N.  Michigan  Ave.,  Chicago,  Illinois  60601 


OFFICERS 

Philip  G.  Thomsen,  President 

13826  Lincoln  Avenue,  Dolton,  60419 

Edward  W.  Cannady,  President-Elect 

4601  State  Street,  East  St.  Louis,  62205 

Casper  Epsteen,  1st  Vice-President 
25  E.  Washington  St.,  Chicago,  60602 

Carl  E.  Clark,  2nd  Vice-President 

225  Edward  Street,  Sycamore,  60178 


TRUSTEES 

Frank  J.  Jirka,  Chairman 

1507  Keystone  Ave.,  River  Forest,  60305 

Joseph  L.  Bordenave,  1st  District 

1665  South  Street,  Geneva,  60134 

William  A.  McNichols,  Jr.,  2nd  District 
101  W.  First  Street,  Dixon,  61021 

William  E.  Adams.  3rd  District 

55  E.  Erie  Street,  Chicago,  60611 

J.  Ernest  Breed,  3rd  District 

55  E.  Washington  Street,  Chicago,  60602 

James  B.  Hartney,  3rd  District 

410  Lake  Street,  Oak  Park,  60302 

Frank  J.  Jirka,  3rd  District 

1507  Keystone  Ave.,  River  Forest,  60305 

William  M.  Lees,  3rd  District 
7000  N.  Kenton  Ave.,  Lincolnwood,  60646 

Warren  W.  Young,  3rd  District 
10816  Parnell  Ave.,  Chicago,  60628 

226 


Jacob  E.  Reisch,  Secretary-Treasurer 
1129  South  2nd  Street,  Springfield,  62704 

Maurice  M.  Iloeltgen,  Speaker 

1836  AYest  87th  Street,  Chicago,  60620 

Paul  W.  Sunderland,  Vice-Speaker 

216  N.  Sangamon  Street,  Gibson  City, 
60936 


Paul  P.  Youngberg,  4lh  District 

1520  7th  Street,  Moline,  61265 

Darrell  H.  Trumpe,  5th  District 

St.  John’s  Sanatorium,  Springfield,  62700 

J.  Alather  Pfeiffenberger,  6th  District 

State  &:  Wall  Streets,  Alton,  62004 

Arthur  F.  Goodyear,  7th  District 
142  E.  Prairie  Avenue,  Decatur,  62523 

Win.  H.  Schowengerdt,  8th  District 

301  E.  University  Avenue,  Champaign, 
61821 

Charles  K.  Wells,  9th  District 

117  N.  10th  Street,  Mt.  Vernon,  62824 

Willard  C.  Scrivner,  10th  District 

4601  State  Street,  East  St.  Louis,  62205 

Josenh  R.  O’Donnell,  11th  District 

444  Park,  Glen  Ellyn,  60137 

Newton  DuPuy,  Trustee-at-Large 

1842  Grove  Ave.,  Quincy,  62301 


Illinois  Medical  Journal 


“Corporate  practice  o£  medicine”— that 
may  sound  like  too  high-blown  an  expres- 
sion to  alarm  us. 

But  alarm  us  it  does— because  it  threat- 
ens the  right  of  the  physician  to  be  his  own 
man,  his  own  guide.  We  must  battle  any 
effort  by  hospitals  to  dominate  our  pro- 
fessional and  economic  lives  . . . our  ties 
to  our  patients. 

Just  what  is  the  nature  of  this  battle, 
though?  In  recent  months  it  has  changed. 

’We  felt,  at  first,  that  we  faced  a chal- 
lenge from  the  Illinois  Hospital  Associa- 
tion. But  conferences  with  IHA  have  been 
fruitful  in  eliminating  any  organized  de- 
sire to  expand  salaried  hospital  practice. 

Now  a real  and  growing  threat  to  the 
continued  independence  of  physicians  is 
from  individual  hospitals  with  full-time 
paid  staffs  . . . primarily  teaching  hospitals. 
Many  of  these  institutions  seek  to  draw 
on  Medicare/Medicaid  funds  under  their 
own  billing  and  fee-payment  setup  . . . 
and  put  the  money  into  a corporate  “slush 
fund.” 

Medicare  fees  for  a physician’s  services, 
of  course,  are  intended  for  him,  not  the 
hospital.  To  get  around  this  obstacle,  the 
teaching  hospitals  might  simply  put  an  ad- 
ministrative physician’s  name  on  the  bill 
. . . make  it  seem  that  he  had  performed 
the  service. 

Needless  to  say,  such  a subterfuge  raises 
a tax  question  for  the  doctor  whose  name 
appears  on  the  bill  . . . and  a question  of 
legal  responsibility  for  the  patient’s  care. 


Philip  C.  Thomsen,  M.D. 

The  whole  ruse  clearly  would  violate  a 
report  given  the  AMA  annual  convention 
last  year  and  declaring,  in  part: 

“Fees  for  professional  medical  services 
are  properly  paid  only  to  the  responsible 
physicians  and  may  not  be  appropriated 
by  any  other  person  or  agency.” 

This  report  spelled  out  acceptable  ways 
in  which  staffs— inclnding  men  with  private 
practice  as  well  as  salaried  doctors  and  fac- 
ulty—could  coordinate  fees.  As  a whole  or 
by  department,  the  staff  could  form  its  own 
group  which  “would  collect,  control  and 
disburse  all  income  generated  by  its  ac- 
tivities. Disbursement  would  be  according 
to  a plan  previously  agreed  upon.” 

To  make  sure  that  any  collective  billing 
at  the  University  of  Illinois  hospitals  would 
follow  such  a plan,  your  society  was  in- 
strumental in  getting  the  General  Assembly 
last  year  to  pass  House  Bill  No.  25. 

We  must  be  vigilant  and  active  to  pre- 
vent other  teaching  hospitals  from  using 
Medicare  as  a road  to  corporate  practice. 
We  must  encourage  medical  staffs  to  fol- 
low the  AMA— and  UI— formulas.  A court 
challenge  of  some  of  the  subterfuges  may 
be  in  order. 

For  corporate  practice— like  federal  con- 
trol—would  deprive  us  of  our  essential 
liberties. 


for  September,  1968 


231 


by  two  independent  national  research  organizations 


Finally.. .a  salicylate 
superior  to  aspirin? 

Not  at  all,  Doctor...but 

mogon 

(magnesium  salicylate,  W-T) 

should  be  considered  for  your  arthritic 

and  rheumatic  patients  who  cannot  tolerate  aspirin. 

Surveys  * made  in  1 966  and  1 967  among  private  practice 
physicians  showed  an  incidence  of  intolerance  to  aspirin 
ranging  from  3-85%.  The  majority  of  physicians  surveyed 
reported  an  intolerance  in  10-30%  of  their  patients. 

How  does  this  compare  with  your  experience? 


« 


WARREN-TEED  PHARMACEUTICALS  INCORPORATED 

COLUMBUS,  OHIO  43215 

SUBSIDIARY  OF  ROHM  AND  HAAS  COMPANY 


The  estrogen  component  in  MEDIATRIC  is  PREMARIN®  (conjugated  estrogens-equine),  the 
orally  active,  natural  estrogen  so  widely  prescribed  for  its  physiologic  and  metabolic  benefits. 
The  combination  of  estrogen  and  methyltestosterone  can  help  maintain  anabolic 
balance  to  forestall  premature  degenerative  changes  related  to  estrogen  deficiency. 
MEDIATRIC  also  supplies  a small  amount  of  methamphetamine  HC I to  provide  a gentle 
mood  uplift,  and  nutritional  supplements  specially  selected  to  meet  the  needs  of  the  aging. 


contraindication:  Carcinoma 
of  the  prostate,  due  to 
methyltestosterone  component. 
warning:  Some  patients  with 
pernicious  anemia  may  not  respond 
to  treatment  with  the  Tablets  or 
Capsules,  nor  is  cessation  of  response 
predictable.  Periodic  examinations 
and  laboratory  studies  of  pernicious 
anemia  patients  are  essential  and 
recommended. 

SIDE  effects:  In  addition 


to  withdrawal  bleeding,  breast 
tenderness  or  hirsutism  may 
occur. 

SUGGESTED  DOSAGES:  Male  and 
female— I Tablet  or  Capsule,  or  3 
teaspoonfuls  Liquid,  daily  or  as 
required. 

In  the  female:  To  avoid  continuous 
stimulation  of  breast  and 
uterus,  cyclic  therapy  is  recom- 
mended (3  week  regimen  with  1 
week  rest  period— Withdrawal 


bleeding  may  occur  during  this 
1 week  rest  period). 

In  the  male:  A careful  check  should 
be  made  on  the  status  of  the  prostate 
gland  when  therapy  is  given  for 
protracted  intervals. 
supplied:  No.  752— MEDIATRIC 
Tablets,  in  bottles  of  100  and  1,000. 
No.  252— MEDIATRIC  Capsules,  in 
bottles  of  30,  100,  and  1,000. 

No.  910— MEDIATRIC  Liquid,  in 
bottles  of  16  fluidounces. 


Each 

MEDIATRIC 
Tablet  or 
Capsule 
contains: 

Each  15  cc. 

(3  teaspoon  fuls) 
of  MEDIATRIC 
Liquid 
contains: 

Conjugated  estrogens-equine  (PREMARIN®) 

0.25  mg. 

0.25  mg. 

Methyltestosterone 

2.5  mg. 

2.5  mg. 

Methamphetamine  HCl 

1 .0  mg. 

1 .0  mg. 

Cyanocobalamin 

2.5  meg. 

1 .5  meg. 

Intrinsic  factor  concentrate 

8.0  mg. 

— 

Thiamine  HCl 

— 

5.0  mg. 

Thiamine  mononitrate 

10.0  mg. 

— 

Riboflavin 

5.0  mg. 

— 

Niacinamide 

50.0  mg. 

— 

Pyridoxine  HCl 

3.0  mg. 

— 

Calcium  pantothenate 

20.0  mg. 

— 

Ferrous  sulfate  exsiccated 

30.0  mg. 

— 

Ascorbic  acid 

100.0  mg. 

(Contains 
15%  alcohol!) 
fSome  Loss 
Unavoidable 

Mediabic  tablets  • capsules  • liquid 

Steroid-nutritional  compound 


AYERST  LABORATORIES  . New  York,  N.  Y.  10017  . Montreal,  Canada 


6837 


for  September,  1968 


245 


New  Pharmaceutical  Specialties 

(Continued  from  page  224) 


GOURMASE-PB  Enzyme-Digestive  R 

Manufacturer;  Rowell  Laboratories 
Composition:  a-amylase  20  mg. 

Pepsin  150  mg. 

Pancreatin  525  mg. 

Ox  bile  extract  100  mg. 

Phenobarbital  15  mg. 

Belladonna  15  mg. 


Indications:  Digestive  disturbances  due  to  over- 
eating, age,  illness,  surgery,  pregnancy,  or 
nervous  indigestion  associated  with  tension 
and/or  pain  due  to  gas  formation. 

Contraindications:  Acute  glaucoma,  advanced 
renal  or  hepatic  disease,  biliary  tract  obstruc- 
tion, or  hypersensitivity  to  any  of  the  ingredi- 
ents. 

Dosage:  One  capsule  with  each  meal. 

Supplied:  Capsules — bottles  of  100,  500,  and  1,000. 

SYNOPHYLATE-GG  Syrup  Bronchial  Dilator  R 

Manufacturer:  Central  Pharmacal  Company 

Composition:  Each  15  cc.  contains:  Theophylline 
sodium  glycinate  300  mg. 

Glyceryl  guaiacolate  10#  mg. 

Indications:  Symptomatic  treatment  of  bronchial 
asthma  and  other  bronchospastic  conditions. 

Contraindications:  Hypersensitivity  to  any  of  the 
ingredients. 

Dosage:  Adults — 1 to  2 tbsp.,  q4-8h.  Children  6- 
12  yrs. — 2 to  3 tsp.,  q4-8h.  Children  rmder  6 
yrs. — 1/4  to  Vz  tsp./lO  lbs.  body  wt.,  q4-8h. 

Supplied:  Bottles  of  4 oz.,  1 pint,  and  1 gallon. 

TELGRA  Diagnostic-Pregnancy 

Manufacturer:  S.F.  Durst  & Co.,  Inc. 


Composition:  Ethisterone  50  mg.  Ethinyl  estradi- 
ol 0.03  mg. 

Indications:  Differential  diagnosis  of  pregnancy 
and  functional  amenorrhea. 

Contraindications:  Carcinoma  of  the  breast  or 
female  reproductive  organs. 

Dosage:  One  tablet  qid,  for  3 days. 

Supplied:  Tablets-bottles  of  12. 

NEW  DOSAGE  FORMS 

MACRODANTIN  Antibacterial-Urinary 

Manufacturer:  Eaton  Laboratories 

Nonproprietary  Name:  Nitrofurantoin  macro- 
crystals 

Indications:  Infections  of  the  genitourinary  tract, 
i.e.  pyelonephritis,  pyelitis,  cystitis,  and  pro- 
statitis due  to  susceptible  organisms,  as  shown 
by  culture  and  sensitivity  testing. 

Contraindications:  Anuria,  oliguria,  hypersensi- 
tivity to  the  drug,  pregnancy  at  term,  infants 
imder  one  month  of  age,  nursing  mothers. 

Dosage;  100  mg.  qid,  with  meals,  for  10-14  days, 
for  individuals  of  less  than  average  size:  5-7 
mg./kg./24  hrs.  in  4 divided  doses,  not  to  ex- 
ceed 400  mg. /day. 

Supplied:  Capsules — 50  and  100  mg.,  bottles  of 
3#,  100,  and  500. 

TINACTIN  Powder  Fungicide-Topical  R 

Manufacturer:  Schering  Corporation 

Nonproprietary  Name:  Tolnaftate 

Indications:  Fungous  infections  of  intertriginal 
and  other  naturally  moist  skin  areas  in  which 
drying  may  enhance  the  therapeutic  response. 

Contraindications:  None  mentioned. 

Dosage;  Apply  locally  twice  a day  for  2 to  3 
weeks,  alone  or  adjimctively  with  Tinactin  so- 
lution of  cream. 

Supplied:  Powder — 1%,  45  gm.  plastic  container. 


iMgg|gipgiii 


APPLICATION  FOR  TIRM  tire  INSURANCE 
to  PROreSSIONAL  Lire  & CASUALTY  COMPANY,  CHICAGO,  ILLINOIS 


MC 


1.  Full  Name  of  Applicant. 
Date  of  Krth 


2.  Height- 


Mo. 

_!LWeight_ 


5.  PERMAN£NT_ 
MAtUNG 
ADDRESS:. 


' *..X - 

Day  Year 

3.  O Male,  Q Female 

4.  Q Married, 

City 

D Single,  Q Divorced,  O 

^ ^ ‘ " r ...  “ ' 

Street  Address 



State 

Nol  of  Yrs. 

Nome 

City  & State 

■ ' ' ' ' . . . ~ 

6.  Medical  School: 


Date  Entered  Medical  School. 


7.  AMOUNT  OFJNSURANCE:  10  YEAR  CONVERTIBLE*  TERM  OR  15  YEAR  CONVERTIBIE*  TERM 

a $10,000.00  O $iow.oo 

□ $20,000.00  □$20,000.00 

*Conyeritbh  to  porHapating  Whole  life  Insurance  of  any  time  prior  to  the  end  of  the  Term  period. 

9.  DISPOSITION  OF  ANNUAL  DIVIDENDS:  O Pdy  tn  Cosh  O Accumulate  ot  Interest  O Apply  to  Premium  " - 


:"Tb*Bendiliiry:MS»  

' ’ " ' 

Nome  in  Full 

11:  Do  yOuAnow  of  ony  Impairment  nOVV  existing:  in  yoM**  health  or  physical  condition?  Yes 

Refotkmshijp  x.,  ' 

No , |f  "yes**^  ^ye  partifutors 

12.  Have  you  consulted  a physician  for  illness  during  the  p«st  three'  years?  Yes No 

, If  "yes^^  g?w  pnrtic^oi^S  - . > 

Tin/I  ,r.m  , 

INFORMATION  in  this  application  is  given  to  obtain  this  insuronce  ond  is  true  and  complete  to  the  best  of  my-  knovdedge  and  belief.  The  Company 
iriraf  no,  obligation  because  of  this  opplicotion  unless  and  until  it  is  approved  fay  the  Company  andjhe  Rrs|^premlum-d^  poid  in  full  vdiile  my 
^health  or  other  conditions  affecHng  my  insurobillty  ore  as  described  In  the  application.  ^ 

- ' - Sinnature  of  Aw^dlcdnt'''^^ 


Dot 


iStart  your  program  of  insurance  protection  today,  white  premiums  are  low  with  a Term>Life  Plan 
that  meets  today's  needs  with  a protective  look  towards  the  future. 

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sh^  m^le  a cairew  of  the  iffe  and  dis-  q ‘participating  plan'  whid>  means 

insurance  needs  of  members  of  the  y^y  participate  in  annua!  divkiends  to'  policy^ 

medioai  community  tntrodut^s  its  new  holders.  You  may  elect  to  have  your  Annual 

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■velo{>ed  for  students,  interns  and  resjd^ts  ypy,.  annual  premium  or  accumulated  at 

who  aiB  commencing  a career  in  the  medical  interest  (see  itwi  9 of  application). 

'profession. 

LOW,  PIXEO  ANNUAL  PREMIUM 

This  plan  is  designed  for  maximum  protection  t-  * ^ ^ 

‘with  a rKiminaf  premium  you  can  afford,'  prior  Annual  is  your  age 

is  nrArtiirtU/ck  oarnirm  ot  ISSU6  (oesrest  birthday)  and  remains  the 

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<rhe  low  annual  premium  provides  a level  changed  by  die  Company. 

non-decreasing  coverage 

protection  and  benefit  of  your  family  and  You  may  select  either  $10,(XX)  or  $20,000  of 

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or  terminated  by  the  Company. 


GUARANTEE  CONVERSION 

Your  term  policy  may  be  converted  to  our 
Participating  Whole  Life  Plan  at  any  time, 
during  tite  pcdicy  period  without  any  restric- . 
dons  or  limitadons, 

THE  IMPORTANCE  OF  CONVERSION 
TO  PLC's  PARTICIPATING  WHOLE 
UFE  PLAN 

Your  Term  Plan  guarantees  you  the  right  to 
obtain  PLC's  participating  Whole  Life  Plan 
which  has  been  rated  the  No.  1 "low  net 
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The  rating  was  based  on  comparisons  with 
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similar  plans  issued  by  the  ICO  lowest  'net 
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Professional  Life  & Casitalty  Company 


HOME  OFFICE:  720  N.  Michigan  Ave.,  Chicago,  tlHnols  60611 


CHAIRMAN-Edwin  S.  Hamilton,  M.D. 
PRESfDENT-Edward  L.  Compere,  M.D, 
GENERAL  MANAGER  & ACTUARY- 
Norman  R,  B.  King 

ASSOC,  MED.  0!R,-E.  Clinton  Texter,  Jr.,  M.D. 


—Premiums  for  $20,000  Policy  are  double  the  above 
rates 

—Premiums  for  Ages  not  shown  will  be  provided  on 
request 


Now  we  have  a Term- Life  Plan 
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GUARANTEED  CONVERTIBLE 
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$33.00  $17.00 

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35.bd: 

36.00 

18.50 

'i 

35.^:; 

/:;ld5d 

19.00 

aem 

37.50 

19.50 

36J^ 

,:38,50 

20,00 

' 37'M'I 

19.50 

40,00 

21.00 

37.50: 

-fMjoo. 

22.00 

Primary  Source  of  Surfactant 
Found  by  Chicago  Scientist 


The  primary  source  for  production  of  the 
substance  which  keeps  300  million  small 
air  spaces  in  the  lung  from  collapsing  is  a 
group  of  cells  never  before  thought  to  be 
involved  in  the  process. 

According  to  the  scientist  at  The  Uni- 
versity of  Chicago  who  made  the  discovery, 
the  production  of  that  lung-coating  sub- 
stance, surfactant,  can  now  be  studied  and 
surfactant  itself  may  perhaps  eventually  be 
controlled. 

Dr.  Albert  H.  Niden,  Associate  Professor 
of  Medicine,  said  that  surfactant  has  been 
implicated  in  hyaline  membrane  disease 
in  newborn  infants.  “It  has  been  fairly  well 
accepted,  but  not  established,”  he  said, 
“that  not  enough  surfactant  is  produced  in 
infants  suffering  from  this  disease.” 

Dr.  Niden’s  finding  offers  a new  oppor- 
tunity to  explore  the  role  of  this  pulmon- 
ary substance  in  hyaline  membrane  dis- 
ease. A reduction  in  surfactant  activity  has 
been  found  in  every  pulmonary  pathologic 
condition  in  which  it  has  been  studied.  Dr. 
Niden  said.  A decrease  in  surfactant  pro- 
duction has  been  implicated  as  causing 
lung  collapse  in  such  other  conditions  as 
pneumonia,  pulmonary  emboli  or  blood 
clots,  and  respiratory  insufficiency. 

Nature  Known  10  Years 

The  role  of  the  phospholipid  substance 
in  healthy  lungs  has  been  known  for  about 
10  years,  according  to  Dr.  Niden,  although 
its  exact  nature  was  unknown. 

Until  Dr.  Niden's  discovery,  surfactant 
was  considered  to  be  produced  primarily  in 
the  cells  around  the  small  air  spaces,  or 
alveoli.  “This  assumption,”  he  said,  “was 
made  because  globules  of  lipid,  presum- 
ably surfactant,  were  seen  to  be  ‘secreted’ 
by  these  cells.  By  radioactive  tracing  we 
now  know  that  these  globules  viewed  in 
nonliving  specimens  were  actually  in  the 
process  of  being  engulfed  rather  than  se- 
creted.” 


The  main  source  of  the  substance,  he 
said,  is  really  the  Clara  cells  lining  the 
terminal  airways  of  the  lungs. 

Dr.  Niden  began  his  research  project, 
which  is  sponsored  by  the  U.S.  Public 
Health  Service,  with  the  belief  that  the 
Clara  cells  in  the  bronchial  tree  were  likely 
candidates  for  production  of  surfactant. 

Doubts  Importance  of  Substance 

To  check  his  hypothesis,  he  spent  three 
years  tracing  carbon  particles  and  radio- 
active fatty  acids  in  the  lung  using  an 
electron  microscope.  By  injecting  radioac- 
tive fatty  acids  into  mice  and  then  fixing 
sections  of  lung  samples  over  a period  of 
time,  he  traced  the  path  of  surfactant  pro- 
duction from  the  Clara  cells  to  the  lung 
lining  and  into  the  large  alveolar  epithe- 
lial cells  which  absorbed,  or  phagocytized, 
the  substance. 

While  Dr.  Niden  is  currently  experi- 
menting on  control  of  surfactant  and  the 
possibility  of  stimulating  its  production,  he 
has  some  doubts  as  to  the  importance  of 
this  substance  in  disease. 

“Previous  experiments  which  have  im- 
plicated surfactant  in  disease  are  not  com- 
pletely reliable,”  he  said.  “For  example, 
animal  lungs  have  been  washed  out  to  ob- 
tain surfactant  which  was  then  tested  on  a 
surface  tension  balance.  The  results  showed 
the  substance  to  be  decreased  in  almost  any 
disease  state  of  the  lungs.  However,  the 
decrease  may  well  follow  the  illness  rather 
than  be  its  cause.  By  the  same  token,  the 
mucous  and  edema  occurring  in  many  dis- 
eases may  inhibit  surfactant  activity  or  by 
blocking  the  small  air  space  may  prevent 
adequate  extraction  by  lung  washings,  thus 
reducing  the  quantity  extracted.” 

Pinning  the  production  source  down 
now  offers  an  opportunity  to  study  directly 
the  role  of  surfactant. 


248 


Illinois  Medical  Journal 


Illinois  Medical  Journal 


volume  134,  number  3 


September,  1968 


Primary  Pulmonary  Sporotrichosis 

In  Illinois 

A Case  Report 

First  epidemiological  link  to  Spagnum  Moss 

By  William  H.  McCain,  M.D.,  and  Walter  F.  Buell,  M.D. /Quincy 


Pulmonary  infection  due  to  Sporotri- 
chum  shenkii  in  the  absence  of  cutaneous 
involvement  has  been  encountered  rarely. 
The  recent  case  report  by  Cruthirds  and 
Patterson^  is  believed  to  be  the  nineteenth 
on  record.  Although  the  more  common 
lymphocutaneous  form  of  sporotrichosis  has 
been  found  related  to  sphagnum  moss  by  a 
number  of  epidemiologic  studies,  recently 
reviewed  by  D’Alessio,  et  al.,^  no  similar  re- 
lationship has  been  noted  in  the  cases  with 
primary  pulmonary  involvement.  The 
present  case  is  submitted  as  the  twentieth 
primary  pulmonary  case  of  sporotrichosis 
and  the  first  to  be  epidemiologically  linked 
to  sphagnum  moss. 


Case  Report 

The  patient,  a 59-year-old,  white,  service 


William  H.  McCain,  M.D.  is  Medical  Direc- 
tor of  the  Hillcrest  Sanitorium  and  the  Adams 
County  Health  Department.  He  received  his 
M.D.  from  the  University  of  Kansas  and  served 
his  interneship  and  residency  at  St.  Louis  City 
Hospital. 

Walter  F.  Buell,  M.D.,  is  Medical  Epidemi- 
ologist, Epidemic  Intelligence  Service,  National 
Communicable  Disease  Center,  assigned  to  the 
Illinois  Department  of  Public  Health,  Spring- 
field.  He  received  his  M.D.  from  the  Univer- 
sity of  Texas  and  served  his  post  M.D.  train- 
ing at  the  University  of  Pittsburgh  Health  Cen- 
ter Hospitals. 


station  operator  was  first  admitted  to  Hill- 
crest  Sanatorium,  Quincy,  on  Nov.  21, 
1964.  Approximately  one  month  prior  to 
admission  he  had  entered  another  hospital 
for  an  elective  surgical  procedure.  At  that 
time  he  had  lost  30  pounds  from  his  pre- 
vious weight  of  180  pounds.  He  described 
a gradual  loss  of  weight  beginning  in  the 
spring  of  1964.  During  the  hospitalization 
a persistent  fever  was  noted,  and  a chest 
x-ray  suggested  pulmonary  inflammation; 
he  admitted  a chronic  cough.  In  the  ab- 
sence of  improvement  on  an  antibiotic 
regimen,  a bronchoscopic  exam  was  per- 
formed. Bronchial  washings  were  reported 
positive,  by  smear,  for  acid  fact  bacilli,  and 
a tuberculin  skin  test  was  positive.  He  was 
then  transferred  to  Hillcrest  Sanatorium 
with  a diagnosis  of  active  tuberculosis,  and 
therapy  was  begun  with  streptomycin  and 
isoniazid.  His  temperature  returned  to  nor- 
mal within  one  week  and  he  began  to  im- 
prove generally.  Over  the  next  6 months 
continued  improvement  was  noted  on  anti- 
tuberculous therapy,  and  chest  x-rays 
cleared  considerably  (Fig.  1).  Sputum  cul- 
tures, including  cultures  of  the  smear-posi- 
tive bronchial  washings,  were  never  posi- 
tive for  M.  tuberculosis.  He  was  discharged 
on  May  27,  1965. 

On  November  29,  1966,  he  was  re-ad- 
mitted for  evaluation  of  persistent  pulmo- 


for  September,  1968 


255 


nary  infiltrate.  The  chest  x-ray  showed  in- 
creased infiltrate,  compared  with  films  o£ 
the  previous  admission.  Tuberculin  and 
histoplasmin  skin  tests  were  positive.  Spu- 
tum culture  for  tubercle  bacilli  was  nega- 
tive; a serologic  test  for  histoplasmosis  re- 
vealed a yeast  phase  complement  fixation 
titer  of  1.8.  Fungus  culture  of  sputum  on 
May  26,  1967,  was  positive  for  Sporotri- 
chum  shenkii,  and  five  subsequent  speci- 
mens were  positive.  The  patient  denied  any 
history  of  chronic  skin  lesions  typical  of 
cutaneous  sporotrichosis.  Treatment  with 
saturated  solution  of  potassium  iodide  was 
initiated,  and  continued  until  discharge  on 
October  11,  1967.  During  this  period,  spu- 
tum cultures  remained  positive  for  S.  sen- 
kii  despite  symptomatic  improvement  and 
weight  gain.  Following  discharge  he  was 
to  have  further  evaluation  of  the  pulmo- 
nary sporotrichosis  by  his  private  physician. 
Chest  x-rays  taken  during  this  second  ad- 
mission are  shown  in  Fig.  2. 

Epidemiologic  Investigation 

The  patient  has  been  a resident  of  west- 
ern Illinois  and  Missouri  for  the  past  30 
years.  His  occupation  during  this  period 
has  been  oil  refinery  and  service  station 
work.  Although  he  related  hobbies  of  hunt- 
ing and  fishing,  he  denied  outdoor  activi- 
ties of  this  type  since  1960.  He  had  never 
worked  in  a nursery  or  florist  shop.  He 


clearly  recalled  contact  with  peat  moss  on 
two  distinct  occasions,  one  of  which  was 
in  1935.  In  the  fall  of  1963  he  purchased 
a 50-pound  bag  of  peat  moss  at  a grocery 
store  in  Jefferson  City,  Mo.  Part  of  this 
moss  was  spread  over  his  lawn  in  the  spring 
of  1964.  Subsequently,  following  separation 
from  his  wife,  he  moved  to  Illinois  in  the 
summer  of  1964.  He  brought  with  him  the 
remainder  of  the  peat  moss  which  was 
given  to  a cousin  in  Quincy.  The  remainder 
of  the  moss  was  used  by  the  patient’s 
cousin. 

The  source  of  the  peat  moss  was  traced 
from  the  grocery  store  in  Jefferson  City. 
The  manager  of  the  store,  who  had  held 
his  position  for  over  10  years,  related  the 
specific  brand  of  the  moss  and  the  supply 
agent.  This  was  traced  to  the  peat  com- 
pany whose  product  in  1963  came  from  only 
two  peat  bogs  in  Michigan.  It  was  noted 
that  one  of  these  bogs  contains  sphagnum 
moss,  which  could  therefore  have  been  in- 
cluded in  the  commercial  peat  moss  prod- 
uct. 

Mycologic  studies  of  the  soil  in  the  yard 
of  the  patient’s  cousin,  who  had  spread  the 
moss  three  years  previously,  were  negative 
for  S.  shenkii.  Due  to  the  extended  interval 
between  the  patient's  contact  with  moss  and 
the  investigation,  no  mycologic  studies  with 
material  from  the  peat  bogs  were  at- 
tempted. 


FIG.  1;  A Case  of  Pulmonary  Sporotrichosis  in  Illinois:  Chest  X-ray  at  the  Beginning 
and  End  of  First  Hospital  Admission. 

Admission  Discharge 


256 


Illinois  Medical  Journal 


‘ v~-.  ; - 


Discussion 

The  lymphocutaneous  form  of  sporo- 
trichosis has  commonly  aroused  the  inter- 
est of  epidemiologists.  Because  of  the  na- 
ture of  S.  shenkii  and  its  transmission,  a 
determined  investigation  almost  always  un- 
earths an  explanation  for  the  presence  of 
the  fungus  in  a given  lesion.  The  discov- 
ery that  sphagnum  moss  is  an  important 
factor  in  the  chain  of  infection  has  added 
still  another  avenue  of  attack. 

Although  direct  inhalation  has  been  sus- 
pected to  be  the  mode  of  transmission'^  of 
primary  pulmonary  sporotrichosis,  no  clear- 
cut  reservoir  has  been  implicated.  The  ex- 
treme rarity  of  the  disease,  combined  with 
the  chronicity  and  difficulty  in  diagnosis, 
are  all  significant  limiting  factors  in  the 
understanding  of  the  mechanism  of  trans- 
mission. 

Table  1 lists  pertinent  epidemiologic 
factors  from  previous  case  reports.  A com- 
parison of  these  factors  is  not  fruitful,  since 
most  reports  were  concerned  with  the  diag- 
nosis and  treatment  of  this  rare  disease 
rather  than  the  transmission  of  the  fungus. 
Nevertheless,  several  of  the  cases,  especially 
case  16  (the  florist),  may  well  have  con- 
tacted sphagnum  moss  and  thereby  inhaled 
the  fungus. 

The  present  case  is  thought  to  be  the 
first  primary  pulmonary  sporotrichosis  case 
linked  to  sphagnum  moss.  Although  the 


FIG.  2:  A case  of  Pulmonary  Sporotrichosis 
End  of  Second  Hospital  Admission. 
Admission 


link  is  somewhat  tenuous,  due  to  the  length 
of  time  between  initial  exposure  and  cul- 
ture diagnosis,  the  lucidity  of  the  history 
given  by  this  patient  seems  to  clearly  place 
his  handling  of  peat  moss  in  the  period  im- 
mediately prior  to  the  first  manifestations 
of  his  illness.  Information  obtained  from 
the  patient,  who  had  extremely  good  re- 
call of  events,  indicated  that  the  period  in 
the  spring  of  1964  following  the  breakup 
of  his  family  was  a trying  time  for  him. 
The  evidence,  obtained  from  the  distribu- 
tors of  the  commercial  product,  that  sphag- 
num moss  was  indeed  present  in  one  of 
the  two  bogs  from  which  the  product  was 
harvested  serves  to  corrobrate  and  strength- 
en the  theory  of  the  relationship. 

Summary 

A case  of  primary  pulmonary  sporotri- 
chosis is  described  in  a 59-year-old,  Illinois, 
service  station  operator.  Epidemiologic  evi- 
dence implicates  the  source  of  infection  as 
a commercial  peat  moss  product  containing 
sphagnum  moss. 

References 

1.  Cruthirds,  T,  P.,  and  Patterson,  D.  O.,  Pri- 
mary Pulmonary  Sporotrichosis,  Journal  of  Res- 
piratory Diseases,  (May  1967)  p.  845 

2.  D’Alessio,  D.  J.,  Leavens,  L.  J.,  Strumpf,  G.  B., 
and  Smith,  C.  D.,  An  Outbreak  of  Sporotri- 
chosis in  Vermont  Associated  with  Sphagnum 
Moss  as  the  Source  of  Infection,  New  Eng.  ].  of 
Med.,  272:  1054-1058,  1965 

in  Illinois:  Chest  X-ray  at  Beginning  and 


Discharge 


for  September,  1968 


257 


3.  Ridgeway,  N,  A.,  Whitcomb,  F.  C.,  Erickson, 
E.  E.,  Law,  S.  “W.,  Primary  Pulmonary  Sporo- 
trichosis, Am.  J.  of  Med.,  32,  153-160,  1962 

4.  Scott,  S.  M.,  Peasley,  E.  D.,  Crymes,  T.  P.,  Pul- 
monary Sporotrichosis,  New  Eng.  J.  of  Med., 
265,  453-457,  1961 

5.  Siegrist,  H.  D.,  Ferrington,  E.,  Primary  Pul- 
monary Sporotrichosis,  Sou.  Med.  J.,  58,  728-735, 
1965 


6.  Trevathan,  R.  D.,  Phillips,  S.,  Primary  Pul- 
monary Sporotrichosis,  JAMA,  195,  965-967, 
1966 

7.  Smith,  D.  T.,  The  Chest,  edited  by  Myers  and 
McKinlay,  Charles  C.  Thomas,  publisher, 
Springfield,  111.,  p.  262,  1948 


Table  1 

A Summary  of  Reported  Cases  of  Primary  Pulmonary  Sporotrichosis 


1. 

I 

— 

— 

— 

— 

— 

2. 

11 

40 

F 

— 

— 

— 

3. 

III 

— 

— 

— 

tobacco  buyer 

— 

4. 

IV 

— 

— 

— 

— 

— 

5. 

V 

34 

F 

— 

— 

— 

6. 

VI 

— 

— 

— 

Pharmacist 

worked  with  tobacco  leaves 

7. 

VII 

— 

— 

— 

— 

— 

8. 

VIII 

57 

M 

— 

— 

— 

9. 

IX 

11 

M 

— 

— 

— 

10. 

X 

10 

F 

— 

— 

— 

11. 

XI 

50 

M 

— 

— 

— 

12. 

XII 

— 

— 

— 

farmer 

— 

13. 

Ridgeway,  et 

al.3 

35 

M 

White 

brick  mason 

illness  probably  began  in  1939  while 
patient  in  Washington  state 

14. 

Ridgeway,  et 

al.3 

30 

M 

Negro 

beer  truck  worker 

hunted  & fished  2-3  times  monthly  in 
southwest  Louisiana 

15. 

Scott,  et  al.4 

26 

M 

— 

x-ray  technician 

— 

16. 

Scott,  et  al.4 

42 

M 

Negro 

florist 

17. 

Siegrist  & 

— 

Ferrington^ 

43 

M 

White 

salesman  for  salt  co. 

worked  on  Florida  tomato  ranch  for 
3 mo.,  otherwise  worked  in  Miss,  as 
salesman  or  service  station  attendant 

18. 

Trevathan  & 
Phillips® 

40 

M 

White 

salesman 

lived  in  urban  communities,  two  deer- 
hunting trips  prior  to  onset 

19. 

Cru  thirds  & 

Pattersoni 

61 

M 

White 

heavy  equipment 

— 

operator 

Information 

on  cases 

1-12  taken  from  review  by  Ridgeway,  et  al.  3 

Abortion  in  Japan 

The  enactment  of  the  Eugenic  Protection  Act  in  Japan  was  followed  by 
many  changes.  The  population  explosion  was  stemmed,  the  birth  rate  was 
halved,  and  while  the  marriage  rate  remained  steady  the  divorce  rate  de- 
clined. The  annual  total  of  abortions  increased  until  1955  and  then  slowly 
declined.  The  highest  incidence  of  abortions  in  families  is  in  the  30  to 
34  age  group  when  there  are  four  children  in  the  family.  As  elsewhere 
abortion  in  advanced  stages  of  pregnancy  is  associated  with  high  morbidity 
and  mortality. 

There  is  little  consensus  as  to  the  number  of  criminal  abortions.  Reasons 
for  criminal  abortions  can  be  found  in  the  legal  restrictions  concerning 
abortion;  licensing  of  the  abortionist,  certification  of  hospitals,  taxation 
of  operations  and  the  requirement  that  abortion  be  reported.  Other  factors 
are  price  competition  and  the  patient’s  desire  for  secrecy. 

Contraception  is  relatively  ineffective  as  a birth  control  method  in  Japan. 
Oral  contraceptives  are  not  yet  government  approved.  In  1958  alone  1.1 
per  cent  of  married  women  were  sterilized  and  the  incidence  of  steriliza- 
tion was  increasing.  (Legalized  Abortion  in  Japan.  Thomas  M.  Hart, 
Calif.  Med.  (Oct.)  1967;  pg.  334). 


258 


Illinois  Medical  Journal 


An  Outbreak  of  Histoplasmosis  in  Illinois 
Associated  with  Starlings 

By  Robert  M.  Younglove,  M.D.,  Richard  M.  Terry,  M.D., 
Norman  J.  Rose,  M.D.,  Russell  J.  Martin,  D.V.M.,  M.P.H. 

AND  Paul  R.  Schnurrenberger,  D.V.M.,  M.P.H. 


The  organism  Histoplasma  capsulatiim 
was  first  isolated  in  1906,  from  the  spleens 
of  three  patients  who  had  succumbed  to 
the  infection;^  however,  it  was  1934  before 
a human  case  was  diagnosed  prior  to  death^ 
and  the  organism  cultured  and  identified 
as  a fungus.^  Fifteen  years  elapsed  before 
the  first  isolation  of  H.  capsulatum  from 
a non-animal,  environmental  source;  Em- 
mons^ in  1949  recovered  the  organism  from 
soil  collected  from  around  a rodent  bur- 
row under  a chicken  coop. 

H.  capsulatum  is  a natural  inhabitant  of 
the  soil  and  thrives  in  areas  contaminated 
with  avian  excreta.  The  organism  is  gen- 
erally believed  to  be  transmitted  to  man 
from  the  natural  environment,  and  the 
clinical  picture  appears  to  be  affected  by 
the  frequency  and  degree  of  exposure  to 
infection.  For  years  this  fungal  infection  of 
the  lungs  has  occurred  in  individuals  who 


have  been  associated  with  caves,^  storm 
cellars,®  or  silos^^  whose  soils  were  contami- 
nated with  the  organism.  Also,  infections 
have  occurred  in  individuals  who  recently 
have  cleaned  abandoned  chicken  houses®-® 
bell  towers,!®  water  towers^!  or  church  bel- 
fries!2  inhabited  by  birds.  Any  of  these  lat- 
ter situations  provide  a large  volume  of 
bird  droppings,  an  excellent  medium  for 
the  growth  of  the  fungus.  Persons  working 
in  these  confined  areas  get  infected  by 
breathing  dust  with  large  numbers  of  H. 
capsulatum  spores. 

More  recently  there  have  been  histoplas- 
mosis outbreaks  under  markedly  different 
circumstances.  Individuals  involved  in  these 
outbreaks  have  been  exposed  in  open  areas, 
and  the  bird  implicated  has  been  the  star- 
ling {Sturnus  vulgaris) This  report 
describes  such  an  epidemic  which  occurred 
in  a northwestern  Illinois  city  of  16,000. 


Robert  M.  Younglove,  M.D.  (left)  is  a general  practitioner  in  Kewanee,  111.  He  received  his  pre- 
med  training  at  Valparaiso  Univ.  and  his  M.D.  from  the  Chicago  Medical  School.  He  served  his 
internship  at  Englewood  Hospital,  Chicago.  He  is  president  of  the  Kewanee  Board  of  Health. 
Richard  M.  Terry,  M.D.  (not  pictured)  is  a general  practitioner  in  Kewanee.  Norman  J.  Rose, 
M.D.,  (second  from  left)  is  assistant  chief  of  the  Division  of  Preventive  Medicine,  Illinois  De- 
partment of  Public  Health,  Springfield.  He  is  a graduate  of  the  Northwestern  University  Medi- 
cal School  and  served  his  residency  at  West  Suburban  Hospital,  Oak  Park.  Dr.  Rose  holds 
the  M.P.H.  from  the  University  of  Minnesota.  Russell  J.  Martin,,  D.V.M.,  M.P.H.,  is  a Regional 
Public  Health  Veterinarian.  At  the  time  of  this  study  Dr.  Martin  was  assigned  to  the  Illinois 
Dept,  of  Public  Health  from  the  National  Communicable  Disease  Center.  His  D.V.M.  is  from 
Texas  A & M with  the  M.P.H.  from  the  University  of  Michigan.  Paul  R.  Schnurrenberger, 
D.V.M.,  M.P.H.  (right)  is  from  the  Div.  of  Preventive  Medicine,  Illinois  Dept,  of  Public  Health. 
He  is  the  Chief  Public  Health  Veterinarian.  He  received  his  M.P.H.  from  the  University  of  Pitts- 
burg and  is  an  assistant  professor  at  the  University  of  Illinois  and  the  University  of  Missouri 
Medical  School. 


for  September,  1968 


259 


LOCATION  OF  SOIL  COLLECTIONS  FROM  SUSPECT  PREMISES;  ILLINOIS 
HISTOPLASMOSIS  OUTBREAK  — 1963 


0 — Negative  Soil  Sample 
X --  Positive  Soil  Sample 


GARAGE 


Fig.  1 


DURATION  OF  ILLNESS  AND  EXPOSURE  TO  SUSPECT  PREMISES 
IN  AN  ILLINOIS  HISTOPLASMOSIS 
OUTBREAK 


S fi7R9ini?'^4S 


JULY 

1 2 I AS  fi  7 R 1 23,4  5 6 7 8 9 10  1 2 3 4 5 6 7 8 9 20  1 2 3 


X --  Present 
- Ill 


Table  1 


260 


Illinois  Medical  Journal 


History 

The  epidemic  reported  here  centers 
around  a 50-year-old  home  (Fig.  1)  that 
was  undergoing  remodeling.  The  house 
was  purchased  by  Family  D in  the  spring, 
and  remodeling  began  in  early  June.  On 
various  dates  members  o£  the  neighboring 
household,  Family  M,  assisted  Family  D 
with  the  work.  Also,  at  times  friends  and 
commercial  laborers  were  present  at  the 
work  site. 

Part  of  the  remodeling  procedure  in- 
volved removal  of  an  old  back  porch  and 
the  construction  of  a new  enlarged  porch 
on  the  same  site.  Dates  of  the  various  acti- 
vities and  the  individuals  that  were  present 
on  these  dates  are  listed  in  Table  1. 

The  initial  case  (E.D.)  was  in  an  eight- 
year-old  white  male  who,  on  June  15,  pre- 
sented with  malaise,  103°F.  temperature, 
headache,  pallor,  fatigue,  severe  chills  and 
night  sweats  (Table  2).  He  lost  8 pounds 
during  the  three-week  illness  and  a con- 
valescent serum  sample  titered  1:256 
against  the  yeast  phase  of  H.  capsulatum 
in  the  complement  fixation  text  (CFT). 
He  was  not  skin  tested  with  histoplasmin. 

Three  days  later,  the  father  (R.D.)  of 
this  patient,  a forty-year-old  executive,  had 
a sudden  onset  of  illness  with  severe  chills, 
extreme  exhaustion,  a fever  of  103.4°F., 
anorexia,  night  sweats,  and  tightness  in  the 
chest.  A radiograph  taken  on  the  second 
day  of  illness  revealed  multiple  vague  loca- 
lized areas  of  increased  opacity  in  both 
lungs.  These  varied  in  size,  from  5 mm.  in 
diameter  upward.  Very  few  were  clear-cut 
or  distinct.  Although  the  patient  had  a 
positive  tuberculin  test,  it  was  the  opinion 
of  the  radiologist  that  the  findings  were 
not  due  to  active  tuberculosis.  The  histo- 
plasmin skin  test  was  positive,  and  a con- 
valescent serum  collected  from  the  patient 
titered  1:64  (CFT).  The  patient  lost  ap- 
proximately 5 pounds  during  his  one  month 
illness. 

R.D.’s  eleven-year-old  daughter  (A.D.) 
developed  a headache,  fever  of  102.4°F., 
general  malaise,  light  chills,  and  sweating 
on  the  same  evening  that  her  father  be- 
came ill.  She  also  complained  of  a mild 
abdominal  discomfort.  The  patient  did  not 
react  to  tuberculin;  however,  a positive 
reaction  was  noted  against  the  standard 
histoplasmin  skin  antigen.  A radiograph 
taken  in  approximately  the  fifth  week  of 


illness  showed  minimal  lesions  in  the  lower 
part  of  one  lung.  A routine  radiograph  of 
this  patient  taken  five  years  earlier  had 
shown  numerous  discrete  calcifications  in- 
volving portions  of  all  lobes  of  both  lung 
fields  which  were  believed  to  have  been 
due  to  histoplasmosis. 

Twelve  persons  were  clinically  ill  dur- 
ing the  course  of  the  outbreak  (Table  2). 
Ten  of  these  individuals  had  been  involved 
in  remodeling  the  old  house  purchased  by 
the  D Family.  Interview  of  these  persons 
revealed  that  June  14  was  the  only  day 
all  the  persons  who  got  sick  had  been  pres- 
ent at  the  house  (Table  1).  On  June  14 
the  children  (A.D.,  E.D.,  S.B.,  C.W.,  T.S., 
J.M.),  had  removed  the  wreckage  of  the 
back  porch,  which  had  been  torn  down  on 
the  13th,  and  disposed  of  it  by  burning  or 
dumping  it  into  an  old  cistern.  Adults 
(R.D.,  P.D.,  E.H.,  E.B.)  dug  the  footings 
for  the  new  porch  on  this  date.  The  other 
two  clinical  cases  (M.M.  and  B.M.),  oc- 
curred in  the  wife  and  daughter  of  E.M. 
In  addition  to  living  next  door  to  the  sus- 
pect house,  these  two  individuals  had 
laundered  clothing  worn  by  J.M.  and  E.M. 
during  the  remodeling  operations  June  14. 

There  were  seven  other  persons  (E.M., 
C.P.,  S.M.,  G.D.,  two  carpenters,  one  elec- 
trician) who  had  either  direct  or  indirect 
exposure  at  the  house  (Table  1).  Skin  tests 
performed  on  three  (E.M.,  S.M.,  G.D.)  of 
these  persons  were  positive.  Blood  samples 
collected  from  two  of  these  persons  (E.M., 
S.M.),  were  reactive  to  the  complement  fixa- 
tion test  for  Histoplasma.  No  tests  were 
performed  on  the  other  four  persons. 
Two  of  these  were  carpenters,  one  was 
an  electrician,  and  the  fourth  was  a con- 
tractor (C.P.).  The  two  carpenters  were 
not  present  on  June  14.  These  two  in- 
dividuals and  the  electrician  also  had 
been  working  inside  the  house  and  thus 
had  not  been  in  direct  contact  with  the 
back  porch  area.  The  contractor  worked  at 
construction  sites  constantly  and  might  be 
expected  to  have  some  immunity  to  histo- 
plasmosis from  previous  exposures. 

A visit  was  made  to  the  residence,  and 
soil  samples  were  collected  from  eight  spots 
(Fig.  1).  The  soil  samples  were  split  and 
one-half  of  each  sample  was  examined  by 
the  laboratories  of  the  Illinois  Department 
of  Public  Health.  The  other  half  was  ex- 
amined at  National  Institute  of  Allergy 
and  Infectious  Diseases  through  the  court- 


/or  September,  1968 


261 


SUMMARY  OF  CLINICAL  AND  DIAGNOSTIC  FINDINGS 
Illinois  Histoplasmosis  Outbreak 
1963 


PATIENT 

R.D.  C.W.  P.D.  T.S.  S.B.  J.M.  A.D.  E.D.  E.B.  E.H.  M.M.  B.M. 


Fever 

103^ 

105^ 

104® 

105 

103 

+ 

102^ 

104^ 

1038 

103® 

102® 

Fatigue 

+ 

-t- 

+ 

-f- 

+ 

+ 

+ 

+ 

+ 

+ 

Chills 

+ 

+ 

+ 

-1- 

+ 

+ 

+ 

+ 

Chest 

Pain 

+ 

+ 

+ 

+ 

-1- 

+ 

+ 

Malaise 

+ 

+ 

+ 

+ 

+ 

+ 

+ 

+ 

Pallor 

+ 

+ 

+ 

+ 

+ 

+ 

+ 

Weight 

Loss 

+ 

+ 

+ 

+ 

+ 

+ 

+ 

Sweating 

+ 

+ 

+ 

+ 

+ 

+ 

Headache 

+ 

+ 

+ 

+ 

+ 

+ 

Anorexia 

+ 

-t- 

+ 

+ 

+ 

+ 

-t- 

Cough 

+ 

+ 

+ 

+ 

+ 

Weakness 

+ 

+ 

+ 

+ 

Tight 

Chest 

+ 

+ 

+ 

Sore 

Throat 

+ 

+ 

Vomiting 

+ 

+ 

Dizziness 

+ 

Sore  Eyes 

+ 

Reciprocal 
of  CF 
Titer 
(Yeast 
Phase) 

64 

32 

512 

128 

512 

256 

128 

256 

ND 

ND 

128 

64 

Radiograph 

+ 

ND 

+ 

+ 

ND 

+ 

+ 

ND 

ND 

+ 

+ 

ND 

Skin  Test 

+ 

ND 

ND 

ND 

ND 

+ 

+ 

ND 

ND 

ND 

+ 

+ 

ND=  Not  Done 

Table  2 


esy  of  Dr.  C.  W.  Emmons,  Chief,  Medical 
Mycology  Section,  National  Institute  of  Al- 
lergy and  Infectious  Diseases.  The  findings 
from  the  two  laboratories  were  identical. 
Histoplasma  capsulatum  was  isolated  from 
only  the  two  samples  collected  under  a tree 
in  the  backyard.  This  particular  tree,  a 
large  elm,  had  been  the  favorite  roost  of 
starlings  in  that  part  of  town  for  a number 
of  years.  The  tree  shaded  the  back  porch. 

There  was  no  similar  illness  in  other 
residents  of  the  city  during  the  period  of 
the  outbreak. 


Comments 

Epidemiologic  evidence  certainly  incri- 
minates the  remodeling  operation  as  the 
precipitating  factor  in  this  epidemic.  The 
accumulation  of  starling  droppings 
around  the  area  of  the  old  back  porch  pro- 
vided adequate  medium  for  the  growth  of 
the  fungus.  The  clean-up  operation  and 
digging  activities  on  June  14  created  the 
dusty  environment  conducive  to  the  trans- 
portation of  the  Histoplasma  capsulatum 
spores  into  the  victims’  lungs. 


262 


Illinois  Medical  Journal 


The  onset  dates  (Table  1)  suggest  the 
possibility  of  three  different  exposure  peri- 
ods. Patients  E.D.,  A.D,  and  R.D.  became 
ill  within  a three-day  period  (June  15-18). 
All  three  individuals  were  present  at  other 
remodeling  operations  (June  2-June  13) 
and  thus  may  have  been  exposed  earlier. 
There  is  strong  evidence  that  six  (P.D., 
J.M.,  S.B.,  C.W.,  T.S.,  E.H.)  of  the  active 
cases  obtained  their  infections  on  June  14. 
These  six  individuals  became  ill  June  27 
or  June  28.  Cases  M.M.  and  B.M.  laundered 
clothing  on  June  22  that  had  been  worn 
on  June  14;  therefore,  their  probable  expo- 
sure date  was  actually  June  22.  E.B.  was 
not  a resident  of  the  city;  therefore,  it  was 
difficult  to  obtain  exact  details  surround- 
ing his  illness.  Family  D related  that  they 
experienced  an  illness  clinically  similar  to 
those  described  earlier  in  this  report  and 
that  his  onset  of  illness  was  July  19.  If  his 
illness  was  histoplasmosis  it  is  difficult  to 
explain  the  long  incubation  period  associ- 
ated with  his  illness,  unless  E.B.  also  ob- 
tained infection  from  contaminated  fomites 
(for  example,  dirty  clothing  worn  June  14). 

Undoubtedly,  H.  capsulatum  can  be 
found  in  many  other  similar  areas  in  Illi- 
nois. These  microfoci  of  infection  are  po- 
tentially dangerous  only  if  they  contain 
large  numbers  of  H.  capsulatum  spores  and 
if  the  area  is  disturbed  sufficiently  to  pro- 
duce a suspension  of  the  organism  in  the 
air.  When  used  as  described  by  Tosh^®, 
formaldehyde  will  decontaminate  the  sur- 
faces of  these  areas  for  practical  purposes. 
This  procedure  will  rid  the  top  three  to 
four  inches  of  soil  of  demonstrable  H.  cap- 
sulatum organisms.  Usually  the  major  lim- 
iting factor  in  the  use  of  this  particular  tech- 
nique is  the  size  of  the  area  to  be  treated. 
If  the  area  is  large,  the  cost  of  materials 
may  prohibit  the  use  of  this  method. 

Investigation  of  this  particular  outbreak 
of  histoplasmosis  demonstrates  the  effec- 
tiveness of  a team  approach  to  certain 
health  problems.  A prompt  and  accurate 
diagnosis  followed  by  rapid  reporting  on 
the  part  of  the  attending  physician  enabled 
public  health  agencies  to  contribute  early 
epidemiologic  assistance.  The  public  health 
laboratory  conducted  complement  fixation 
tests  using  the  sera  collected  from  the  pa- 
tients. These  results  confirmed  the  attend- 
ing physician’s  diagnoses  and  also  supplied 
valuable  information  to  the  epidemiologist. 
Soil  culture  services  furnished  by  the  labor- 


atory provided  proof  that  H.  capsulatum 
organisms  were  present  at  the  remodeling 
site.  Thus,  many  facets  of  an  epidemic  situ- 
ation can  be  tied  together  when  contribu- 
tions are  made  by  several  interested  disci- 
plines. 

References 


1.  Darling,  S.T.:  A Protozoan  General  Infection 
Producing  Pseudotubercles  in  the  Lungs  and 
Focal  Necrosis  in  the  Liver,  Spleen  and  Lymph 
Nodes.  JAMA  46:1283,  1906. 

2.  Dodd,  K.  and  Tomkins,  E.H.:  Histoplasmosis 
of  Darling  in  an  Infant.  Amer.  J.  Trop.  Med. 
14:127,  1934. 

3.  DeMonbreun,  W.A.:  Cultivation  and  Cultural 
Characteristics  of  Darling’s  Histoplasma  cap- 
sulatum. Amer.  J.  Trop.  Med.  14:93,  1934. 

4.  Emmons,  C.W.:  Isolation  of  Histoplasma  cap- 
sulatum from  Soil.  Public  Health  Reports. 
64:892,  1949. 

5.  Washburn,  A.M.,  Tuohy,  J.H.,  and  Davis,  E.L.: 
Cave  Sickness:  A New  Disease  Entity?  A.J.P.H. 
38:1521,  1948. 

6.  Cain,  J.C.,  Devins,  E.J.,  and  Downing,  J.E.:  An 
Unusual  Pulmonary  Disease.  Arch.  Int.  Med. 
79:626,  1947. 

7.  Grayston,  J.T.,  Loosli,  C.G.,  and  Alexander, 
E.R.:  The  Isolation  of  Histoplasma  capsulatum 
from  Soil  in  an  Unusued  Silo.  Science.  114:323, 
1951. 

8.  Idstrom,  L.G.,  and  Rosenberg,  B.:  Primary 

Atypical  Pneumonia.  Bull.  U.S.  Army  M.  Dept. 
81:88,  1944. 

9.  Grayston,  J.  T.,  and  Furcolow,  M.L.:  The  Oc- 
currence of  Histoplasmosis  in  Epidemics— Epi- 
demiological Studies.  A.J.P.H.,  43:665,  1953. 

10.  Nauen,  R.,  and  Korns,  R.F.:  A Localized  Epi- 
demic of  Acute  Miliary  Pneumonitis  Associ- 
ated with  the  Handling  of  Pigeon  Manure. 
Paper  read  at  the  Annual  Meeting  of  the 
APHA  (Oct.),  1944. 

11.  Feldman,  H.A.,  and  Sabin,  A.B.:  Pneumonitis 
of  Unknown  Etiology  in  a Group  of  Men  Ex- 
posed to  Pigeon  Excreta.  T.  Clin.  Investigation. 
27:533,  1948 

12.  Parrott,  T.,  Jr.,  Taylor,  G.,  Poston,  M.A.,  and 
Smith,  D.T.:  An  Epidemic  of  Histoplasmosis 
in  Warrenton,  North  Carolina.  Southern  Med. 
J.  48:1147,  1955. 

13.  Furcolow,  M.L.,  Tosh,  F.E.,  Larsh,  H.W.,  Lynch, 
H.J.,  Jr.,  and  Shaw,  G:  The  Emerging  Pattern 
of  Urban  Histoplosmosis:  Studies  on  an  Epi- 
demic in  Mexico,  Missouri.  New  England  J. 
Med.  264:1226,  1961. 

14.  D’Alessio,  D.J.,  Heeren,  R.H.,  Hendricks,  S.L., 
Ogilvie,  P.H.,  and  Furcolow,  M.L.:  A Starling 
Roost  as  the  Source  of  Urban  Epidemic  Histo- 
plasmosis in  an  Area  of  Low  Incidence.  Ameri- 
can Review  of  Respiratory  Diseases.  92:725, 
1965. 

15.  Tosh,  F.E.,  Doto,  I.L.,  D’Alessio,  D.J.,  Medei- 
ros, A.A.,  Hendricks,  S.L.,  and  Chin,  T.D.Y.: 
The  Second  of  Two  Epidemics  of  Histoplasmo- 
sis Resulting  From  Work  on  the  Same  Starling 
Roost.  American  Review  of  Respiratory  Dis- 
eases. 94:406,  1966. 

16.  Tosh,  F.E.,  Weeks,  R.J.,  Pfeiffer,  F.R.,  Hen- 
dricks, S.L.,  and  Chin,  T.D.Y.:  Clinical  Decon- 
tamination of  Soil  Containing  Histoplasma  cap- 
sulatum. American  Journal  of  Epidemiology. 
83:262,  1966. 


for  September,  1968 


263 


THE  VIEW  BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Diagnostic  Radiology,  Cook  County  Hospital, 
and  Clinical  Professor  of  Radiology,  Chicago  Medical  School 

This  6-year-old  boy  entered  the  hospital  with  chief  complaint  that  he  had  felt  a 
sudden  sharp  pain  in  his  left  knee  while  running.  Physical  examination  revealed  ten- 
derness in  the  region  of  the  proximal  tibia. 


Fig.  1 

What’s  your  diagnosis? 

1)  Eosinophilic  granuloma. 

2)  Enchondroma. 

3)  Eibrous  dysplasia. 

4)  Solitary  bone  cyst.  (Answer  on  page  309.) 


264 


Illinois  Medical  Journal 


Medical  Progress  in  the 
Use  of  Drugs  in  Pregnancy 


By  Roy  M.  Pitkin^  M.D. /Chicago 


It  has  long  been  recognized  that  vir- 
tually any  drug  administered  to  a 
pregnant  woman  is  actually  given,  for  good 
or  ill,  to  two  individuals.  However,  full 
realization  of  the  significance  of  this  con- 
cept has  only  come  recently,  largely  as  a 
result  of  the  thalidomide  disaster.  The 
widespread  publicity  attendant  upon  that 
particular  therapeutic  misadventure,  with 
its  results  as  dramatic  as  they  were  tragic, 
has  markedly  increased  the  level  of  aware- 
ness of  the  possible  harmful  effects  of  drugs 
in  pregnancy. 

Adverse  effects  of  drugs  in  pregnancy 
may  be  found  in  mother  or  fetus  or  both. 
Untoward  sequelae  in  the  mother,  when 
they  occur,  are  generally  the  result  of  toxic- 
ity of  the  particular  drug  enhanced  by 
the  physiological  alterations  of  pregnancy. 
An  example  of  this  type  of  reaction,  to  be 
considered  in  detail  later,  is  that  seen  with 
the  antibiotic  tetracycline.  Fetal  ill-effects 
may  be  either  of  two  types.  Certain  drugs, 
such  as  thalidomide,  when  administered 
during  the  critical  period  of  organogenesis, 
may  cause  a morphologic  abnormality  in 
the  developing  embryo  or  fetus.  The  second 
type  of  fetal  effect  consists  of  some  abnor- 
mality in  physiology  during  fetal  life  or 
after  birth  and  may  be  seen  as  the  result 
of  a drug,  such  as  a long  acting  sulfona- 
mide, given  in  late  pregnancy. 


Roy  M.  Pitkin,  M.D.,  is  from  the  Department 
of  Obstetrics  and  Gynecology,  University  of  Illi- 
nois at  the  Medical  Center.  He  is  a graduate  of 
the  University  of  Iowa  College  of  Medicine.  This 
paper  was  originally  presented  at  the  Annual  Con- 
vention of  the  Illinois  State  Medical  Society,  May 
21,  1968. 


Medical  Progress 


Harvey  Kravitz,  M.D. 
Medical  Progress  Editor 


The  present  report  consists  of  a review 
of  some  of  the  drugs  which  may  have  ill- 
effects  in  pregnancy  and  an  attempt  to  de- 
velop some  general  principles  regarding 
drug  therapy  in  the  pregnant  woman. 

It  is  first  necessary  to  say  something  about 
the  placenta  since  this  organ  represents  the 
portal  of  entry  for  all  agents  reach- 
ing the  fetus.  The  frequently-used  term 
“placental  barrier”  should  be  deleted  from 
our  vocabulary;  the  placenta  is  not  much 
of  a barrier,  at  least  to  the  agents  under 
discussion.  It  is  more  like  a sieve  and  in- 
deed, in  the  case  of  some  agents,  such  as 
ascorbic  acidh  it  seems  to  behave  like  a 
pump,  resulting  in  higher  concentrations 
on  the  fetal  side  than  on  the  maternal. 
Wffiile  it  is  true  that  some  drugs  and  chemi- 
cals, such  as  curare^,  do  not  traverse  the 
placenta  and  others,  such  as  insulin^,  are 
transported  to  only  a limited  degree,  the 
general  rule  is  that  most  drugs  adminis- 
tered to  a pregnant  woman  reach  her  fetus 
in  therapeutic  concentrations. 

Antimicrobial  Agents 

The  wide  use  of  antimicrobial  agents  for 
various  infectious  diseases  coincidental  with 
pregnancy  has  led  to  recognition  of  ma- 


for  September,  1968 


265 


ternal  or  fetal  complications  related  to 
several  drugs. 

Tetracycline  appears  to  be  associated  with 
adverse  effects  in  both  mother  and  fetus. 
Its  principal  fetal  effect  is  a brownish  or 
yellowish  discoloration  of  deciduous  teeth 
due  to  deposition  of  a tetracycline  fluores- 
cent complex.  Observations  in  premature 
infants  treated  with  tetracycline  and  ex- 
periments in  pregnant  rats^  suggest  that 
a similar  effect  in  growing  bone  may  re- 
sult in  abnormalities  of  skeletal  growth. 
It  should  be  noted  that,  from  the  fetal 
point  of  view,  the  critical  period  for  tetra- 
cycline damage  is  the  latter  half  of  gesta- 
tion, in  contrast  to  most  other  agents  which 
cause  fetal  ill-effects.  The  maternal  compli- 
cations seen  with  tetracycline  administra- 
tion are  related  to  fatty  infiltration  of  the 
liver,  a histologic  finding  in  many  preg- 
nant women  receiving  tetracycline^.  A 
number  of  maternal  deaths  have  occurred 
in  patients  given  high  doses  of  tetracycline 
intravenously  for  pyelonephritis  of  preg- 
nancy. Though  the  mechanism  is  not  pre- 
cisely understood,  it  seems  clear  that  the 
combination  of  pregnancy,  diminished  ren- 
al function,  and  tetracycline  is  potentially 
dangerous.  For  these  reasons,  tetracycline 
generally  should  be  avoided  in  pregnancy, 
particularly  in  late  pregnancy  and  in  pa- 
tients with  possible  renal  disease.  When 
used,  the  dose  should  not  exceed  one  gram 
per  day. 

Sulfonamides  readily  cross  the  placenta 
and  reach  therapeutic  concentrations  in  the 
fetus  where  they  compete  with  bilirubin 
for  binding  sites  on  serum  albumin®.  Thus, 
the  effect  may  be  an  increase  of  uncon- 
jugated bilirubin.  This  effect  is  most 
marked  when  long-acting  sulfonamides  are 
used.  Hyperbilirubinemia  constitutes  no 
threat  during  intrauterine  life  because  of 
placental  clearance  of  bilirubin,  but  a new- 
born infant  with  high  sulfonamide  levels 
from  previous  maternal  administration 
could  conceivably  be  at  risk  for  kernicterus. 
It  is  therefore  recommended  that  long-act- 
ing sulfonamides  be  avoided  in  pregnancies 
in  which  there  is  likely  to  be  impaired 
bilirubin  metabolism  in  the  newborn  in- 
fant. Examples  of  such  conditions  are 
erythroblastosis  fetalis  and  prematurity. 

Chloramphenicol  administered  to  pre- 
mature infants  appears  to  be  associated  with 
development  of  the  “gray  syndrome.”  How- 


ever, there  is  no  evidence  to  suggest  that 
it  has  any  ill-effects  when  it  reaches  the 
fetus  after  maternal  administration.  Bone 
marrow  depression  in  pregnant  women  re- 
ceiving chloramphenicol  appears  to  be  no 
more  frequent  than  in  non-pregnant  pa- 
tients. 

Penicillin  is  present  in  fetal  blood  in 
therapeutic  levels  following  maternal  ad- 
ministration. There  are  no  apparent  ill- 
effects  on  either  mother  or  fetus  associated 
with  its  use  in  pregnancy. 

Hormones  and  Related  Drugs 

Masculinization  of  the  external  genitalia 
of  a female  fetus  with  androgenic  sub- 
stances administered  during  pregnancy  has 
been  recognized  for  many  years.  With  the 
advent  of  synthetic  progestins  and  their 
recommended  use  by  some  in  threatened  or 
habitual  abortion,  a number  of  cases  have 
been  reported  in  which  the  prolonged  use 
of  oral  progestins  during  pregnancy  has 
been  associated  with  clitoral  enlargement 
and  fusion  of  the  labio-scrotal  groove^. 

The  use  of  corticosteroids  in  pregnancy 
has  been  subjected  to  considerable  scrutiny 
because  of  the  experimental  production  of 
cleft  palate  by  administration  of  cortisone 
to  rats  in  early  pregancy.  Careful  review 
of  human  pregnancies  in  which  cortisone 
was  given  during  the  time  before  palatal 
fusion  is  complete,  however,  has  not  sub- 
stantiated an  increased  incidence  of  palatal 
lesions  in  such  patients®.  Moreover,  there 
is  no  evidence,  experimental  or  clinical, 
linking  any  of  the  cortisone  analogs  (hydro- 
cortisone, prednisone,  triancinolone,  and 
dexamethasone)  with  congenial  malforma- 
tion in  the  fetus.  The  possibility  of  acute 
adrenal  insufficiency  in  an  infant  born  to 
a woman  on  long  term  corticosteroid  ther- 
apy, although  rarely  reported,  should  be 
borne  in  mind. 

Though  there  are  a few  if  any  adverse 
fetal  effects  of  maternal  thyroxine  admin- 
istration, probably  because  of  limited 
placental  permeability  of  the  hormone, 
iodine  has  been  implicated  as  a cause  of 
congenital  goiter  and  the  prolonged  use  of 
iodine-containing  substances  during  preg- 
nancy is  not  recommended®.  Congenital 
goiter  has  also  been  reported  in  infants 
whose  mothers  received  thiouracil  deriv- 
atives for  hyperthyroidism  during  preg- 
nancy. 


266 


Illinois  Medical  Journal 


Cancer  Chemotherapy  Drugs 

Antimetabolites  may  exert  profound  fetal 
effects  when  administered  during  the  period 
of  organogenesis.  Methotrexate  given  in 
early  pregancy,  for  example,  virtually  al- 
ways causes  either  abortion  or  serious  fetal 
malformation^^.  Alkylating  agents  appear 
to  be  less  teratogenic  in  humans,  but  con- 
genial anomalies  have  occurred  following 
their  use.  These  therapeutic  agents  are 
used  for  maternal  malignant  diseases  and 
are  therefore  rarely  indicated.  When  such 
an  indication  exists,  however,  it  usually 
takes  priority  over  possible  adverse  fetal 
effects. 

Anticoagulants 

Heparin  apparently  does  not  cross  the 
placenta  and  its  use  in  pregnancy  has  not 
been  associated  with  adverse  effects  on  the 
fetus  or  newborn^i.  Coumadin  derivatives, 
on  the  other  hand,  readily  traverse  the 
placenta  and  the  incidence  of  fetal  loss  in 
coumadin-treated  pregancy  is  approximate- 
ly twice  that  of  normal  patients.  It  has 
been  suggested  that  this  increased  loss  is 
related  to  excessive  dosage  but  some  authors 
have  reported  fetal  or  neonatal  death  due 
to  multiple  hemorrhages  which  occurred  in 
spite  of  careful  control  of  maternal  pro- 
thrombin levels^i. 

The  threat  of  postpartum  hemorrhage 
in  a patient  who  is  therapeutically  anti- 
coagulated is  not  nearly  as  great  as  might 
be  thought.  Hemostasis  in  the  uterus  after 
delivery  depends  to  a relatively  minor  de- 
gree on  the  coagulation  mechanism.  If 
excessive  bleeding  does  occur,  a patient 
anticoagulated  with  heparin  has  an  ad- 
vantage over  one  who  has  been  taking 
Coumadin  because  of  the  rapid  reversibil- 
ity of  the  former  with  protamine. 

Tranquilizers 

In  view  of  the  widespread  use  of  psy- 
chopharmacologic  agents  in  our  culture, 
it  is  rather  surprising  that  not  more  is 
known  of  their  effects  on  reproduction. 
Reserpine  administered  shortly  before  de- 
livery has  been  associated  with  a syndrome 
of  nasal  congestion,  lethargy,  and  brady- 
cardia in  the  newborn  infant^^.  The  pheno- 
thiazines,  which  have  a definite  incidence 
of  liver  toxicity  in  adults,  have  been  exon- 
erated with  regard  to  accentuation  of  neo- 
natal jaundice.  Meclizine  and  similar 
agents  have  been  reported  to  be  associated 


in  increased  incidence  of  fetal  malforma- 
tion in  laboratory  animals  but  no  such 
association  in  humans  has  been  demon- 
strated. 

Beyond  these  few  observations,  little  is 
known.  There  is,  however,  a general  feel- 
ing of  conservatism  in  regard  to  using  drugs 
of  this  type  in  pregnancy.  Such  conserva- 
tism is  undoubtedly  based  on  the  fact  that 
such  drugs  are  seldom  essential  or  life- 
saving and,  as  such,  is  sound.  It  should  not 
be  forgotten  that  thalidomide  was  original- 
ly introduced  for  this  type  of  indication. 

Summary 

With  this  admittedly  brief  review  of  the 
effects  of  some  pharmacologic  agents  on 
mother  and  fetus,  it  is  possible  to  summar- 
ize by  drawing  some  general  conclusions 
regarding  the  use  of  drugs  in  pregnancy. 

Firstly,  and  most  importantly,  before  ad- 
ministering any  drug  to  a pregnant  woman, 
one  must  consider  very  carefully  the  in- 
dication for  therapy  and  the  possible  bene- 
fit to  be  derived.  In  deciding  whether  to 
treat  a patient  with  threatened  abortion 
with  a synthetic  progestin,  for  example, 
possible  masculinization  of  a female  fetus 
is  really  rather  beside  the  point,  in  view  of 
well-controlled  studies^^  demonstrating  no 
increased  fetal  salvage  with  progestational 
therapy  in  threatened  or  habitual  abortion. 

Secondly,  in  instances  in  which  one  drug 
is  clearly  indicated  for  treatment  of  a life 
or  health-threatening  condition,  that  agent 
should,  in  general,  be  used  even  though  it 
may  pose  a threat  to  the  fetus.  For  example, 
if  the  treatment  of  choice  of  thyrotoxicosis 
in  a particular  patient,  who  happened  to  be 
pregnant,  were  thought  to  be  propylthi- 
ouracil, then  this  is  the  medication  which 
should  be  employed. 

Thirdly,  in  instances  in  which  treatment 
is  indicated  but  either  of  two  equally  ef- 
ficacious agents  may  be  used,  the  one  hav- 
ing the  last  toxicity  or  suspension  of  toxi- 
city should  be  selected.  For  example,  anti- 
coagulation for  thrombophlebitis  in  preg- 
nancy is  better  accomplished  with  heparin 
rather  than  coumadin,  all  other  factors 
being  equal,  because  of  the  lack  of  placental 
transfer  of  heparin  and  its  ready  reversi- 
bility. 

Finally,  in  the  absence  of  more  specific 
data  than  are  presently  available,  we  must 
adopt  a generally  conservative  approach  to 


for  September,  1968 


267 


the  use  of  drugs  in  pregnancy.  We  must 
recognize,  and  we  must  convince  our  pa- 
tients, that  life  is  not,  in  fact,  a "drug- 
deficiency  state." 

References 

1.  Manhan,  C.  P.,  and  Eastman,  N.  J.:  “The 
cevitamic  acid  content  of  fetal  blood.”  Bull. 
John  Hopkins  Hosp.  62:478,  1938 

2.  Cohen,  E.  N.,  Paulson,  W.  J.,  Wall,  J.,  and 
Elbert,  B.:  “Thiopental,  curare  and  nitrous 
oxide  anesthesia  for  cesarean  section  with 
studies  on  placental  transmission.”  Surg. 
Gynec.  and  Obst.  97:456,  1953 

3.  Pitkin,  R.  M.,  and  Reynolds,  W.  A.:  Unpub- 
lished data. 

4.  Cohlan,  S.  Q.,  Bevelander,  G.,  and  Tiamsic, 
T.:  “Growth  inhibition  of  prematures  receiv- 
ing tetracycline.”  Am.  J.  Dis.  Child.  105:453, 
1963 

5.  Allen,  E.  S.,  and  Brown,  W.  E.:  “Hepatic 
toxicity  of  tetracycline  in  pregancy.”  Am.  J. 
Obst.  and  Gynec.  95:12,  1966. 


6.  Odell,  G.  B.:  “Studies  in  kemicterus.  I.  The 
protein  binding  of  bilirubin.”  J.  Clin.  Invest. 
38:823,  1959. 

7.  Wilkins,  L.:  “Masculinization  of  female  fetus 
due  to  use  of  orally  given  progestins.” 
J.A.M.A.  172:1028,  1960. 

8.  Bongiovani,  A.,  'and  McPadden,  A.  J.:  “Ster- 
oids during  pregnancy  and  possible  fetal  con- 
sequences.” Fertil.  & Steril.  11:181,  1960. 

9.  Petty,  C.  S.,  and  Dibenedetto,  R.  L.:  “Goiter 
of  the  newborn.”  New  England  J.  Med. 
256:1103,  1957 

10.  Kistner,  R.  W.:  “Hazards  of  obstetrical  and 
gynecological  drugs.”  Ohio  M.J.  60:1125,  1964 

11.  Adamsons,  K.,  and  Joelson,  I.:  “The  effects 
of  pharmacologic  agents  upon  the  fetus  and 
newborn.”  Am.  J.  Obst.  & Gynec.  96:437,  1966. 

12.  Desmond,  W.  M.,  Rogers,  S.  F.,  Lindley,  J.  E. 
and  Noyer,  J.  H.:  “Management  of  toxemia 
of  pregnancy  with  reserpine.  II.  The  new- 
born infant.”  Obst.  & Gynec.  10:140,  1957. 

13.  Goldzieker,  J.  A.:  “Double-blind  trial  of  a 
progestin  in  habitual  abortion.”  J.A.M.A. 
188:651,  1964. 


School  Immunization 


As  you  are  undoubtedly  aware,  the  re- 
cent session  of  the  Legislature  passed  bills, 
approved  by  the  Governor,  requiring  im- 
munization of  all  Illinois  school  children 
prior  to  entering  kindergarten  or  first 
grade,  and  of  every  child  first  entering  any 
public,  private  or  parochial  school  in  this 
State,  against  measles,  poliomyelitis,  diph- 
theria, pertussis,  tetanus  and  smallpox.  One 
of  the  bills  (H.B.  1411)  gave  the  Illinois 
Department  of  Public  Health  responsibility 
for  promulgating  rules  and  regulations  re- 
quiring immunization  of  children.  This  sta- 
tute also  provides  that  the  Director  shall 
appoint  an  Immunization  Advisory  Com- 
mittee consisting  of  seven  members  who 
shall  advise  and  consult  with  the  Depart- 
ment in  the  development  of  the  rules  and 
regulations  to  be  promulgated  under  this 
Act. 

In  order  that  the  medical  society  mem- 
bers may  be  fully  informed  in  regard  to 
the  implementation  of  these  bills,  copies  of 
the  "Policy  of  the  Illinois  Department  of 
Public  Health  Concerning  Implementation 
of  An  Act  to  Amend  Section  27-8  of  the 


School  Code”  (H.B.  1410)  and  the  com- 
panion bill  (H.B.  1411)  are  available 

through  the  state  or  the  county  medical  so- 
ciety. Copies  of  the  informational  releases 
prepared  by  the  various  agencies  of  State 
Government  that  are  concerned  with  ad- 
ministration of  the  compulsory  immuniza- 
tion laws,  and  with  changes  in  the  School 
Code  related  to  physical  examination  of 
school  children,  (S.B.  954)  are  also  avail- 
able. 

We  have  discussed  the  matter  of  who  is 
permitted  to  give  physical  examinations 
and  immunizations  with  the  Office  of  the 
Superintendent  of  Public  Instruction. 
While  the  literal  interpretation  of  S.B. 
954  may  be  construed  to  be  that  both  physi- 
cal examinations  and  immunizations  can 
be  done  only  by  physicians  licensed  to  prac- 
tice medicine  in  all  its  branches,  by  prac- 
tice in  this  State  registered  nurses  do  give 
immunizations  at  the  authorization  and  in- 
structions of  the  physician  licensed  to  prac- 
tice medicine  in  all  its  branches. 

Franklin  D.  Yoder,  M.D. 

Director  of  Public  Health 


268 


Illinois  Medical  Journal 


Hernia  Of  The  Esophageal  Hiatus  In  Infants 


By  Mark  M.  Ravitch,  M.D.,  Marc  I.  Rowe,  M.D., 
AND  David  C.  Halperin,  M.D./Chicago 


Hernia  of  the  esophageal  hiatus  in  in- 
fants is  frequently  an  obscure  and  troub- 
ling phenomenon,  hazardous  to  the  growth 
and  development  of  the  child  and  often  ex- 
tremely difficult  to  diagnose.  For  some  years 
it  has  been  commonplace  to  say  that  this 
condition  has  been  more  commonly  ob- 
served in  England  where  larger  series  have 
been  accumulated  than  in  this  country. 
As  might  be  expected,  closer  attention  to 
the  symptomatology  involved,  and  sophis- 
ticated diagnostic  studies  have  resulted, 
here  as  well,  in  more  frequent  diagnosis 
with  consequent  relief  to  the  patients  in- 
volved. 

The  vast  majority  of  infants,  as  every 
mother  knows,  burp  and  regurgitate.  In 
the  infant  with  a sliding  hernia  of  the 
esophageal  hiatus  and  resultant  incompe- 
tence of  the  sphincter  mechanism  of  the 
esophago-cardiac  junction  this  occurs  to  so 
marked  a degree  that  the  infant  seems 
actually  to  vomit,  is  unable  to  retain 
enough  to  gain  weight  properly  and  may 
actually  lose  weight  seriously.  If  the  con- 
dition is  neglected,  the  prolonged  exposure 
of  the  esophagus  to  the  acid  gastric  juice 
results  in  esophagitis  which  may  be  mani- 
fested in  the  infant  by  occasional  blood 
in  the  vomitus  and  presently  by  the  de- 
velopment of  an  esophageal  stricture. 

As  the  stricture  begins  to  develop  it  may 
offer  enough  obstruction  to  regurgitation 
so  that  the  child  deceptively  enough  may 
seem  improved  for  a period  of  time.  Pres- 
ently, however,  the  stricture  becomes  so 


dense  as  to  interfere  with  swallowing  and 
one  is  then  faced  with  one  of  the  most 
serious  problems  of  esophageal  surgery  in 
infancy.  Such  strictures  may  respond  to 
dilatation  and  it  may  then  be  possible  to 
operate  successfully  upon  the  esophageal 
hiatus  hernia.  However,  in  general,  once 
a stricture  develops,  one  is  faced  with  a 
situation  in  which  in  the  first  place,  the 
stricture  does  not  yield  very  well  to  dila- 
tation and  in  the  second,  the  reconstruc- 
tion of  the  esophageal  hiatus  is  no  longer 
possible  because  the  esophagus,  contracted, 
scarred  and  adherent  to  the  mediastinum, 
cannot  be  successfully  brought  down  to 
allow  the  stomach  to  lie  entirely  in  the 
abdomen.  The  frequent  result  is  that  one 
must  resort  in  such  unfortunate  children 
to  the  major  expedient  of  resecting  the 
esophago-gastric  junction  with  the  stric- 
ture, and  interposing  a segment  of  bowel, 
usually  colon.  "While  this  is  a satisfactory 
enough  procedure,  compatible  with  a long 
and  normal  existence  and  unimpaired 
deglutition,  it  still  involves  a very  large 
operative  procedure  and  is  something 
which  one  would  wish  to  avoid. 

The  diagnosis  of  esophageal  hiatus  her- 
nia is  entirely  dependent  upon  careful  and 
repeated  roentgenogiaphy.  One  cannot 
count  on  being  able  to  demonstrate  an 
esophageal  hiatus  hernia  by  a single  bar- 
ium swallow  and  the  following  report  il- 
lustrates the  difficulties  which  may  be  in- 
volved in  making  the  diagnosis  even  when 
it  is  suspected. 


Mark  M.  Ravitch,  M.D.  (left),  is  Professor 
of  Surgery,  Professor  of  Pediatric  Surgery,  and 
Head  of  the  Division  of  Pediatric  Surgery  the 
Wyler  Children’s  Hospital,  University  of  Chi- 
cago. He  is  a graduate  of  the  Johns  Hopkins 
University.  David  Carlos  Halperin,  M.D.  (right) 
is  engaged  in  the  private  practice  of  General 
and  Pediatric  Surgery.  He  is  a graduate  of  the 
University  of  Chicago.  He 
served  his  internship  at 
Chicago  and  a residency 
in  general  surgery  at  Hines 
V.A.  hospital,  and  is 
Chief  Resident,  Wyler 
Children’s  Hospital.  Marc 
I.  Rowe  is  Ass’t  Professor 
of  Pediatric  Surgery,  Dept, 
of  Surgery,  the  Univer- 
sity of  Chicago,  Wyler 
Children’s  Hospital.  He  is 
a graduate  of  Tufts  Uni- 
versity School  of  Medicine. 


for  September,  1968 


269 


f^^LOROMYOTOMY 


NASOGASTRIC 
yrUBE  INSERTED 


NASOGASTRIC 
yTUBE  REMOVED 


Fig.  1.  Weight  chart  of  infant  4 weeks  old,  admitted  for  vomiting  and  failure  to  thrive.  The 
pyloric  tumor  was  palpable.  A hiatus  hernia  was  suspected  but  not  demonstrated  radiologically 
and  a pyloromyotomy  was  performed.  The  child  failed  to  gain.  Cinefluorography  was  unsuccess- 
ful in  demonstrating  any  hiatus  hernia.  The  child  was  put  in  an  esophageal  box  and  fed  with  an 
indwelling  nasogastric  tube.  Weight  gain  was  progressive.  The  third  radiologic  examination  now 
demonstrated  the  hiatus  hernia  (Figures  2a  and  b).  After  almost  four  weeks  of  nasogastric 
feedings,  the  tube  was  removed  and  the  child  continued  to  gain  weight,  being  maintained  in  the 
esophageal  box.  He  has  had  no  difficulty  since. 


Case  History 


the  child  had  in  fact  vomited  for  the  first 
three  weeks  of  its  life  before  the  severe 


A baby  (A.  McG.,  History  No,  94  26  67) 
was  admitted  to  the  Wyler  Children’s  Hos- 
pital of  the  University  of  Chicago  with 
the  diagnosis  of  pyloric  stenosis  on  the 
basis  of  one  week  of  violent  vomiting.  It 
had,  indeed,  been  noted  that  the  child 
had  vomited  for  the  three  preceding  weeks 
of  its  life,  although  the  vomiting  had  not 
been  so  dramatic.  A small  pyloric  tumor 
was  felt  by  a number  of  seasoned  observers 
so  that  the  diagnosis  of  congenital  hyper- 
trophic pyloric  stenosis  was  not  in  doubt. 
However,  in  view  of  the  fact  that  the  tumor 
was  a small  one,  that  there  is  an  incidence 
of  something  like  10  per  cent  of  con- 
genital hyp»ertrophic  pyloric  stenosis  in 
association  with  hiatal  hernias,  and  because 


projectile  vomiting  of  the  fourth  week,  a 
barium  swallow  was  undertaken  on  the 
morning  of  the  day  on  which  the  child 
had  already  been  posted  for  operation. 
This  roentgen  study  failed  to  show  a hia- 
tus hernia.  At  operation  a typical  rubbery 
edematous  pyloric  tumor  was  found  and 
the  usual  Fredet  Ramstedt  procedure  per- 
formed. After  operation  the  child  con- 
tinued to  vomit  precisely  as  he  had  be- 
fore and  another  radiographic  study  was 
undertaken,  this  one  with  the  aid  of  cine- 
fluoroscopy.  Once  more  no  hiatus  hernia 
was  seen  and  the  stomach  emptied  well. 
The  child’s  progressive  weight  loss  was 
beginning  to  cause  concern  (Fig.  1).  The 
child  seemed  constantly  hungry  but 


270 


Illinois  Medical  Journal 


vomited  most  of  what  it  took.  There 
was  no  bile  in  the  vomitus.  It  finally 
seemed  best  to  pass  a nasogastric  tube  and 
to  instill  frequent  small  feedings,  keep- 
ing the  child  constantly  upright.  With 
this  measure  the  weight  loss  stopped  and 
the  weight  began  to  increase  and  now  an- 
other cinefluoroscopic  study  was  under- 
taken. This  time  there  was  shown  an  un- 
equivocal herniation  of  the  stomach 
through  the  hiatus  well  up  into  the  chest 
(Figs.  2a  and  b).  This  had  not  been  seen 
on  either  the  first  or  the  second  study  and 
in  the  second  study,  the  first  cinefluoro- 
scopic study,  the  esophagus  had  seemed  to 
show  only  abnormal  and  poor  motility. 

On  this  basis  the  child  was  continued  for 
one  week  more  with  gavage,  being  con- 
stantly maintained  in  the  erect  position  in 
a little  plastic  “esophageal  chair.” 

Most  esophageal  hiatal  hernias  in  in- 
fants will  respond  to  the  maintenance  day 
and  night  of  the  erect  position  and  opera- 
tion will  usually  not  be  necessary.  In  very 
large  hiatus  hernias,  in  neglected  ones  in 
which  esophagitis  has  become  manifest,  or 
in  occasional  patients  who  do  not  respond 
within  a reasonable  period  of  time  to  the 
constant  maintenance  of  the  erect  position, 
operation  should  be  undertaken. 

What  is  the  fate  of  the  hiatal  hernia  in 
the  child  whose  symptoms  recede  on  treat- 
ment in  the  erect  position?  Certainly  the 
symptoms  do  not  recur  and  the  children 
have  seemed  well.  An  ususual  study  is  that 
of  Roviralta^  who  was  able  to  trace 
eleven  children  5 to  20  years  after  non- 
operative treatment  for  hiatus  hernia.  He 
found  that  their  symptoms  had  never  re- 
curred and  that  barium  swallow  years  later 


showed  either  significantly  less  herniation 
or  no  hiatus  hernia  at  all.  This  is  per- 
haps analogous  to  the  situation  in  the 
treatment  of  rectal  prolapse  in  infants. 
Rectal  prolapses  in  infants  are  as  true 
prolapses  as  those  in  adults  but  instead  of 
being  progressive  and  inevitably  requiring 
an  operation,  the  vast  majority  of  them 
yield  to  reposition  and  strapping  of  the 
buttock  and  after  one,  two,  or  three  re- 
currences usually  remain  successfully  and 
permanently  reduced  and  lead  to  no  fur- 
ther trouble. 

In  the  children  in  the  three  categories 
described,  those  with  large  hernias,  those 
with  incipient  esophagitis,  and  those  fail- 
ing to  respond  symptomatically  to  main- 
tenance in  the  erect  position,  operation  is 
undertaken.  This  is  exemplified  by  patient 
number  2.  This  child,  at  the  age  of  eight 
months,  weighed  4.6  kg.  Her  mother  stated 
that  during  the  child’s  entire  life  there  had 
never  been  a day  when  she  had  not  vom- 
ited all  of  one  feeding  and  never  a feeding 
of  which  she  had  not  returned  a consider- 
able portion.  Otherwise  the  child  was  well 


Fig.  2.  a.  h. 

a.  Roentgenogram. 

b.  Artist’s  sketch  of  the  roentgenogram  taken  from  a single  cine  frame.  There  is  an  obvious 
gastric  pouch  above  the  diaphragm.  As  obvious  as  this  was  in  this  examination,  it  was  completely 
missed  in  two  previous  examinations  and  was  not  seen  in  a portion  of  this  examination. 


for  September,  1968 


271 


Fig.  3.  a.  ht 

Hernia  in  8 month  old  infant  who  had  vomited  part  of  every  feeding  from  birth 
and  vomited  at  least  all  of  one  feeding  each  day  since  birth  and  was  admitted  with 
malnutrition,  underdevelopment  and  the  appearance  of  blood  in  the  vomitus. 

a. )  Preoperative  roentgengram  showing  large  gastric  sliding  hernia  (left). 

b. )  Roentgengram  following  Nissen  Fundoplication  showing  correction  of  the  hernia 
and  subdiaphragmatic  length  of  the  esophagus. 


and  she  ate  hungrily.  At  the  time  she  was 
admitted  to  the  hospital  there  had  begun 
to  be  blood  mixed  with  the  vomitus.  Again 
it  required  two  barium  swallows  to  demon- 
strate the  hiatus  hernia  but  it  was  clearly 
demonstrated  as  seen  in  Fig.  3.  We  were 
faced  with  a severely  under-nourished 
child,  one  in  whom  the  appearance  of 
blood  in  the  vomitus  suggested  beginning 


FIG.  4. 


esophagitis,  and  it  therefore  seemed  wise 
to  proceed  at  once  with  the  operation. 

A left  subcostal  incision  was  made.  When 
the  stomach  was  drawn  down,  an  esopha- 
geal hiatus  was  found  which  accommodated 


b. 


Operative  repair  of  hiatus  hernia  in  an  infant. 

a.  Three  sutures  have  been  placed  to  approximate  the  crura  behind  the  esophagus  which  is 
seen  with  a large  rubber  sound  in  it.  The  cardia  is  now  tacked  up  to  the  edge  of  the  hiatus. 

b.  A penrose  tubing  is  shown  around  the  esophagus  while  the  fundus  ha^  been  pulled  up 
around  the  esophagus  and  sutured  to  itself  and  to  the  esophagus. 

The  operation  is  readily  performed  through  the  abdomen  and  we  prefer  a subcostal  inci- 
sion. The  effect  of  the  operation  is:  1)  to  re-create  the  re-entrant  of  His,  2)  to  produce  a valve- 
like projection  of  the  esophagus  into  the  stomach,  and  3)  to  produce  a mass  of  tissue  which  must 
effectively  work  against  re-herniation,  quite  apart  from  the  sutures  tightening  the  hiatus. 


272 


Illinois  Medical  Journal 


three  of  the  operator’s  fingers  in  addition 
to  a number  34  stomach  tube  which  had 
been  passed  through  the  mouth,  a large 
hernia.  As  is  usual  with  hiatal  hernias, 
there  was  not  a significant  hernial  sac.  A 
Nissen  repair  was  performed  as  indicated 
on  the  accompanying  illustration  (Fig.  4), 
and  a gastrostomy  tube  inserted. 

The  child  has  not  vomited  since  opera- 
tion. The  gastrostomy  tube  was  removed 
in  a few  days  without  ever  having  been 
used. 

From  the  standpoint  of  operative  repair, 
we  feel  that  in  addition  to  the  standard 
closure  of  the  hiatus  it  is  important  to 
tack  the  fundus  high  in  order  to  re-create 
the  re-entrant  angle  of  His.  We  find  the 
Nissen  fundoplasty  a very  useful  technique 
for  maintaining  this  angle  and  accentuat- 
ing its  valve-like  function  as  well  as  for 
creating  a bulk  of  tissue  which  will  not 
easily  ascend  through  the  hiatal  orifice. 

Summary 

Hernia  of  the  hiatal  orifice  in  infants 


is  manifested  by  vomiting,  often  suggestive 
of  pyloric  stenosis  and  sometimes  mistaken 
for  it.  The  diagnosis  may  require  repeated 
and  careful  fluoroscopy  particularly  with 
a cine  apparatus.  In  most  patients  the 
treatment  is  postural,  maintaining  the 
children  day  and  night  in  erect  position. 
The  evidence  is  that  most  children  will  re- 
spond to  this  treatment  and  that  the  her- 
nia will  recede  or  disappear. 

In  children  who  do  not  respond  to  this 
treatment,  or  who  demonstrate  beginning- 
esophagitis,  or  who  have  very  large  hern- 
ias, operation  is  advised  and  our  present 
preference  is  for  the  Nissen  fundoplasty. 

References 

1.  Nissen  R.,  The  Treatment  of  Hiatal  Hernia 
and  Esophageal  Reflux  by  Fundoplication.  In 
Hernia,  Nyhus,  L.  M.,  and  Harkins,  H.  N., 
Philadelphia,  J.  B.  Lippincott,  1964. 

2.  Roviralta,  E.,  Historia  Natural  de  las  Hernias 
Hiatales,  Rev.  Clinical  Exp.,  96:235-244,  1965. 

3.  Waterson,  D.,  in  Pediatric  Surgery,  C.  D.  Ben- 
son, W.  T.  Mustard,  M.  M.  Ravitch,  K.  J. 
Welch,  and  W.  H.  Snyder,  Chicago,  Yearbook 
Medical  Publishers,  1962. 


Bundle  Branch  Studies  Reported 

In  36  cases  the  atrioventricular  node  and  main  bundle  were  normal,  but 
lesions  were  found  in  both  bundle  branches.  In  only  six  cases  in  this  group 
was  the  lesion  due  to  ischemia,  and  these  old  septal  myocardial  infarcts 
extended  into  the  conducting  tissue.  The  commonest  lesion,  found  in  19 
cases,  was  a loss  of  conducting  fibers  and  their  replacement  by  fibrous  tis- 
sue restricted  to  the  original  outlines  of  the  two  bundle  branches.  In  all 
these  cases  the  myocardium  adjacent  to  the  bundle  was  normal,  though 
some  showed  small  focal  scars  elsewhere  in  the  myocardium.  Detailed  study 
of  the  coronary  arteries  in  these  19  cases  revealed  no  significant  occlusive 
disease  to  produce  ischemia.  In  the  remaining  patients  the  bundle-branch 
lesions  were  due  to  cardiomyopathy  in  seven,  rheumatic  myocarditis  in  two, 
and  active  non-specific  myocarditis  in  two.  Findings  in  the  14  cases  of 
heart-block  associated  with  acute  myocardial  infarction  were  quite  dif- 
ferent and  of  importance  in  assessing  the  role  of  coronary-artery  disease  in 
chronic  heart-block.  Recent  posteroseptal  infarcts  were  found  in  13  cases, 
with  occlusion  of  the  right  coronary  artery  in  nine  and  the  left  circumflex 
artery  in  four:  the  other  case  had  a massive  anteroseptal  infarct,  with  occlu- 
sion of  the  anterior  descending  coronary  artery.  The  findings  in  the  con- 
ducting system  were  of  particular  interest.  Two  cases  showed  necrosis  of 
both  bundle  branches,  and,  had  the  patients  survived,  the  lesions  would 
probably  have  been  permanent.  In  four  cases  no  lesion  of  conducting  tissue 
was  found,  and  in  the  remainder  only  partial  lesions  were  present:  in  all 
these  patients  sinus  rhythm  would  probably  have  been  restored  had  they 
survived.  These  findings  support  the  clinical  observation  that  permanent 
heart-block  is  an  uncommon  sequel  of  myocardial  infection.  The  conduct- 
ing systems  of  the  control  hearts  were  intact,  though  there  was  some  fibrosis 
of  the  atrioventricular  node  and  bundle  with  increasing  age.  Etiology  of 
Complete  Heart-Block.  (Leading  Article)  The  Lancet  (Apr.  6)  1968,  pgs. 
731-732. 


for  September,  1968 


275 


EDUCATION  IN  COMMUNITY  MEDICINE 
AT  THE  UNIVERSITY  OF  CHICAGO 


The  University  of  Chicago’s  major  in- 
volvement in  community  medicine,  at  the 
present  time,  centers  about  the  establish- 
ment of  a Comprehensive  Care  Center  for 
children  in  the  Woodlawn  community. 

Woodlawn  is  a neighborhood  just  south 
of  the  University  which  represents  a micro- 
cosm of  the  kinds  of  problems  found  in  a 
disadvantaged  urban  neighborhood.  Over- 
crowding, absentee  landlords,  and  gangs 
are  difficulties  with  which  Woodlawn  has 
to  deal.  The  infant  mortality  rate,  that 
critical  index  of  how  medically  disadvant- 
aged an  area  is,  is  54  per  1000.  Woodlawn 
also  has  strengths,  chief  among  which  are 
its  organizations  and  its  wealth  of  con- 
cerned citizens,  who  are  willing  and  capa- 
ble of  helping  to  work  out  solutions  to  the 
area’s  problems. 

Working  in  conjunction  with  the  neigh- 
borhood, through  an  Advisory  Board,  the 
University  of  Chicago  has  established  the 
Woodlawn  Child  Health  Center  for  the 
indigent  children  of  Woodlawn.  The  Cli- 
nic is  financed  through  the  United  States 
Children’s  Bureau,  and  is  an  integral  part 
of  an  over-all  city  program,  directed  by  the 
state  and  city  Boards  of  Health. 

The  aim  of  this  Clinic  is  to  provide  care 
for  acute  and  chronic  illnesses,  diagnostic 
consultation,  preventive  medicine,  and 
health  education.  This  is  to  be  done  with 
an  attitude  and  in  an  atmosphere  that  will 
not  jeopardize  the  dignity  and  self-esteem 


of  those  served.  The  underlying  premise  is 
that  good  health  is  a right  and  not  a privi- 
lege. 

The  Center  is  operated  as  a referral  cen- 
ter for  such  agencies  as  the  Board  of 
Health,  Infant  Welfare  Stations,  the 
schools,  both  public  and  parochial,  and 
Head  Start,  as  well  as  a self-referral  clinic 
for  the  community.  The  location  is  in  the 
main  business  district  of  the  neighborhood. 

The  purpose  of  this  is  really  twofold, 
bringing  the  services  to  the  people  and,  on 
the  other  hand,  helping  those  who  provide 
the  service  to  become  more  aware  of  the 
problems  they  are  trying  to  solve. 

In  our  efforts  to  provide  education  in 
community  medicine  we  have  formally  es- 
tablished an  elective  period  in  the  senior 
year  during  which  the  student  can  work 
alongside  and  under  the  supervision  of  the 
attending  pediatricians.  We  also  provide  a 
rotation  through  the  Center  as  an  integral 
part  of  the  residency  program  in  pediatrics. 

Resident  physicians  in  other  specialties 
also  become  involved  by  providing  consul- 
tation services  to  patients.  Our  educational 
aims  are  multiple.  We  hope,  of  course,  to 
provide  our  students  and  house  staff  with 
an  abundance  of  clinical  experience.  This 
is  in  keeping  with  the  traditional  aim  of 
medical  education— the  development  of  a 
highly  competent  physician. 

We  are  also  highly  interested  in  setting 
(Continued  on  page  330) 


274 


Illinois  Medical  Journal 


Blunt 

Abdominal 

Trauma 


Case  Presentation: 

Dr.  William  Schiller:  The  patient,  a 41 
year  old  Negro  male,  struck  an  abutment 
while  driving  intoxicated.  The  steering 
wheel  struck  his  upper  abdomen.  He  was 
taken  to  another  hospital  where  he  was 
found  to  have  a blood  pressure  of  70/50. 
He  was  transferred  to  the  Veterans  Admin- 
istration Research  Hospital  five  hours  after 
the  accident.  Past  history  revealed  that  he 
had  had  a left  thoracoplasty  for  tuberculo- 
sis 17  years  previously.  On  physical  exami- 
nation in  the  admitting  room:  blood  pres- 
sure 60/40,  pulse  weak  and  thready.  Physi- 
cal examination:  marked  tenderness  in  the 
epigastrium  with  rigidity  in  the  right  up- 
per quadrant:  bowel  sounds  were  hypoac- 
tive.  His  hematocrit  was  40  and  white 
blood  cell  count  was  11,000.  The  remain- 
der of  his  laboratory  findings  were  normal. 
After  infusing  two  liters  of  lactated  Rin- 
ger’s solution  the  patient’s  vital  signs  be- 
came stable.  X-rays  of  the  chest  and  abdo- 
men were  obtained. 

Dr.  Abram  Cannon:  The  film  of  the  chest 
showed  evidence  of  the  previous  thoraco- 
plasty. The  abdomen  films  were  non-speci- 
fic. There  was  air  in  the  stomach  and  scat- 
tered through  the  bowel.  Free  air  was  not 
seen  under  the  diaphragm  and  fractures  of 
ribs  were  absent. 

Dr.  Schiller:  The  patient  was  operated 
upon  within  two  hours  of  admission.  The 
abdomen  was  opened  through  a left  para- 
median incision.  Immediately  upon  enter- 
ing the  peritoneal  cavity  blood  was  encoun- 
tered. Approximately  a liter  of  blood  was 
aspirated.  Exploration  of  the  upper  abdo- 
men revealed  that  the  falciform  ligament 


Surgical  Grand  Rounds  are  held  weekly 
on  Saturday  at  8:00  A.M.;  alternating  be- 
tween the  Staff  Room,  Chicago  Wesley  Me- 
morial Hospital  and  Offield  Auditorium, 
Passavant  Memorial  Hospital.  Patient  pres- 
entations from  these  hospitals  and  from 
the  Veterans  Administration  Research  Hos- 
pital form  the  basis  of  the  discussions.  This 
case  report  was  part  of  the  Surgical  Grand 
Rounds  held  at  Chicago  Wesley  Memorial 
Hospital  on  January  20,  1968. 


had  been  avulsed  from  the  liver.  Lateral  to 
this  there  was  a linear  fracture  on  the  su- 
perior or  diaphragmatic  surface  of  the  liv- 
er, which  extended  to  the  left  lobe  of  the 
liver.  It  was  not  bleeding  actively.  The  re- 
mainder of  the  peritoneal  cavity  was  ex- 
plored for  evidence  of  other  injuries.  The 
common  duct  was  normal.  A Kocher  man- 
euver demonstrated  that  the  head  of  the 
pancreas  and  duodenum  were  unharmed. 
The  lesser  peritoneal  was  opened  and  in- 
spection of  the  remainder  of  the  duodenum 
and  pancreas  failed  to  reveal  any  other  in- 
jury. 

During  this  period  of  exploration  fur- 
ther bleeding  from  the  liver  had  not  occur- 
red. The  laceration  was  linear  and  was 
well  approximated  without  sutures.  There- 
fore, through  separate  stab  wounds,  three 
cigarette  drains  were  brought  out  the  left 
side  with  two  of  the  cigarette  drains  over 
the  dome  of  the  liver  and  one  into  the  left 
gutter.  Three  additional  drains  were  placed 
through  the  right  side  into  the  foramen  of 
Winslow  and  into  the  intrahepatic  fossa. 
Postoperatively  some  serosanguinous  fluid 
has  appeared  from  these  drain  sites.  He  has 
made  an  uneventful  recovery  six  days  after 
operation. 

Dr.  Julius  Conn : This  man  illustrates 
many  of  the  problems  encountered  in 
treating  blunt  abdominal  trauma.  The  de- 
lay from  time  of  injury  to  the  time  of  opera- 
tion was  approximately  seven  hours,  which 
is  in  keeping  with  reports  from  most  cen- 
ters. Nonpenetrating  wounds  of  the  liver 
account  for  from  10  to  30  per  cent  of  all 


276 


Illinois  Medical  Journal 


liver  injuries. 

The  mortality  rate  varies  directly  with 
the  length  of  time  from  injury  to  diagnosis. 
Therefore,  delay  in  diagnosis  and  treat- 
ment is  a critical  factor.  Another  highly 
significant  factor  is  the  presence  of  associ- 
ated injuries.  The  reported  mortality  rate 
for  a single  injury  of  the  liver  varies  from 
5 to  10  per  cent,  depending  on  the  extent 
of  injury  to  the  liver.  When  there  is  injury 
to  the  liver  and  one  other  organ  the  mor- 
tality rate  rises  to  approximately  25  per 
cent.  When  two  other  organs  are  injured 
as  well  as  the  liver  a mortality  rate  of  40  to 
50  per  cent  is  encountered.  Approximately 
one-third  of  these  people  will  have  associ- 
ated head  injuries.  Analysis  of  pedestrian 
and  automobile  fatalities  has  shown  rup- 
ture of  the  liver  to  be  the  most  common  ab- 
dominal injury.  It  has  been  estimated  that 
one-third  of  the  victims  are  dead  on  arrival 
at  the  hospital,  one-third  die  within  six 
hours  of  the  accident,  and  one-third  will 
survive. 

The  diagnosis  of  intraabdominal  injury 
in  this  patient  was  not  complex.  He  had 
obvious  signs  of  peritoneal  irritation  so  fur- 
ther studies,  such  as  a peritoneal  tap  or 
arteriography  were  not  required.  At  least 
three-fourths  of  patients  with  a liver  injury 
will  develop  shock.  In  addition  to  blood 
loss,  these  patients  sequester  large  amounts 
of  fluid  secondary  to  the  bile  leakage  plus 
the  local  tissue  trauma  itself.  Leukocytosis 
is  frequently  present. 

The  patient  presented  today  was  opera- 
ted upon  with  a minimum  of  delay.  Meth- 
ods of  treatment  for  these  injuries  have 
varied,  but  the  control  of  hemorrhage  and 
adequate  surgical  drainage  are  of  prime  im- 
portance. If  the  bleeding  is  massive  a clamp 
on  the  portal  triad  will  control  bleeding 
temporarily.  Under  these  circumstances 
one  has  about  15  minutes  of  safe  ischemia 
time  at  normal  body  temperature.  However 
if  the  patient’s  temperature  is  lowered  to 
about  32 °C.  occlusion  can  be  prolonged  for 
approximately  30  minutes.  Therefore,  these 
patients  should  be  placed  on  a hypother- 
mia blanket  prior  to  operation  if  liver  in- 
jury is  suspected.  Resection  is  becoming 
more  frequent  with  the  blunt  type  of  in- 
jury. Most  of  these  require  sublobular  re- 
sections. T-tube  drainage  has  been  advo- 
cated since  patients  who  have  sustained  in- 
juries to  the  liver  will  frequently  have  an 
elevation  of  the  pressure  within  the  biliary 


tree.  Drainage  of  the  common  duct  with 
the  T-tube  or  catheter  lowers  the  intraduc- 
tal pressure  and  facilitates  sealing  of  lacer- 
ated bile  ducts.  It  did  not  seem  necessary 
in  this  case  to  drain  the  common  duct  be- 
cause the  laceration  seemed  to  be  relatively 
superficial. 

The  laceration  was  not  closed  in  this  pa- 
tient. Tight  closure  associated  with  con- 
tinued bleeding  into  the  parenchyma  of 
the  liver  will  result  in  a large  hematoma 
which  may  fracture  the  liver  or  else  become 
infected.  It  is  better  in  a superficial  hepa- 
tic laceration  to  simply  drain  the  area 
widely. 

There  has  been  considerable  interest  in 
the  use  of  the  cyanoacrylate  tissue  adhe- 
sives on  liver  lacerations.  These  sprays  are 
undergoing  extensive  study.  Application  of 
the  spray  to  the  surface  of  the  liver  seals 
open  vessels  and  ducts.  Another  new  tool 
that  may  become  available  in  the  manage- 
ment of  liver  injuries  is  the  use  of  cryo- 
genic apparatus.  These  are  also  being  eval- 
uated in  controlling  massive  bleeding  from 
the  raw  surfaces  of  the  liver. 

Dr.  James  Hines:  Acrylic  sprays  are  be- 
ing tested  for  many  other  uses,  including 
incisions  for  laparotomy.  There  is  an  at- 
tempt being  made  now  to  develop  these 
sprays  so  one  can  just  open  the  abdomen 
or  chest  and  simply  spray  the  surface  to  ob- 
tain hemostasis.  Currently  their  use  has 
been  confined  to  intraabdominal  or  intra- 
thoracic  injuries  where  there  were  large 
areas  of  oozing. 

Dr.  John  Beal:  This  patient  had  been 
subjected  to  thoracoplasty  in  the  past  and 
now  suffered  a serious  abdominal  injury 
which  required  operation  and  anesthesia. 
Dr.  Eckenhoff,  do  such  patients  offer  any 
special  problems? 

Dr.  James  Eckenhoff:  I would  not  have 
been  particularly  concerned  about  the  thor- 
acoplasty in  this  individual  because  it  was 
performed  a long  time  ago  and  he  had  ac- 
commodated well  to  it.  There  is  a real  possi- 
bility that  some  one  might  become  too  wor- 
ried about  the  thoracoplasty,  and  as  a con- 
sequence attempt  to  anesthetize  the  man 
too  fast  and  too  deeply.  In  the  presence  of 
shock  deep  anesthesia  results  in  loss  of  com- 
pensatory circulatory  reflexes  and  a sudden 
demise  may  occur  under  these  circumstan- 
ces. A reasonably  slow  induction  of  anes- 
thesia with  the  establishment  of  an  airway 
with  an  endotracheal  tube  is  proper.  | 


/or  September,  1968 


277 


Obstetric  Analgesia  and  Anesthesia.  By 

Charles  E.  Flowers  Jr.,  M.D.  Hoeber 

Medical  Division,  Harper  and  Row,  Pub- 
lishers, New  York,  1967. 

This  book  is  written  by  an  obstetrician  for 
obstetricians.  The  author  has  had  a long, 
active  and  fruitful  interest  in  the  problems 
of  obstetrical  anesthesia,  culminating  in  his 
service  as  Chairman  of  the  American  Col- 
lege of  Obstetrics  and  Gynecology  Commit- 
tee on  Obstetrical  Analgesia  and  Anesthesia 
in  1965-66.  In  spite  of  this,  or  perhaps  be- 
cause of  it.  Dr.  Flowers’  approach  in  this 
textbook  to  anesthesia  in  the  obstetrical  pa- 
tient largely  excludes  the  anesthesiologist. 
He  chooses  to  stress  the  problems  of  the  past 
instead  of  providing  the  instruction  that 
will  lead  to  solutions  in  the  future.  For  ex- 
ample, the  chapter  on  “Anesthesia  Coverage 
and  Maternal  Mortality”  explores,  in  detail, 
the  lack  of  obstetrical  anesthesia  coverage  in 
North  Carolina,  but  one  is  unable  to  find  in 
this  book  an  adequate  discussion  of  methods 
of  maintaining  airway  patency  or  of  treating 
the  patient  who  has  vomited  and  aspirated 
stomach  contents,  although  this  is  stated  to 
be  the  greatest  hazard  in  obstetrics.  One 
must,  of  course,  disagree  with  this  latter 
statement  of  the  author.  The  greatest  haz- 
ard in  obstetrics,  as  in  all  of  medicine,  is  the 
physician  who  does  not  understand  the  lim- 
its of  his  own  capabilities. 

Providing  a cookbook  approach  to  the 
superficialities  of  anesthetic  administration, 
without  providing  a sound  basis  in  the  prin- 
ciples of  anesthesia  will  lead  to  still  another 
generation  of  obstetricians  who  fail  to  com- 
prehend their  own  inadequacy  in  this  field. 
Dr.  Flowers’  statement,  for  example,  that 
ethylene  should  never  be  administered  in  a 
closed  system  because  of  the  explosive  haz- 
ard shows  a lack  of  insight  into  primary 


anesthetic  principles— cyclopropane  is  often 
given  in  a closed  system  just  because  it  is 
explosive  and  a closed  system  confines  the 
explosive  mixture.  Ethylene  is  not  given  in 
a closed  system,  but  for  other  reasons.  The 
recommendation  to  use  thiopental  as  a five 
percent  solution,  a practice  which  may  have 
been  acceptable  twenty  years  ago,  would  be 
criticized  by  most  practicing  anesthesiolo- 
gists as  being  unduly  hazardous. 

The  failure  to  discuss  the  pros  and  cons 
of  spontaneous,  assisted  and  controlled  ven- 
tilation—a subject  of  current  interest  among 
obstetric  anesthetists— clearly  demonstrates 
a lack  of  anesthetic  orientation  in  this  text. 
The  index  entry  for  “respiration,  control” 
refers  to  breathing  exercises  to  be  used  by 
the  patient  to  facilitate  labor,  an  obvious 
reflection  of  the  obstetric  orientation  of  the 
author.  When  the  author  discusses  sys- 
temic analgesia  and  amnesia  for  labor  and 
delivery,  or  when  he  discusses  techniques  of 
conduction  anesthesia  the  principles  which 
he  propounds  are  firmly  based.  On  the  other 
hand,  the  chapters  which  discuss  inhalation 
anesthesia,  intravenous  anesthesia,  the  use 
of  muscle  relaxants  or  which  concern  them- 
selves with  the  general  principles  of  anes- 
thestic  practice  treat  of  their  subject  in  the 
most  superficial  way.  The  practice  of  medi- 
cine has  progressed  beyond  the  point  where 
diagrammatic  representations  of  flow,  meter 
settings  are  useful  to  teach  the  neophyte  to 
administer  anesthesia.  He  must  be  taught 
the  physiology  and  pharmacology  of  anes- 
thesia as  well  as  the  mechanics.  This  book 
fails  in  this  respect  and  therefore  has  little 
to  recommend  it  as  a text  for  learning  ob- 
stetrical anesthesia.  It  may  be  useful  to  the 
obstetrician  learning  the  principles  of  pain 
relief  during  labor. 

Edward  A.  Brunner,  M.D.,  Ph.D. 


278 


Illinois  Medical  Journal 


r 


122  Years  of  Aesculapian 


By  G.  T.  Mitchell,  M.D. /Marshall,  and 
E.  P.  Johnson,  M.D. /Casey 

The  names  of  doctors  appear  prominent- 
ly among  those  who  forged  westward  in  the 
early  exploration  of  the  vast  unknown  be- 
yond the  Allegheny  mountains. 

In  March,  1773,  Dr.  John  Briscoe,  with 
five  large  canoes  and  15  men  under  his 
command,  put  ashore  at  a fine  bottom- 
land opposite  a nearly  mile-long  island 
close  to  the  Ohio  shore  just  six  miles  above 
the  Little  Konawha  River  (the  present  site 
of  Boaz,  W.  Va.).  It  is  stated  that  “John 
Briscoe  was  not  only  an  adventurer  and 
land  speculator:  he  was  a good  doctor  as 
well.“i  In  April,  1774,  the  Earl  of  Duns- 
more,  governor  of  New  York  and  the  Vir- 
ginia Colonies,  ordered  Capt.  John  Con- 
nelly, a physician  by  profession,  to  raise  an 
army  of  3,000  men  to  go  against  the  Scioto 
River  Indians.^ 

And  so  it  was  in  Southern  Illinois.  The 
medical  profession  was  well  represented 
among  the  white  men  first  to  enter  this 
region.  One  of  the  earliest  to  come  was  Dr. 
George  Fisher.  His  lonely  grave  lies  near 
the  intersection  of  Illinois  highways  3 and 
155  at  the  village  of  Ruma.  Dr.  Fisher  built 
a home  and  opened  a farm  in  1806.  It  was 
here  that  he  built  a hospital,  the  first  in 
Illinois,  in  1808.  He  was  a member  of  the 
first  House  of  Representatives  of  the  Indi- 
ana Territory,  Speaker  of  the  House  in  the 
first  and  third  Illinois  Territorial  Assem- 
blies (1812-1814,  1816-1818)  and  a member 
of  the  First  Illinois  Constitutional  Conven- 
tion, 1818.3 


Pioneer  Life  Described 

The  life  of  a pioneer  doctor  in  Illinois 
was  a vigorous  and  lonely  one.  There  were 
no  good  highways  to  travel.  It  was  necessary 
to  walk  or  to  travel  horseback,  following 
narrow  trails  through  the  woods  or  across 
the  prairies.  No  bridges  existed  and  crossing 
the  streams  was  a most  hazardous  proce- 
dure at  times,  especially  when  the  spring 
floods  came.  The  waters  would  come  rush- 
ing downstream  and  out  into  the  bottom 
lands  and  many  a helpless  rider  was  swept 
from  his  horse  to  his  death,  or,  if  fortune 
was  with  him,  he  at  last  dragged  himself 
up  on  the  bank,  soaked  through  with  the 
icy  water. 

House  visits  were  the  custom,  since  it  was 
most  difficult  to  transport  the  patient  to 
the  doctor;  he  often  was  away  from  home 
for  many  days,  being  sent  from  one  lonely 
cabin  to  another  to  minister  to  the  sick  and 
injured.  His  few  instruments  and  medica- 
tions were  carried  in  a small  bag  strapped 
to  his  saddlebags.  The  pioneer  doctor  had 
no  stethoscope,  no  thermometer,  no  sphy- 
gmomanometer, no  hypodermic.  Labora- 
tory procedures  were  unknown.  His  eyes, 
his  ears,  his  sensitive  fingers  were  his  diag- 
nostic tools,  and  these  he  learned  to  use  to 
a degree  of  proficiency  unknown  today. 
Rare  was  the  doctor  of  those  times  who  had 
the  advantage  of  a classical  course  in  medi- 
cine; most  of  them  had  taken  training  for  a 
year  under  an  old  preceptor  and  then  a 


for  September,  1968 


279 


four  month  course  of  lectures  in  some  med- 
ical school. 

The  pioneer  doctor  was  daily  faced  with 
the  innumerable  demands  of  medicine— 
usually  alone,  as  his  colleagues  were  far 
away  and  consultations  not  easily  secured. 
No  telephones,  no  medical  journals,  no 
staff  meetings  existed  to  link  him  with  his 
fellows.  Decisions  made,  right  or  wrong, 
were  the  responsibility  of  but  one  man. 
The  pioneer  doctor  longed  for  the  oppor- 
tunity to  talk  to  a colleague,  to  consult, 
and  to  swap  information.  It  was  this  sort 
of  yearning  which  led  to  the  formation  of 
the  earliest  medical  society  west  of  the  Al- 
leghany mountains.  This  society,  “The  Aes- 
culapian  Society  of  the  Wabash  Valley,” 
was  organized  in  Lawrenceville  in  1846 
and  is  still  active.*  The  story  of  the  forma- 
tion of  the  society  can  best  be  told  we  be- 
lieve by  the  President's  address  entitled 
‘Evolution  of  the  Aesculapian,  delivered  by 
Dr.  Charles  B.  Johnson  of  Champaign  on 
Oct.  31,  1907,  during  the  Society’s  Sixty- 
First  Annual  Meeting  at  Paris.'* 

Some  Experiences 

“Something  like  two  generations  ago  a 
certain  doctor  who  had  his  biding  place 
not  far  distant  from  the  Wabash  River, 
was  giving  his  days  and  no  inconsiderable 
part  of  his  nights  to  the  manifold  and  la- 
borious duties  of  a large  country  practice. 
Naturally  the  greater  part  of  this  man’s 
work  pertained  to  internal  medicine.  Nev- 
ertheless, he  was  no  mean  obstetrician,  had 
some  skill  as  a surgeon  and  was,  moreover, 
something  of  a gynecologist.  This  last,  how- 
ever, without  knowing  it.  I speak  advisedly 
when  I say  ‘without  knowing  it,’  for  in  that 
period  the  word  gynecologist  had  yet  to  be 
coined.  ...” 

“At  this  period  our  Wabash  Valley  doc- 
tor was  in  the  prime  of  life  and  busy  mak- 
ing the  rounds  among  his  patients,  scat- 
tered as  they  were,  over  a large  extent  of 
country.  ...  It  was  a virgin  country,  as 
wild  and  as  nearly  over-run  by  rank  vege- 
tation as  a warm  sunshine,  a quickening 
rain-fall  and  a responsive  soil  could  make 
it.  . . . ” 

“Perhaps  a very  brief  recountal  of  some 

*The  society  was  chartered  in  1847  as  the  “Law- 
renceville Aesculapian  Medical  Society.’’  In  1894, 
the  name  was  changed  to  the  “Aesculapian  Society 
of  the  Wabash  Valley’’  since  it  had  long  served  a 
wide  area  of  both  Illinois  and  Indiana,  on  both 
sides  of  the  Wabash  River. 


of  this  pioneer  doctor’s  experiences  would 
not  prove  wholly  uninteresting:  Early  one 
morning  in  mid-winter  a call  came  to  go 
a long  distance  and  see  a man  who  was 
thought  to  have  ‘winter  fever’,  or  as  we 
say  today,  pneumonia.  Promptly  the  doc- 
tor mounted  his  horse  and  with  his  well- 
filled  saddle  bags,  started  his  long  journey. 
It  was  one  of  those  disagreeable  winter  days 
when  the  ground  was  neither  solid  enough 
to  hold  the  horse  on  its  surface,  nor  thawed 
sufficiently  to  admit  of  the  animal’s  feet 
with  certainty  touching  bottom.  But  tedious 
as  was  the  way,  a reasonable  degree  of 
progress  was  made  ‘till  a creek  was  reached 
which  had  to  be  forded,  a most  difficult 
task,  as  a sheet  of  ice  reached  out  several 
feet  from  either  bank  and  this  the  faithful 
horse  had  to  break  through  at  every  step. 
Finally  the  footing  proved  so  uncertain 
that  he  floundered  and  fell,  but  in  the 
end  regained  his  feet  with  no  greater  harm 
than  an  ice-cold  bath  to  the  rider.” 

An  Urgent  Call 

“As  the  nearest  house  was  miles  away, 
there  was  nothing  for  the  doctor  to  do  but 
ride  as  hurriedly  as  he  could  to  his  des- 
tination. When  he  arrived  there  the  con- 
dition of  the  sick  man  was  found  to  be 
vastly  more  comfortable  than  that  of  his 
medical  advisor.  Faithful  to  what  he  es- 


George  T.  Mitchell,  M.D.,  left,  is  engaged  in 
general  practice  in  Marshall.  He  received  his  M.D. 
from  George  Washington  University  and  served 
his  internship  at  Methodist  Hospital,  Indianapolis. 
He  is  president  of  the  Clark  County  Historical 
Society  and  past  president  of  the  Aesculapian  So- 
ciety. Eugene  P.  Johnson,  M.D.,  right,  is  a gen- 
eral practitioner  in  Casey.  He  received  his  M.D. 
from  Washington  University,  St.  Louis  and  served 
his  internship  with  the  U.S.  Navy.  He  is  a dele- 
gate to  the  ISMS  and  president  of  the  Clark  Coun- 
ty Medical  Society.  In  addition  he  is  sec’y-treas.  of 
the  Aesculapian  Society  of  the  Wabash  Valley. 
This  article  is  one  of  the  series  commemorating 
Illinois’  Sesquicentennial. 


280 


Illinois  Medical  Journal 


teemed  his  duty,  however,  the  physician 
at  once  proceeded  to  minister  to  the  pa- 
tient’s wants  and  put  his  own  needs  aside 
for  the  time  being.  But  while  he  was  yet 
at  the  bedside  a messenger,  pale  with  ex- 
citement, came  for  him  to  go  to  a cabin  a 
mile  distant  and  see  a man  who  was 
thought  to  be  bleeding  to  death.  The  call 
seemed  to  admit  of  no  delay;  consequently, 
our  hard-tv'orked  doctor,  though  wet,  cold 
and  hungry,  again  got  in  the  saddle  and 
made  his  way  fast  as  his  horse  could  carry 
him  to  the  place  designated  and  where  was 
found  a man  who  had  been  caught  under 
a falling  tree  and  in  consequence,  sustained 
a compound  fracture  of  the  femur  involv- 
ing one  of  his  knee-joints;  an  injury  which 
in  that  day  called  for  immediate  amputa- 
tion.” 

‘‘The  only  instrument  in  the  doctor’s 
possession  was  a thumb  lance  for  bleeding, 
an  operation  which  two  generations  ago 
was  practiced  on  substantially  every  second 
patient.  Fortunately,  however,  our  ^Vabash 
Valley  doctor,  like  most  country  praction- 
ers,  was  resourceful  and  upon  searching  the 
premises,  finally  found  at  his  service  a 
sharp  butcher  knife,  a hand  saw,  some 
strong  linen  thread,  several  large  sewing 
needles,  a supply  of  old  clean  muslin  and 
a tea-kettle  of  hot  water.” 

‘‘Assisted  by  the  more  heroic  among  the 
neighbors,  the  patient,  after  being  properly 
tied,  bound  and  strapped  to  a table,  sub- 
mitted as  best  he  could  to  the  tortures  of 
an  amputation  of  the  femur  at  the  junc- 
tion of  the  middle  and  lower  thirds.  Too 
bad,  some  one  will  say,  that  the  operator 
did  not  have  an  anesthetic  at  his  command. 
Yes,  it  was  too  bad.  But  in  this  particular 
case  our  pioneer  doctor  was  as  well  off  as 
the  most  advanced  and  progressive  surgeon 
in  Xew  York  or  London  as  the  discovery  of 
practical  anesthesia  was  as  yet  more  than  a 
year  in  the  future.  Crude  and  painful  as 
was  the  operation,  the  man  in  the  end 
made  a good  recovery,  though  it  goes  with- 
out saying  that  the  healing  process  was 
accompanied  with  a free  discharge  of  what 
the  older  surgeons  called  ‘laudable’  pus. . . .” 

‘‘But  fortunately  for  this  pioneer  doctor’s 
comfort  and  peace  of  mind,  the  roads  were 
not  always  so  bad,  the  cases  not  always 
so  critical  ...  as  on  this  strenuous  winter 
day.  ...” 

‘‘Towards  noon  one  mid-summer  day, 
with  his  horse  in  a lather  of  sweat,  a man 


rode  up  to  the  physician’s  gate  and  said 
the  services  of  a doctor  -vsere  urgently 
needed  some  miles  in  the  country  at  the 
farmhouse  of  one  Joel  Strong,  whose  young- 
est child  was  thought  to  be  dying  of  spasms. 
To  throw  a saddle  on  his  fastest  horse  and 
ride  rapidly  to  the  relief  of  the  little  suf- 
ferer was  only  carrying  out  Avhat  had  be- 
come second  nature  in  the  life  of  this  busy 
country  practitioner.” 

Self -Treatment  Obviates  Need  for 
Physician 

‘‘In  due  time  the  farmhouse  was  reached 
and  at  its  front  gate  stood  Joel  Strong. 
His  face,  instead  of  wearing  the  expected 
troubled  look,  lighted  up  with  a smile  as 
he  said:  ‘"Well,  Doc,  guess  the  old  wimmin’s 
’bout  got  your  patient  cured,  by  givin’  him 
a puke  and  puttin’  him  in  hot  water,  and 
when  I come  out  a minit  ago  he  was  sittin’ 
up  and  seemed  as  pert  as  could  be.  But 
say!  a young  one  like  that  can  be  laffin’  one 
minit  and  dyin’  the  next,  so  you  go  right  in 
and  see  what  he  needs.’  ” 

‘‘Upon  examination  the  condition  of  the 
little  patient  was  found  so  favorable  that 
some  directions  relative  to  diet  and  the 
use  of  a little  compound  spirits  of  Laven- 
der met  every  indication  in  the  case.”f 

‘‘Upon  one  occasion  this  pioneer  doctor 
was  called  upon  to  assist  a physician  whose 
field  of  practice  adjoined  his  own.  It  was 
a difiScult  labor  case.  In  due  time  the  pa- 
tient was  relieved,  but  meanwhile  the  night 
had  so  far  advanced  that  the  medical  at- 
tendants decided  to  remain  ’till  morning. 
They  were  thus  given  opportunity  for  be- 
coming better  acquainted  and  passed  the 
time  so  pleasantly,  exchanging  experiences, 

fjoel  Strong  was  a thrifty  pioneer  and  had  the 
reputation  among  the  neighbors  of  being  a ‘good 
liver’  and  among  the  women  folks  was  kno^vn  as 
a ‘good  provider.'  He  lived  in  a large  double  log 
house  with  an  ample  roofed-in  and  floored  open- 
way between  the  two  rooms,  ^\here  ^vas  spread 
the  dinner  table  to  which  the  doctor  was  invited 
and  at  which  with  the  family  he  seated  himself 
while  the  host  and  hostess  were  profuse  in  their 
apologies  for  having  so  little  to  offer  their  guest. . . . 
This  little,  with  which  the  table  was  spread,  con- 
sisted in  part  of  fresh  beef,  fresh  pork,  venison, 
prairie  chicken,  wild  turkey,  fried  chicken,  fried 
eggs,  broiled  ham,  Irish  potatoes,  sweet  potatoes, 
turnips,  snapbeans,  butter  beans,  onions,  cabbage, 
roasting-ears,  egg  bread,  corn  pones,  wheat  bread, 
biscuits,  fritters,  buck-wheat  cakes,  stewed  peaches, 
stewed  apples,  stewed  tomatoes,  stewed  pumpkin, 
baked  squash,  quince  preserves,  plum  preserves, 
pear  preserves,  apple  pie,  pumpkin  pie,  peach  cob- 
bler, cream  pudding,  maple  syrup,  honey,  peaches, 
sweet  cream,  doughnuts,  pound-cake,  srveet  milk, 
butter  milk,  clabber,  sweet  cider,  hot  coffee.  . . . 


for  September j 1968 


281 


discussing  cases  and  swapping  stories  that 
when  they  separated  next  morning,  each 
resolved  in  his  own  mind  that  this  meeting 
should  not  be  the  last.” 

Idea  for  Medical  Society  Born 

“As  our  Wabash  Valley  doctor  rode 
homeward,  ...  he  found  himself  mentally 
asking  the  question,  ‘If  so  much  satisfac- 
tion and  helpfulness  can  come  from  the 
meeting  of  two  physicians  why  can  not  a 
corresponding  degree  of  profit  and  pleasure 
be  derived  from  the  coming  together  of 
six  and  maybe  a dozen?’  Then  came  the 
Idea.  The  Idea— forceful,  dominant  and 
that  like  Banquo’s  ghost  would  not  down. 
The  Idea— that  imprinted  itself  so  indelibly 
on  the  brain  of  our  Wabash  Valley  doctor 
that  it  gave  him  no  peace  of  mind  'till  he 
had  mentally  planned  the  coming  together 
of  the  physicians  in  his  locality  and  joining 
hands  with  them  in  the  organization  of  a 
medical  society.” 

“For  a time  unexpected  obstacles  were 
encountered  and  the  contemplated  enter- 
prise was  not  consummated  as  soon  as  de- 
sired. But  if  with  proverbial  deliberation 
the  Gods  ground  slow,  they  also  with  tra- 
ditional thoroughness  ground  so  fine  that 
eventually  a meeting  held  at  Lawrenceville, 
in  1846,  resulted  in  the  organization  of  the 
Aesculapian  Society.  ...” 

Earliest  Members 

“Prominent  among  those  who  attended 
this  meeting  are  the  names  of  Drs.  David 
Adams,  Elisha  C.  Banks,  J.  M.  Doyle  and 
Charles  M.  Hamilton.” 

“Save  Dr.  Hamilton  I knew  none  of  these 
earlier  men  personally.  Indeed,  for  the  most 
part  they  had  done  their  work  and  passed 
off  the  stage  before  I entered  the  pro- 
fession. ...” 

“With  the  immediate  successors  of  this 
first  generation  of  Aesculapians  it  was  my 
fortunate  privilege  to  become  acquainted 
some  thirty-odd  years  ago.  And  in  the  fore- 
front of  this  second  generation  are  the 
names  of  Drs.  A.  J.  Miller,  John  Ten- 
Broeck,  William  Massie,  James  M.  Steele 
and  William  M.  Chambers,  each  of  whom 
had  an  individuality  and  general  make-up 
all  his  own.  ...” 

“Thus  we  see:  The  first  generation  gone 


into  history:  The  second  generation  gone 
into  history:  The  third  generation  fast  pass- 
ing into  history:  But  happily  the  fourth 
generation,  in  the  prime  and  flower  of 
manhood,  has  in  its  safe  keeping  our  be- 
loved Society,  stronger,  more  aggressive, 
more  useful  and  in  every  way  better  than 
ever  before!  Verily,  ‘One  generation  passeth 
away  and  another  generation  cometh,  but 
the  ‘Aesculapian’  abideth  forever.’  ” 

We  may  add  in  1968,  that  the  fifth  and 
sixth  generations  are  now  in  charge. 

Early  growth  of  the  group  was  phe- 
nomenal. The  meetings  always  lasted  two 
days,  and  many  in  attendance  used  a day 
in  coming  and  another  in  returning.  Popu- 
lation in  the  area  was  increasing;  the  Alton 
and  Terre  Haute,  the  Ohio  and  Mississippi, 
and  Illinois  Central  Railroads  were  built; 
roads  were  improved  and  buggies  and  carts 
were  plentiful;  and  the  Aesculapian  So- 
ciety flourished. 

Because  travel  was  difficult  these  doc- 
tors of  the  past  had  to  exert  a great  effort 
to  attend  the  meetings  of  the  Society.  Their 
meeting  must  have  been  the  highlight  of 
the  year.  At  first  they  travelled  by  horse- 
back, perhaps  taking  several  days  to  make 
the  trip,  later  by  horse  and  buggy  or  maybe 
stage  coach,  later  by  train  and  today  by 
automobile.  In  those  early  days  there  were 
no  journals,  no  closed  circuit  television, 
(yes,  and  no  detail  men);  so  to  satisfy  their 
thirst  for  the  latest  in  medicine  they  put 
forth  the  greatest  effort  to  attend  the  an- 
nual meeting  of  the  Society.  It  is  our  hope 
that  this  great  old  medical  society  will 
never  die  but  will  continue  as  a living 
memorial  to  those  hardy  pioneer  doctors 
who  first  ministered  to  needs  of  the  peo- 
ple of  the  Wabash  Valley. 


References 


1.  Eckert,  Allan  W.  The  Frontiersmen.  Boston, 
1967.  pp.  57-61. 

2.  Ibid.  p.  78. 

3.  Allen,  John  W.  Legends  and  Lore  of  Southern 
Illinois.  Carbondale,  1963.  p.  13. 

4.  “Proceedings  and  Presidential  Addresses  of  the 
Aesculapian  Society  of  the  Wabash  Valley,” 
Volume  III;  Paris,  111.,  1912. 

5.  Hunt,  George  W.,  M.D.,  “Historical  Sketch 
of  the  Aesculapian,”  read  at  Lawrenceville, 
111.,  May  28,  1931. 

6.  Proceedings  and  Presidential  Addresses  of  the 
Aesculapian  Society  of  the  Wabash  Valley,” 
Volume  V;  Paris,  111.,  1916. 


282 


Illinois  Medical  Journal 


Surgery  In  Infertility 


By  A.  F.  Lash,  M.D.,  Ph.D. /Chicago 

Surgery  in  infertility  is  considered  when 
all  other  therapeutic  measures  have  failed 
or  there  is  an  obvious  causative  factor  pres- 
ent which  can  only  be  corrected  by  an 
operative  procedure.  Surveys  of  fertility 
studies  have  indicated  that  the  lack  of 
therapeutic  success  results  from  inadequate 
studies  of  the  couple.  It  is  most  impor- 
tant to  thoroughly  investigate  a couple  to 
determine  the  presence  of  one  or  multiple 
factors  contributing  to  the  sterility.  The 
obvious  cause  may  be  only  one  of  several 
contributing  factors.  It  is  well  to  apprise 
the  couple  of  the  prognosis  of  the  pro- 
cedure contemplated,  so  that  there  may  not 
be  too  great  an  expectation,  followed  by 
disappointment.  Surgery  may  establish  the 
incurability  of  the  sterility  so  that  they  may 
start  adopting  their  children  without  fur- 
ther delay. 

Considering  the  lower  genital  tract,  the 
obstructive  anomalies  encountered  are: 
fibrotic  hymen  preventing  penile  introition, 
transverse  vaginal  septa,  and  partial  or  com- 
plete absence  of  the  vagina.  These  condi- 
tions may  be  corrected  by  surgery  and 
conception  will  follow  if  the  upper  genital 
tract  is  normal. 

Dilation  mth  Stem  Pessary 

The  cervical  obstructive  lesions  may  be 
strictures  or  synechiae  due  to  chemical, 
cautery,  infection  or  poor  healing  after 
surgery.  In  order  to  render  it  normal. 


Abraham  F.  Lash,  M.D.,  is  Director,  Division 
of  Obstetrics  and  Gynecology,  Cook  County 
Hospital.  He  is  a graduate  of  Rush  Medical 
College  and  also  received  his  Ph.D.  from  the 
University  of  Illinois.  Dr.  Lash  is  professor 
emeritus  of  the  Northwestern  University  Medi- 
cal School. 


dilatation  with  stem  pessary  may  be  neces- 
sary. Therefore  dilatation  and  curettage 
is  part  of  the  surgical  study  of  all  sterility 
problems  and  usually  combined  with 
culdoscopy.  Its  relation  to  synechiae  will 
be  considered  under  uterine  factors.  Also 
cervical  polyps,  erosion  or  eversion,  cervi- 
cal fibroids  or  prolapsed  submucous  fibro- 
myomata  must  be  dealt  with  surgically, 
Contrawise,  lacerations  through  the  whole 
length  of  the  cervical  wall  or  only  at  the 
isthmus  produces  incompetency  of  the  in- 
ternal os  with  resulting  repeated  abortions. 
These  individuals  are  just  as  infertile  as 
those  who  are  unable  to  conceive  because 
they  are  unable  to  carry  a pregnancy  to 
maturity.  Repair  of  these  traumatized  cer- 
vices allows  for  normal  pregnancies  to  go 
to  term.  The  visible  lacerations  are  ob- 
viously recognized  and  trachelorrhaphy  re- 
stores them  to  normal  functions.  The  less 
commonly  injured  isthmial  area  is  not 
readily  diagnosed  without  exploration  of 
the  cervicouterine  canal  and  determining 
the  abnormally  enlarged  internal  os  with 
a defect  (scar)  in  its  circumference.  Its 
presence  is  confirmed  by  the  cervicohystero- 
gram  which  not  only  establishes  the  ab- 
normal orifice  but  on  transverse  or  oblique 
views  may  disclose  the  defect.  The  wedge 
shaped  excision  of  the  defect  or  scarred 
tissue  and  closure  of  the  resulting  wound, 
restores  the  normal  competency  of  the  isth- 
mus. When  this  condition  becomes  mani- 
fest during  the  second  trimester  of  a preg- 
nancy by  beginning  effacement  and  dilata- 
tion plus  herniating  B.O.'W.,  the  canal 
may  be  closed  by  circlage  procedures  which 
may  allow  the  pregnancy  to  progress  nor- 
mally. 

Uterine  Factors  Concerned 

The  uterine  factors  playing  an  impor- 
tant role  in  infertility  are  readily  recog- 
nized in  the  course  of  an  adequate  diag- 
nostic investigation.  These  uterine  factors 
which  concern  us  in  a therapeutic  surgical 
approach  are  anomalies,  endometrial  syn- 
echiae, polypi,  fibromyomata  and  fixed  ret- 
rodisplacement  due  to  adhesions  (en- 
dometriosis or  P.I.D.).  Among  the  anoma- 
lies, the  subseptus  and  the  bicornuate  uni- 


for  September,  1968 


283 


collis  variety  usually  require  operative  cor- 
rection after  repeated^  abortions.  The 
Strassmann^s  technique  has  been  utilized 
with  the  definite  effort  being  made  to  pre- 
vent adhesions  between  the  wound  and 
loops  of  intestines.  The  vesicouterine  peri- 
toneum, the  round  ligaments  or  free  trans- 
plants of  the  omentum  are  used  to  leave  a 
smooth  surface  toward  the  peritoneal  cav- 
ity. In  1954  Steinberg^i  reported  a collec- 
tion of  107  cases  operated  on  by  Strass- 
mann  method.  Of  these,  61  had  become 
pregnant  and  51  of  these  pregnancies  had 
resulted  in  the  birth  of  living  children. 

Adhesions  Loosened 

Atresia  of  the  endometrial  cavity,  partial 
or  complete,  resulting  in  amenorrhea  and 
sterility  is  rare.  The  partial  type  may  be 
helped  by  probing  and  gradual  dilatation. 
These  atretic  conditions  result  from  over- 
zealous  curettage,  manual  removal  of  the 
placenta  or  intrauterine  packing.  Ascher- 
man  suggested  manual  loosening  of  these 
adhesions  in  association  with  abortion  or 
delivery.  He  reported  of  158  such  patients, 
only  33  became  pregnant.  In  20,  pregnancy 
went  on  to  term,  six  aborted  and  four  ter- 
minated in  premature  delivery  while  two  of 
his  patients  were  pregnant  at  the  time  of 
his  publication.  Of  Bergman’s  30  patients 
16  were  involuntarily  sterile.  There  is  no 
generally  recognized  form  of  treatment  for 
these  traumatic  lesions.  If  recognized  dur- 
ing an  abortion  or  delivery  the  adhesions 
may  be  manually  loosened.  Brett  and  Le- 
gros  have  suggested  hysterotomy  as  a means 
of  liberating  intrauterine  adhesions. 

Although  the  prognosis  is  poor  in  the 
presence  of  marked  adhesions,  additional 
indications  such  as  incapacitating  dys* 
menorrhea  may  make  surgery  necessary. 
Transplantation  of  endometrial  tissue  in 
the  treatment  of  these  traumatic  conditions 
have  been  described  by  several  investi- 
gators . (Gruenberger,  Serdjukoff,  Siebke 
and  Westman.)  Westman  reported  in- 
stances of  recovery  of  menstruation  fol- 
lowed by  conception.  However,  spontaneous 
regeneration  of  the  mucosa  may  also  oc- 
cur. In  Bergman’s  series  of  seven  women,  in 
four  of  them  menstruation  returned  spon- 
taneously without  therapy,  after  one,  two, 
three  and  six  years  respectively.  Paul  Strass- 
mann  in  1929  successfully  transplanted  a 
fallopian  tube  into  an  artificially  created 
uterine  cavity.  Erwin  O.  Strassmaun  re- 


ported on  the  surgical  reconstruction  of  a 
functional  uterine  cavity  in  six  patients 
having  complete  atresia.  In  all  six,  men- 
struation was  reestablished.  One  patient 
who  became  pregnant  went  to  term.  Fortu- 
nately this  uterine  factor  does  not  occur 
too  often  to  be  a serious  infertility  factor. 
However  in  the  last  two  years,  a number 
of  series  have  been  reported  by  Musset, 
Netter  and  Solal,  Onetto  et  al,  Pinto  and 
Sweeney. 

Myomatous  Uterus 

Fibromyomata  are  not  uncommon  (Ru- 
bin) and  the  incidence  varies  with  the 
race  and  age  of  the  individual  (Barter  and 
Parks).  About  five  percent  of  all  patients 
complaining  of  infertility  will  possess  a 
myomatous-uterus  which  may  account  for 
their  infertility  problem,  either  partially 
or  completely.  According  to  Rubin’s  sta- 
tistics, 42  percent  of  his  patients  operated 
for  myomas  did  not  conceive  while  the 
incidence  of  sterility  in  the  general  popu- 
lation is  about  15  percent.  The  mere  pres- 
ence of  myomas  in  the  uterus  of  an  in- 
fertile woman  does  not  imply  a causative 
relation.  Only  when  a thorough  investiga- 
tion has  established  the  husband’s  fertility 
potential  and  ruled  out  any  cervical  or 
tubal  factors,  myomectomy  may  be  in- 
dicated. Surgery  is  the  only  means  by 
which  fibromyomata  associated  with  steril- 
ity can  be  eliminated.  No  hormone  therapy 
has  been  found  effective  in  inducing 
shrinkage  or  disappearance  of  these  tumors. 
The  sterility  or  infertility  is  caused  by  the 
obstructive  nature  of  the  tumor  at  the 
tubal  or  cervical  orifices,  distortion  of  the 
uterine  cavity  or  by  the  endometrial 
changes,  hyperplasia  or  atrophy  induced 
by  the  location  of  the  fibroid;  also  the 
disturbances  of  circulation  in  the  tumor 
with  their  resulting  degenerative  changes 
and  their  irritative  effects  upon  the  uterine 
muscle  during  pregnancy  resulting  in 
abortion  or  premature  labor.  Tubal  disease 
is  not  infrequently  concomitantly  present. 

Myomectomy  may  be  single  or  multiple 
and  currently  is  a relatively  safe  proced- 
ure. Certain  principles  must  still  be  fol- 
lowed to  avoid  complications.  A routine 
Papanicolaou  smear  and  diagnostic  curet- 
tage must  be  performed  on  every  patient 
regardless  of  age,  particularly  if  there  is 
menstrual  disturbance.  Personal  experience 
with  both  cervical  and  endometrial  car- 


284 


Illinois  Medical  Journal 


cinomas  associated  with  fibroids  in  the  sec- 
ond and  third  decade  of  life  in  patients 
coming  for  an  infertility  problem  are  the 
basis  for  the  emphasis  on  these  simple  diag- 
nostic measures.  At  the  same  time  the  pres- 
ence of  submucous  fibroids,  of  hyperplasia 
and  polypi  or  atretic  areas  may  be  de- 
termined, The  guiding  surgical  principles 
are:  complete  hemostasis,  removal  of  as 
many  fibroids  as  possible  through  one 
uterine  incision,  even  invading  the  uterine 
cavity  for  the  submucous  type,  properly 
coapting  of  uterine  wall  edges  as  in  a 
cesarean  section,  results  in  good  wound 
healing;  redundant  uterine  muscle  should 
not  be  trimmed  because  it  usually  shrinks. 
Sutures  should  not  be  tight  or  too  close 
together  so  necrosis  will  not  occur.  The 
serosal  layer  sutured  with  #00  chromic 
catgut  should  leave  a smooth  surface  or 
a free  omental  transplant  may  be  used  to 
cover  the  wound  with  #0000  chromic  cat- 
gut to  tack  down  the  edges  of  the  trans- 
plant. The  vesicouterine  peritoneum  or  the 
round  ligaments  may  be  utilized  for  peri- 
tonealization  purposes.  Avoiding  adhesion 
of  the  small  bowel  to  the  wound  will  pre- 
vent a possible  future  bowel  obstruction. 
This  complication  becomes  serious  especial- 
ly during  pregnancy.  The  future  course  of 
pregnancy  is  usually  good  and  the  char- 
acter of  the  delivery  will  depend  on  the 
cephalopelvic  relationship,  the  position  and 
variety  of  the  presenting  part  as  well  as 
the  character  of  the  labor.  It  is  obvious 
these  women  in  labor  are  more  closely 
watched  and  under  proper  indications  ab- 
dominal delivery  is  anticipated  sooner  than 
in  a normal  uterus. 

The  fixed  retrodisplacement  of  the 
uterus  will  be  dealt  with  in  dealing  with 
the  tubal  factor. 

Common  Factors  in  Sterility 

The  most  common  factor  in  sterility  in 
the  female  has  been  tubal  obstruction  due 
to  infection.  The  diagnostic  procedures  of 
culdoscopy  and  pertinoscopy  play  an  im- 
portant part  in  revealing  tubal  obstruction 
in  the  absence  of  palpatory  findings.  Sal- 
pingograms are  necessary  obviously  in  de- 
termining the  sites  of  obstruction.  Hydro- 
tubation  may  be  utilized  in  conjunction 
with  the  above  mentioned  procedures  be- 
fore, during  and  after  surgery.  Colored 
liquids  may  be  used  to  guide  the  observer 
to  the  point  of  obstruction.  Therapeutic 


agents  introduced  via  hydrotubation  may 
be  spasmolytic,  mucolytic,  antibiotics  (large 
spectrum  antituberculous),  and  cortisone. 
The  aim  of  hydrotubation  is  to  release 
tubal  occlusion  and  promote  favorable 
changes  in  the  tubal  mucosa.  Since  partially 
open  tubes  do  not  necessarily  mean  func- 
tional tubes,  these  various  therapeutic 
agents  help  to  restore  normal  physiology 
of  the  tubes. 

When  the  medical  measures  fail  and 
culdoscopy  or  peritoneoscopy  reveal  ad- 
hesions, constricted  or  adherent  tubes  to 
ovary  or  surrounding  structures,  then  sur- 
gery is  required. 

Surgical  Procedures 

The  surgical  procedures  to  restore  patent 
tubes  are:  1.  salpingolysis;  2.  salpingostomy; 
3.  implantation  of  intact  patent  tubes  into 
the  cornua;  4.  end  to  end  anastomosis  after 
removing  the  impassable  obstruction  or 
after  a section  of  a tube  has  been  removed 
with  an  intact  tubal  pregnancy.  When 
there  is  no  tubal  conduit  available,  then 
the  ovary  may  be  transplanted  into  the 
cornuae  of  the  corpus. 

The  fine  fimbrae  of  the  tubes  when  ag- 
glutinated require  the  gentlest  manipula- 
tion with  sharp  dissection  to  achieve  fa- 
vorable results  by  salpingolysis,  the  mini- 
mal procedure  in  tubal  operations.  For 
salpingostomy  either  a cuff  or  linear  tech- 
nique as  well  as  end  to  end  anastomosis 
may  be  performed.  Not  only  gentle  hand- 
ling of  the  tissues  is  necessary  but  also  fine 
catgut  or  teflon  suture  (#0000  or  #00000) 
is  essential.  Having  achieved  patency,  re- 
tention is  the  ultimate  aim  of  all  these 
efforts.  The  postoperative  care  will  be  de- 
scribed later. 

Ovarian  Conditions 

The  ovarian  conditions  contributing  to 
sterility  and  requiring  surgery  are,  essen- 
tially, pelvic  inflammatory  disease,  neo- 
plasms, polycystic  ovaries  and  endometrio- 
sis. Although  being  repetitive,  it  is  impor- 
tant to  emphasize  sharp  dissection,  gentle 
manipulation,  finest  adequate  suturing 
hemostasis  and  supportive  procedures  for 
the  ovaries. 

The  ovaries  are  usually  involved  with 
the  tubes  in  pelvic  inflammatory  disease. 
In  post  gonococcal  infection,  adhesions  are 
readily  separated  and  the  ovarian  envelop 
of  adhesions  may  be  readily  removed.  How- 


for  September,  1968 


285 


ever,  the  postabortal  or  mixed  streptococcal 
infection  or  post  appendicial  type  are  more 
difficult  and  give  poor  postoperative  re- 
sults. One  must  be  alert  for  tuberculosus 
infection  adhesions  which  grossly  resemble 
the  nonspecific  type.  It  requires  keen 
judgment  to  allow  tuberculosus  pelvic 
structures  to  remain  and  to  depend  on 
chemotherapy  for  cure.  Burnt  out  ovarian 
abscesses  and  cysts  may  be  resected. 

Bilateral  dermoid  and  other  benign 
neoplasms  are  occasionally  encountered 
and  may  be  removed  by  resection,  retain- 
ing functioning  ovaries.  It  is  surprising  at 
times  what  small  portions  of  ovarian  tis- 
sue may  be  functional.  Therefore  all  ef- 
forts must  be  made  to  retain  ovarian  tis- 
sue. Only  in  the  presence  of  bilateral 
malignant  neoplasm  is  one  justified  in 
sacrificing  all  ovarian  tissue. 

It  is  common  knowledge  at  present 
that  the  polycystic  ovaries  (Stein-Leven- 
thal)  will  respond  to  careful  ovarian 
wedge  resection.  Normal  menstruation 
follows  in  90  percent  of  instances  and 
gives  about  60  percent  good  outlook  for 
pregnancy  to  follow. 

Progestin  Therapy = Surgery 

Currently  endometriosis  of  the  ovaries 
and  pelvis  are  subjected  to  progestin 
therapy  with  the  hope  of  resolution  of  the 
lesions  and  the  likihood  of  pregnancy  fol- 
lowing. When  this  expected  result  does  not 
occur  and  symptoms  or  infertility  persists 
after  an  adequate  time  interval  then  sur- 
gery is  indicated.  In  a recent  report  of  a 
large  series  of  infertile  patients  (283)  with 
endometriosis,  Alan  Grant  found  that  these 
patients  are  subject  to  a wide  range  of  as- 
sociated pelvic  disorders.  The  first  physi- 
ologic mechanism  to  deteriorate  is  that  of 
the  corpus  luteum.  Therefore  conserva- 
tive surgery  should  be  the  primary  treat- 
ment, with  progestrogens  a secondary 
therapeutic  measure.  Of  246  patients,  94 
or  38  percent  became  pregnant  (includ- 
ing nine  miscarriages  and  three  tubal 
pregnancies).  The  operative  procedures 
performed  are:  (1)  resection  of  ovaries, 

(2)  destruction  or  removal  of  implants  on 
the  pelvic  peritoneum,  (3)  usually  utero- 
sacral  ligament  reefing  to  give  better  sup- 
port to  the  ovaries  by  creating  better  fos- 
sae for  the  ovaries  to  rest  in  and  incident- 
ally decrease  the  dilatation  of  the  pampini- 


form venous  plexus.  Presacral  nerve  re- 
section may  also  be  considered.  The  short- 
ening of  the  uterosacral  ligaments  may 
also  help  the  position  of  the  retroverted 
or  retrocessed  corpus  uteri.  Less  common- 
ly the  Barrett  round  ligament  shortening 
operation  is  also  used. 

Although  the  anatomical  sites  of  the 
generative  tract  were  considered  separate- 
ly, not  infrequently  multiple  sites  may  be 
the  seat  of  pathology  requiring  surgical 
attention.  Therefore  it  is  important  to  in- 
clude all  sites  in  the  surgery.  Further  post- 
operative care  is  important  in  the  form  of 
hydrotubation.  Currently,  much  em- 
phasis has  been  put  on  hydrotubation 
postoperatively  as  well  as  preoperatively. 
Colored  (indigo  carmine)  fluid  in  hydrotu- 
bation helps  indentify  points  of  stricture 
and  obstruction  in  tubes.  The  dis- 
tal obstruction  is  found  five  times  more 
frequently  than  the  proximal.  The 
cornual  obstructions  accounts  for  % 
of  the  failures.  Hydrocortisone  hy- 
drotubation (10  mgms  in  50  ml.  of  norm- 
al saline)  is  suggested  by  several  investi- 
gators, about  three  times  in  ten  days  in 
the  hospital.  A Rubin  test  may  be  done 
immediately  after  the  first  period  follow- 
ing the  operation.  During  this  hospital 
stay  the  patient  is  covered  with  antibiotics 
and  antibacterial  agents.  To  reduce  pain- 
ful reactions,  phenergran  and  antispasmo- 
dics  are  utilized.  Some  suggest  a hydro- 
tubation (about  10  ml.)  mixture  of  peni- 
cillin, streptomycin,  soludecadron,  hyalu- 
ronidose  and  alpha-chymotrypin.  This 
mixture  is  slowly  injected  in  the  first  half 
of  each  cycle  following  the  plastic  sur- 
gery two  or  three  times.  The  aim  of  the 
hydrotubation  is  to  release  tubal  occlu- 
sion by  adhesions  following  surgery  and 
to  promote  favorable  changes  in  the  tubal 
mucosa. 

The  Rock-Mulligan  hoods  are  most  ef- 
fective in  keeping  the  fimbriated  ends 
open.  A secondary  operation  is  necessary 
in  two  or  three  months  to  remove  them. 

Recently  Hurteau  and  Bradley  have  re- 
ported experimental  studies  in  animals 
on  the  use  of  a mechanical  stapler,  com- 
parable to  that  used  for  anastomosis  of 
blood  vessels  and  ureters.  Although  there 
has  been  some  increase  in  success  in  the 
salpingolysis  procedures;  the  salpingo- 
stomy and  the  cornual  implants  still  give 
a low  percent  of  good  results.  An  open 


286 


Illinois  Medical  Journal 


tube  does  not  necessarily  mean  a func- 
tioning tube. 

Summary 

In  summarizing,  the  results  of  surgical 
effort  to  restore  fertility  are  least  reward- 
ing in  the  site  of  greatest  incidence  of 
etiologic  factors,  the  fallopion  tubes.  The 
prospects  for  organ  transplant  may  not  be 
too  far  in  the  future.  Dog  experimenta- 
tion suggests  that  clinical  uterine  ovarian 
homotransplantation  would  probably  be 
feasible  should  the  immunologic  rejection 
problems  be  solved. 

References 

1.  Ascherman,  J.  G.:  Amenorrhea  Traumatic 

(Atretica):  J.  Obst.  & Gynec.  Brit.  Emp.  5:23, 
1948. 

2.  Ibid:  Internat.  J.  Fertil.  2:49  1957. 

3.  Barter,  R.H.  and  Parks,  J.:  Myoma  Uteri  As- 
sociated with  Pregnancy,  Clin.  Obst.  & Gynec. 
1:519-533,  1958. 

4.  Bergman,  P.:  Treatment  of  Sterility  of  Intrau- 
terine Origin,  Clin.  Obst.  & Gynec.  3:852-861, 
1959. 

5.  Brett,  A.  J.  and  Legpros,  R.:  Evolution  of 
Treatment  of  Uterine  Corpus  Synechiae  of 
Traumatic  Origin,  Rev.  Fronc.  Gynec.  et  Obst. 
61:107-122  (March)  1966. 

6.  Eraslan,  S.  et.  al:  Successful  Pregnancy  After 
Experimental  Uterine- Ovarian  Replantation 
Arch.  Surg.  92:9-12,  1966. 

7.  Grant,  A.:  Additional  Sterility  Factors  in  En- 
dometriosis Fertil.  and  Sterility,  17:514,  1966. 

8.  Gruenberger,  V.:  Proc.  Second  World  Congress 
Fertil.  & Steril.  2:248,  1956. 


9.  Hayashi,  M.:  5th  World  Congress  of  Internal. 
Fertil.  Assoc.  Stockholm,  Sweden,  June  16-22, 
1966. 

10.  Hurteau,  G.  D.  and  Bradley,  G.:  Evaluation  of 
the  Stapled  Anastomosis  in  Experimental  Sal- 
pingoplasty. Fertil.  and  Sterility,  17:323,  1966. 

11.  Mackey,  R.:  5th  World  Congress  of  Internat. 
Fertil.  Assoc.  Stockholm,  Sweden,  June  16-22, 
1966. 

12.  Mulligan,  W.  J.,  Rock,  J.  and  Easterday,  C.  L.: 
Use  of  Polyethylene  in  Tuboplasty,  Fertil.  and 
Steril.  4:428-435.  1953. 

13.  Musset,  R.,  Netter,  A.  Solol,  R.:  Repercussion 
of  Traumatic  Uterine  Synechiae  on  Reproduc- 
tive Function,  Presse  Med.  73:2137,  1965. 

14.  Onetta,  E.,  Saavedra,  R.,  Crisosto,  C.  and  Ham- 
blen, E.  C.:  Treatment  of  Uterine  Synechiae 
with  Help  of  Iatrogenic  Pseudopregnancy: 
Anatomic  and  Functional  Results  Internat.  J. 
Fertil.  10:217,  1965. 

15.  Palmer,  R.:  5th  World  Congress  of  Internat. 
Fertil.  Assoc.  Stockholm,  Sweden,  June  16- 
22,  1966. 

16.  Pinto,  V.  B.:  Uterine  Synechiae  Rev.  Obst.  y 
Gynec.  Venezuela  25:272,  1965. 

17.  Roch,  J.:  Investigation  and  Treatment  of  In- 
fertility M.  Clin.  North  America  91:1171,  1948. 

18.  Rubin,  I.  C.:  Uterine  Fibromyomas  and  Steri- 
lity Clin.  Obstet.  & Gynec.  1:501-518,  1958. 

19.  Serdjukoff,  M.  G.:  Ber  Gynak.  28:551,  1935. 

20.  Siebke,  H.:  Zentralbl.  Gynak.  22:1034,  1941. 

21.  Steinberg,  W.:  Obst.  & Gynec.  Surv.  10:400, 
1954. 

22.  Strassman,  P.:  Zentrabl.  Gynak.  31:1322,  1907. 

23.  Strassman,  P.:  Zentrabl.  Gynak.  52:2626,  1930. 

24.  Strassman,  E.  O.:  Surgical  Reconstruction  of 
a Functioning  Uterine  Cavity  in  Six  Patients 
Having  Complete  Atresia  South.  Med.  Jour.  49: 
458-563,  1956. 

25.  Sweeney,  Wm.  J.:  Intrauterine  Synechiae  Obst. 
and  Gynec.  27:284,  1966. 

26.  Westman,  A.:  Am.  J.  Obst.  &:  Gynec,  61:15, 
1951. 


Utilization  Review  Guidelines  Suggested 


Utilization  review  is  the  sole  prerogative 
of  physicians  and  it  has  been  held  in  this 
context  in  the  implementation  of  Medicare 
programs.  The  Department  of  Public 
Health  has  formulated  basic  guidelines  up- 
on which  it  will  base  its  investigations  of 
utilization  review  committees.  These  rec- 
ommendations should  be  followed  by  all 
physicians  engaged  in  utilization  review  to 
obviate  difficulties  which  may  arise. 

Listed  below  are  the  recommendations. 
If  questions  regarding  phrasing  or  interpre- 
tation arise,  it  is  suggested  inquiry  be  made 
of  the  Department  of  Public  Health. 

1.  That  the  committee  meet  regularly 
and  that  minutes  be  kept  of  the  decisions. 

2.  That  the  committee  make  the  required 
review  of  the  long-stay  cases  within  7 days 
of  the  date  they  become  “long-stay’'  cases, 
as  defined  in  the  review  plan. 

3.  That  the  committee  conduct  the  re- 
quired review  on  a sample,  or  other  basis. 


of  admissions,  durations  of  stay,  and  pro- 
fessional services  rendered,  as  described  in 
the  written  utilization  review  plan. 

4.  That  physician  members  of  the  com- 
mittee consult  with  the  attending  physician 
prior  to  deciding  that  further  in-patient 
stay  is  not  medically  necessary. 

5.  That  the  committee  provide  timely 
written  notice  to  the  appropriate  parties 
when  it  determines  that  further  in-patient 
stay  in  a particular  case  is  not  medically 
necessary. 

6.  That  the  committee  be  composed  of 
at  least  two  or  more  physicians  with  or 
without  the  participation  of  other  profes- 
sional personnel. 

7.  That  the  committee  have  at  least  one 
member  who  has  no  financial  interest  in 
the  institution. 

These  guidelines  will  be  the  basis  upon 
which  the  Department  of  Public  Health 
will  base  its  investigations  of  utilization  re- 
view committees. 


for  September,  1968 


287 


Comprehensive  Health  Planning  in  Illinois 

By  Francis  J.  Weber,  M.D.,  Dr.  P.H. /Springfield 


I.  Besinninss  of  Health  Colloboration 
Efforts 

The  attempt  to  plan  comprehensively 
for  health  activities,  which  means  any  and 
all  such  efforts  for  which  the  state  is  of- 
ficially charged,  is  so  new  that  definable 
results  are  yet  to  appear.  Therefore,  the 
quickest  way  to  the  heart  of  the  matter 
rests  in  examination  of  what  governing  leg- 
islation provides  as  the  raison  d‘etre  for  pas- 
sage of  such  legislation. 

Comprehensive  Health  Planning  is  now 
provided  for  in  what  is  popularly  called 
the  “Partnership  for  Health”  program,  a 
new  undertaking  with  a legal  base  in  the 
1966  amendments  of  Public  Law  410  (79th 
Congress,  July  1,  1944)  under  which  the 
U.  S.  Public  Health  Service  operates.  The 
new  amendments  are  contained  in  Public 
Law  89-749  (89th  Congress,  November  1, 
1966). 

Many  will  recall  that  the  Public  Law  410 
mentioned,  after  its  July  1,  1944  enactment, 
came  to  be  regarded  as  a milestone  in 
health  legislation.  It  successfully  brought 
together  in  one  place  many  earlier  and 
separate  pieces  of  Federal  legislation  that 
authorized  vafious  public  health  and  medi- 
cal programs,  the  first  one  of  which  enabled 
establishment  of  the  U.  S.  Marine  Hospital 
Service  in  1798. 

Therefore,  we  can  say  a form  of  health 
partnership  emerged  early,  one  strength- 
ened in  succeeding  years,  beginning  with 
various  campaigns  to  eliminate  epidemic 
spread  of  communicable  diseases.  If  the 
19th  century  can  be  regarded  as  an  era  of 
basic  medical  discovery,  in  building  upon 
that  our  20th  century  has  been  forced  into 
an  ever  widening  circle  of  medical  and 
public  health  collaboration.  A Public 
Health  Service  Reorganization  Act,  even  as 
early  as  1902,  recognized  a need  for  a for- 
mal partnership  when  Congress  established 
the  Conference  of  State  and  Territorial 


Health  Officers  with  the  Surgeon  General. 

Besides  a growing  sense  of  partnership, 
in  which  organized  medicine  plays  a signi- 
ficant role,  one  can  read  into  accounts  of 
the  period,  deliberate  efforts  to  develop 
some  systematic  approach  to  health  prob- 
lems where  the  general  community  was  the 
focus  of  concern.  Soon  the  expanding  con- 
tent of  medicine  and  public  health  began 
to  be  reflected  in  many  interesting  ways. 
One  revealed  itself  in  our  increased  knowl- 
edge of  prevention,  a fruit  of  medical  re- 
search and  empirical  observations.  Its 
steady  growth  gave  sufficient  content  to 
render  feasible  organization  of  full-time 
state  and  local  health  departments.  Deliber- 
ate planning  was  provided  for  in  such  con- 
nections and  we  were  not  long  in  discover- 
ing that  good  results  in  this  type  of  effort 
depend  in  large  measure  on  wide  commun- 
ity involvement.  It  is  this  type  of  involve- 
ment we  hope  to  formalize  in  the  activity 
of  the  so-called  regional  (as  contrasted  with 
state)  comprehensive  health  planning  agen- 
cies to  be  described  later. 

In  any  case,  the  July  1,  1944  birth-date  of 
Public  Law  410,  (the  1966  amendments  of 
which  we  are  considering  here)  found  those 
of  us  who  were  members  of  medical  and 
public  health  professions  at  that  time,  in 
possession  of  certain  basic  elements  neces- 
sary to  sound  health  organization  and  well 
conceived  program  content,  ones  upon 
which  we  still  depend  to  provide  essential 
ingredients  for  comprehensive  health  plan- 
ning. These  include:  a body  of  medical, 
plus  other  forms  of  knowledge  relevant  to 
health,  that  lends  itself  to  disease  preven- 
tion via  health  protective  and  health  pro- 
motion measures;  an  awareness  of  environ- 
mental and  human  ecological  problems 
along  with  some  well  founded  notions  gov- 
erning employment  of  needed  corrective 
measures  in  solving  problems  resident 
within  that  realm;  the  beginnings  of  a 


2S8 


Illinois  Medical  Journal 


flourishing  research  effort  that  has  since 
proved  its  worth  in  dealing  with  an  altered 
disease  picture  w'hile  mounting  research  has 
provided  multiple  options  for  therapy;  and 
finally,  a good  understanding  of  what  an  or- 
ganization requires  in  various  special  areas 
when  it  arrives  at  the  actual  “doing”  stage. 

A point  is  made  of  such  developments 
because  the  planning  activities  we  are  to 
consider,  authorized  under  Public  Law  89- 
749,  represent  another  necessary  stage  in 
organized  health  work  as  an  outcome  of 
the  abundant  health  programs  Public  Law 
410  encouraged. 

II.  General  Provisions  for  Planning  as 
Contained  in  the  Form  of  Amend- 
ments to  Section  314,  Public  Law  410, 
78th  Congress  (1944) 

The  changes  in  Section  314  come  under 
the  title  of  “Comprehensive  Health  Plan- 
ning and  Public  Health  Service  Amend- 
ments of  1966”  and  have  been  designated 
collectively  as  Public  Law  89-749,  89th 
Congress  (1966).  Many  will  recall  that  Sec- 
tion 314  of  Public  Health  Law  had  enabled 
cooperative  work,  including  grants-in-aid 
to  public  and  other  non-profit  health  agen- 
cies, e.g.,  314  (a)  provided  support  for  the 
highly  successful  Venereal  Disease  Control 
effort  of  the  30’s  and  40’s,  314  (b)  author- 
ized comparable  activities  for  Tul^rculosis 
Control  starting  in  1944,  and  so  on.  For- 
tunately, experience  with  such  activities 
has  disclosed  certain  factors  that  need  be 
taken  into  account  once  communities  be- 
come concerned  in  particular  aspects  of 
health  status.  In  leaping  over  the  inter- 
vening period  to  nearly  a quarter  century 
later,  we  are  free  to  consider  what  the  1966 
legislation  on  health  planning  enables  us 
to  do. 

Provisions  for  the  “Conduct”  of  Com- 
prehensive Health  Planning 

: This  is  considered  under  three  subsec- 
tions of  89-749:  314  (a)  concerns  state  level 
planning,  including  financing  the  same; 
314  (b)  authorizes  “Project  Grants  for 
Areawide  Health  Planning,”  enabling  de- 
velopment of  Comprehensive  Health  Plans 
at  a regional,  metropolitan,  or  other  local 
area  level,  and  314  (c)  authorizes  “Project 
Grants  for  Training,  Studies  and  Demon- 
strations” to,  so  to  speak,  “improve  the 
state  of  the  art”  in  health  planning  fields. 


Formation  of  a Division  (the  State  Com- 
prehensive Health  Planning  Agency)  and 
a State  Advisory  Council 

Since  an  important  requirement.  Amend- 
ment (a)  to  314,  provides  for  a single  state 
comprehensive  health  planning  agency  be 
designated  by  the  Governor,  the  State  De- 
partment of  Public  Health  has  been  named 
Illinois’  official  health  planning  agency. 
Along  with  this  action  a Division  of  Health 
Planning  and  Resource  Development  was 
established  for  the  purpose  of  forming  an 
organization  capable  of  discharging  respon- 
sibilities assigned  through  this  legislation. 
An  important  one  of  these  consists  in  pre- 
paration of  an  Annual  State  Plan,  which 
will  take  into  consideration  all  aspects  of 
health  in  the  State,  one  which  is  also  ex- 
pected to  indicate  how  progress  toward 
health  goals  and  objectives  will  be  mea- 
sured and  evaluated.  Therefore,  compared 
to  past  Federal  requirements  for  planning 
document  submittal,  as  a condition  for  re- 
ceipt of  Federal  Grants-in-Aid  allotted  the 
Department,  the  present  requirement  for  a 
planning  document  calls  for  a much  broad- 
er scope  (as  befits  the  term,  “comprehen- 
sive”) as  well  as  one  with  more  detail.  An- 
other provision  (314  (a)  (2)  (B)  ) gives  the 
Governor  responsibility  to  form  a state 
health  planning  council,  one  which: 

a.  Is  so  organized  that  a majority  of  its 
members  represent  “consumers  of  health 
services,”  and 

b.  Renders  advice  to  the  state  health 
planning  agency  on  matters  coming  within 
its  purview,  including  review  of  the 
agency’s  annual  statewide  comprehensive 
state  plan. 

Gov.  Shapiro  brought  the  Illinois 
Health  Planning  Advisory  Council  into  be- 
ing May  28,  1968,  and  named  Dr.  Clifton 
L.  Reeder,  Chicago,  as  Chairman.  The 
Council  numbers  67  members. 


Dr.  Weber  is  Chief, 
Division  of  Health  Plan- 
ning and  Resource  De- 
velopment, Department 
of  Public  Health,  State 
of  Illinois, 


for  September,  1968 


289 


Comprehensive  Health  Planning  on  a 
Local  or  Regional  Basis. 

An  important  new  feature  in  health  plan- 
ning is  provided  for  under  another  amend- 
ment (of  Section  314)  enabling  regional, 
metropolitan  or  other  local  areas  that  qual- 
ify to  form  Comprehensive  Health  Plan- 
ning Bodies  via  Project  Grant  assistance. 
These  entail: 

a.  Federal  financing  up  to  75%  of  cost; 

b.  Grants  that  may  be  made  to  either 
governmental  or  voluntary  non-profit 
agencies  undertaking  plan  development, 
except  that  only  one  such  group  can  be  ac- 
corded official  state  recognition  for  any  one 
area.  Many  Illinois  communities  have  al- 
ready expressed  great  interest  in  forming 
regional  planning  groups  and  two  metropo- 
litan areas  have  progressed  to  the  point  of 
grant  application  submittal. 

Studies,  Demonstrations  and  Training 
Activities  in  Support  of  Comprehensive 
Health  Planning 

A third  amendment  (c)  to  Section  314 
enables  financing  of  activities  designed  to 
effect  improvements  “in  the  state  of  the 
art”  apropos  comprehensive  health  plan- 
ning: studies;  demonstrations;  training  ac- 
tivities. Qualified  public  or  private  non- 
profit organizations,  with  interest  in  im- 
proving health  planning  performance,  are 
eligible  for  sponsorship.  Thus  far  the  prin- 
cipal interest  has  been  in  applications  for 
educational  and  training  efforts.  While  this 
is  encouraging,  we  would  like  to  see  certain 
difficult  problem  areas  made  subjects  for 
study,  utilizing  this  type  of  project  support. 
There  is  an  opportunity,  especially  for 
county  medical  societies,  to  work  in  region- 
al comprehensive  health  planning,  and  to 
conduct  project  studies  as  a form  of  neces- 
sary applied  research.  Insights  gained  from 
such  studies  can  be  of  great  help  to  making 
planning  more  realistic  as  well  as  more 
helpful  to  the  public. 

Early  Indications  for  Organizational 
Emphasis 

Up  to  this  point,  we  have  considered  in 
just  the  briefest  fashion  the  principal  legal 
authorizations  for  health  planning,  plus  a 
few  early  steps  taken  under  them  toward 
organizing  Illinois  planning  functions. 
With  just  a few  months  in  which  to  carry 
out  such  things,  we  needed  to  assign  some 


order  of  priority,  in  terms  of  actions  de- 
m a n d i n g first  attention.  Now  that 
such  are  well  started,  increased  emphasis 
becomes  possible  for  work  in  what  may 
eventually  prove  to  be  the  most  significant 
part  of  the  statewide  program,  the  local 
areas. 

These  are  now  evincing  strong  in- 
terest in  organizing  for  comprehensive 
health  planning.  When  incorporated,  such 
groups,  sometimes  called  the  M4  (b)  agen- 
cies, (let  us  say  “B”)  must  evolve  as  well 
functioning  regional  units,  if  all  statewide 
objectives  are  to  be  adequately  met.  Be- 
cause of  the  multitude  of  health  programs 
now  impinging  on  the  local  scene  it  is  felt 
that  intimate,  day-to-day  local  involvement 
is  a necessity  for  long  term,  sound  health 
planning  and  management.  Physicians, 
through  their  official  organization  (or  in- 
dividually at  times),  must  be  at  the  center 
of  planning  organizations.  At  the  same 
time,  health  concerns  are  so  wide-spread  a 
confinement  of  planning  to  physicians  alone 
when  we  concern  ourselves  in  regional  or 
community-wide  planning  would  not  prove 
adequate.  On  the  contrary,  other  profes- 
sional bodies  with  direct  concern  (e.g., 
hospital  administrators  and  their  advisors), 
official  health  agencies,  welfare  associations, 
especially  those  with  public  responsibility 
for  medical  relief  of  low  income  families, 
need  also  be  associated  professionally. 

The  Matter  of  Legislative  “Intent” 

Because  of  the  effort’s  newness,  special 
attention  has  been  given  interpretation  of 
legislative  intent  underlying  various  pro- 
visions of  89-749,  especially  the  extent  to 
which  the  latter  might  modify  earlier  ones. 
Congressional  attitudes  in  these  respects 
are  probably  best  expressed  by  Section  2 
(a)  and  (b)  of  the  Act  under  “Findings  and 
Declaration  of  Purpose:” 

“Section  2 (a)  The  Congress  declares  that 
fulfillment  of  our  national  purpose  de- 
pends on  promoting  and  assuring  the  high- 
est level  of  health  attainable  for  every  per- 
son, in  an  environment  which  contributes 
positively  to  healthful  individual  and  fam- 
ily living;  that  attainment  of  this  goal  de- 
pends on  an  effective  partnership,  involv- 
ing close  intergovernmental  collaboration, 
official  and  voluntary  efforts,  and  participa- 
tion of  individuals  and  organizations;  that 
Federal  financial  assistance  must  be  di- 
(Continued  on  page  299) 


290 


Illinois  Medical  Journal 


Tour  of  President  of  ISMS 
Presents  Varied  Program 


Plans  for  the  new  enhanced  President’s 
Tour  ’68  programs,  starting  in  September, 
are  well  along. 

Blending  insights  into  vital  issues  with 
sociability,  programs  already  have  been  set 
for  Rockford  Sept.  10  and  Nov.  6;  Car- 
bondale  Sept.  24  and  25;  Alton  Oct.  2; 
Joliet  Oct  9;  Peoria  Oct.  10  and  11,  and 
Moline  Oct.  23. 

Highlights  at  each  place  will  be: 

*A  Workshop  on  Government  Health 
Programs,  to  show  physicians  and  medical 
assistants  how  to  file  claims  accurately  and 
get  prompter,  fuller  payments.  Representa- 
tives of  state  agencies  and  insurance  car- 
riers will  outline  procedures— and  answer 
questions— on  Medicare,  Medicaid,  (pub- 
lic aid)  and  combinations  of  the  two  . . . 
general  assistance,  vocational  rehabilita- 
tion, children  and  family  services,  and  mili- 
tary dependents  care  (CHAMPUS). 

*A  President’s  Dinner  for  physicians 
and  their  wives.  Dr.  Philip  G.  Thomsen, 
ISMS  president,  or  Dr.  Edward  W.  Can- 
nady,  president-elect,  will  talk  on  issues 
covered  in  the  questionnaire  mailed  to  all 
members  in  July,  and  tell  how  members 
voted.  A prominent  public  official  also 
will  speak. 

Dr.  Thomsen  or  Dr.  Cannady  also  will 
hold  press  conferences,  appear  on  radio  or 
television,  and  address  civic  clubs. 

At  most  places,  the  programs  will  be 
on  a district-wide  basis. 

As  this  issue  of  the  IMJ  went  to  press, 
the  schedule  included  the  following  ar- 
rangements: 

Rockford— Tuesday,  September  10: 
Talk  by  Dr.  Thomsen  to  Rockford  Ki- 
wanis  Club,  which  meets  at  12:10  p.m.  in 
Faust  Hotel.  President’s  Dinner,  Henrici’s 


Restaurant,  at  7 p.m.,  preceded  by  cocktail 
hour  and  concluding  with  addresses  by  Dr. 
Thomsen  and  a political  figure;  ISMS  and 
Winnebago  County  Medical  Society  will 
cosponsor  the  dinner.  Wednesday,  Nov.  6: 
W^orkshop  on  Government  Health  Pro- 
grams at  1 p.m.  in  Faust  Hotel. 

Carbondale— Tuesday,  Sept.  24:  Presi- 
dent’s Dinner  at  7 p.m.  (with  a 6 p.m.  re- 
ception) at  Holiday  Inn,  in  cosponsorship 
with  Jackson  County  Medical  Society;  ad- 
dress by  Dr.  Thomsen.  Wednesday,  Sept. 
25:  Workshop  on  Government  Health  Pro- 
grams at  1 p.m.  in  Holiday  Inn.  Noon  talk 
by  Dr.  Thomsen  to  Carbondale  Rotary 
Club. 

Alton— Wednesday,  Oct.  2:  Workshop 
at  1 p.m.  in  Stratford  Hotel.  President’s 
Dinner  in  co-sponsorship  with  Madison 
County  Medical  Society;  address  by  Dr. 
Cannady. 

Joliet— Wednesday,  Oct.  9:  Workshop 
at  1 p.m.  in  Howard  Johnson’s  Motor 
Lodge.  President’s  Dinner  there  at  7 p.m. 
(with  6 p.m.  reception);  address  by  Dr. 
Thomsen. 

Peoria— Thursday,  Oct.  10:  Workshop 
at  1:15  p.m.  Friday,  Oct.  11:  Speech  by  Dr. 
Thomsen  at  noon  luncheon  of  Peoria  Ro- 
tary Club.  President’s  Dinner  arrangements 
are  awaiting  completion. 

Moline— Wednesday,  Oct.  23:  "Work- 
shop at  1:15  p.m.  in  Holiday  Inn.  Presi- 
dent’s Dinner  at  same  motel,  with  address 
by  Dr.  Thomsen. 

Further  stops— to  be  announced  later 
—will  take  the  President’s  Tour  ’68-’69 
through  the  rest  of  the  state. 

Blue  Shield  Plan  of  Illinois  Medical 
Service  is  sponsor  of  the  manual  to  be  used 
by  registrants  at  the  workshops. 


New  Film  Catalog  Available 


International  Film  Bureau  Inc.,  332  S. 
Michigan  Ave.,  Chicago,  111.  60604,  an- 
nounced the  publication  of  a new  Health, 
Education  and  Welfare  catalog  containing 
descriptions  of  127  16mm  films  and  42 
filmstrips.  The  list  of  films  includes  such 
categories  as  Adolescence,  Aging,  Audio- 
visual Training,  Child  Care,  Community 
Health  Services,  First  Aid,  Health— Cigar- 


ette smoking.  Mental  Health,  and  Mental- 
ly Handicapped  Children.  The  filmstrips 
include  series  in  Character  Development, 
Child  Training,  and  Municipal  Govern- 
ment. For  copies  of  this  catalog  or  for  ad- 
ditional information,  WTite  to: 

International  Film  Bureau  Inc. 

332  South  Michigan  Avenue 
Chicago,  Illinois  60604 


for  September,  1968 


291 


ECONOMIC 

news 


A service  of  the  Public  Relations  and  Economics  Division 


Payments  to  M.  D/s 
Upped  by  Fee  For- 
mula, IDPA  Says 


ISMS  Disaster-Care 
Stand  Affirmed  in 
State  Senate 


More  Counties  Move 
Forward  In  Compre- 
hensive Planning 


Payments  to  Illinois  physicians  for  treating  Medicaid 
(public  aid)  recipients  are  more  than  double  the  total 
that  preceded  adoption  of  usual,  customary  and  reason- 
able fees,  said  Dr.  Henry  A.  Holle.  He  is  medical  director 
of  the  Illinois  Department  of  Public  Aid.  In  the  first 
five  months  of  each  year,  the  amount  was  $2,892,023  in 
1966;  $3,794,585  in  1967,  and  $7,349,134  in  1968.  The 
u-c-and-r  fee  pattern  became  effective  January  1,  1967, 
after  agreement  was  reached  between  IDPA  and  ISMS. 
While  the  case  load  went  up  from  346,743  in  April,  1966, 
to  425,508  last  April,  the  higher  payments  result  largely 
from  the  fee  formula— and  the  fact  that  this  formula  has 
encouraged  more  physicians  to  take  part  in  the  program. 
Dr.  Holle  said.  He  announced  the  payment  figures  at  the 
July  meeting  of  the  ISMS  Board  of  Trustees.  They  were  in 
line  with  predictions  made  by  Harold  O.  Swank,  IDPA 
director,  and  Dr.  Philip  G.  Thomsen,  now  ISMS  president, 
at  the  time  the  fee  pattern  was  adopted. 

The  Illinois  Senate  this  summer  adopted  a resolution 
calling  for  adequate  protection  of  medical  personnel,  hos- 
pital equipment  and  patients  during  civil  disorders.  It  is 
modeled  on  a resolution  voted  by  the  ISMS  House  of 
Delegates  in  May  and  later  by  the  AMA  annual  conven- 
tion. The  proposal  originated  in  the  ISMS  Committee  on 
Disaster  Medical  Care,  chaired  by  Dr.  Max  Klinghoffer. 


Will-Grundy,  Lake,  McHenry,  DuPage  and  Kankakee 
County  Medical  Societies  have  been  working  toward 
formation  of  an  areawide  council  for  comprehensive  health 
planning.  “In  other  areas  informational  meetings  are  being 
scheduled  and  local  planning  councils  are  being  formed,” 
Dr.  V.  P.  Siegel,  chairman  of  the  ISMS  task  force  on 
comprehensive  health  planning,  told  the  society’s  Board 
of  Trustees  in  July.  Already  well  along,  the  councils  in 
Cook  County  and  Greater  St.  Louis  (including  St.  Clair, 
Madison  and  Monroe  Counties,  111.)  have  applied  for 
federal  grants.  Made  up  of  consumers  as  well  as  providers 
of  health  services,  planning  councils  are  to  consider  the 
full  spectrum  of  health  needs  and  goals. 


292 


Illinois  Medical  Journal 


Clark  County  Doctors 
Get  ISMS  Nod  on 
Fee  Plan 


Shapiro  Urges  Local 
Role  in  Mental- 
Health  Care 


Cost  of  Minor  Surgery 
Up  50%  Over  1955 


ISMS  Malpractice 
Program  Stirs 
Nationwide  Interest 


The  ISMS  Board  of  Trustees  in  July  gave  its  assent  to 
a “test”  plan  proposed  by  Clark  County  physicians  who 
object  to  “accepting  assignment”  in  Medicare/Medicaid 
cases.  The  plan  calls  for  a uniform  arrangement  whereby 
the  Illinois  Department  of  Public  Aid  would  pay  the 
first  $50  of  each  patient’s  annual  bill  under  Medicare 
standards  . . , the  carrier  would  pay  80  per  cent  of 
the  remainder  . . . the  physician  would  absorb  the  final 
20  per  cent  . . . and  no  “assignment”  of  unpaid  bills 
would  be  necessary.  All  billings  would  be  under  usual, 
customary  and  reasonable  fee  formulas.  “We’re  giving 
the  service  for  nothing  now,”  said  Dr.  Eugene  P.  Johnson, 
president  of  Clark  County  Medical  Society.  To  put  the 
plan  into  effect,  the  Clark  gi'oup  would  need  approval 
from  IDPA  and  the  Social  Security  Administration.  “From 
our  standpoint,  some  of  the  bugs  on  deductible  amounts 
would  have  to  be  ironed  out,”  said  Dr.  Henry  A.  Holle, 
IDPA  medical  director.  If  implemented,  the  plan  might 
set  a pattern  for  other  counties,  said  Dr.  Johnson.  A com- 
parable program  exists  in  Indiana. 


Gov.  Samuel  H.  Shapiro  predicted  that  local  communi- 
ties will  assume  a much  more  important  role  in  the 
state’s  mental  health  program.  Addressing  the  Kiwanis 
Club  in  Chicago,  he  commended  recent  votes  in  various 
localities  to  set  up  mental  health  services.  The  short-term 
expense  of  such  services,  he  said,  is  more  than  offset  by 
the  patients’  earlier  return  to  a productive  life  “and  the 
decreasing  need  of  direct  care  and  family  assistance  fund- 
ing.” 


The  cost  of  minor  surgical  procedures  in  the  U.  S. 
has  risen  more  than  50  per  cent  since  1955,  according 
to  a study  conducted  by  the  Health  Insurance  Association 
of  America.  The  study  covered  charges  and  benefit  pay- 
ments under  group  insurance  plans.  It  found  that  some 
77  per  cent  of  covered  surgery  charges  last  year  were 
paid  under  group  insurance  contracts. 

Inquiries  from  many  out-of-state  physicians  have  greeted 
ISMS’  inception  of  a malpractice-insurance  program.  Sev- 
eral of  these  were  from  medical-society  officers,  who  said 
their  groups  might  sponsor  similar  coverage.  More  than 
30  physicians,  from  California  to  Virginia,  expressed  an 
eagerness  to  enroll  in  the  ISMS  program;  they  had  to 
be  told  that  only  ISAIS  members  practicing  in  Illinois 
could  enroll— partly  because  any  premium-rate  adjust- 
ments must  be  based  on  malpractice  experience  in  this 
state.  One  aim  of  the  program— which  took  effect  in  June— 
is  to  stabilize  rates  by  improving  the  Illinois  legal  climate 
and  discouraging  bogus  claims. 

-By  DON  B.  FREEMAN 


for  September,  1968 


293 


In  the  complex  picture 
of  moderate  to  severe  anxiety... 


there  is  a Inewl  reason 
for  prescribing  Mellaril 

* ^ (Thioridazine  HCl) 


effectiveness  in 
mixed  anxiety- depression 


Long  recognized  for  its  usefulness  in  the 
treatment  of  moderate  to  severe  anxiety, 
Mellaril  is  now  also  known  to  be  effective 
against  mixed  anxiety-depression. 

Often  the  symptoms  of  anxiety  states  are 
difficult  to  sort  out— even  with  the  most  careful 
probing.  The  patient  may  manifest  symptoms  of 
agitation,  restlessness,  insomnia,  somatic 
complaints.  But  what  of  the  depression  that  may 
be  mixed  in  the  total  picture?  It  is  reassuring 
to  know  that  Mellaril  may  be  prescribed— with 
strong  possibilities  of  success— when  there  is 
anxiety  alone  or  a mixture  of  anxiety 
and  depression. 


Before  prescribing  or  administering,  see  Sandoz 
literature  for  full  product  information,  including 
adverse  reactions  reported  with  phenothiazines.  The 
following  is  a brief  precautionary  statement. 
Contraindications : Severe  central  nervous  system 
depression,  comatose  states  from  any  cause, 
hypertensive  or  hypotensive  heart  disease  of 
extreme  degree. 

Warnings : Administer  cautiously  to  patients  who 
have  previously  exhibited  a hypersensitivity  reaction 
(e.g.,  blood  dyscrasias,  jaundice)  to  phenothiazines. 
Phenothiazines  are  capable  of  potentiating  central 
nervous  system  depressants  (e.g.,  anesthetics, 
opiates,  alcohol,  etc.)  as  well  as  atropine  and 
phosphorus  insecticides.  During  pregnancy, 
administer  only  when  necessary. 

Precautions : There  have  been  infrequent  reports  of 
leukopenia  and/or  agranulocytosis  and  convulsive 
seizures.  In  epileptic  patients,  anticonvulsant 
medication  should  also  be  maintained.  Pigmentary 
retinopathy  may  be  avoided  by  remaining  within  the 
recommended  limits  of  dosage.  Administer 
cautiously  to  patients  participating  in  activities 
requiring  complete  mental  alertness  (e.g.,  driving). 
Orthostatic  hypotension  is  more  common  in  females 
than  in  males.  Do  not  use  epinephrine  in  treating 
drug-induced  hypotension.  Daily  doses  in  excess  of 
300  mg.  should  be  used  only  in  severe 
neuropsychiatric  conditions. 

Adverse  Reactions:  Central  Nervous  System— 
Drowsiness,  especially  with  large  doses,  early  in 
treatment;  infrequently,  pseudoparkinsonism  and 
other  extrapyramidal  symptoms;  nocturnal 
confusion,  hyperactivity,  lethargy,  psychotic 
reactions,  restlessness,  and  headache.  Autonomic 
Nervous  System— Dryness  of  mouth,  blurred  vision, 
constipation,  nausea,  vomiting,  diarrhea,  nasal 
stuffiness,  and  pallor.  Endocrine  System— 
Galactorrhea,  breast  engorgement,  amenorrhea, 
inhibition  of  ejaculation,  and  peripheral  edema. 
Skin— Dermatitis  and  skin  eruptions  of  the  urticarial 
type,  photosensitivity.  Cardiovascular  System- 
Changes  in  the  terminal  portion  of  the 
electrocardiogram  have  been  observed  in  some 
patients  receiving  the  phenothiazine  tranquilizers, 
including  Mellaril  (thioridazine  hydrochloride). 
While  there  is  no  evidence  at  present  that  these 
changes  are  in  any  way  precursors  of  any  significant 
disturbance  of  cardiac  rhythm,  several  sudden  and 
unexpected  deaths  apparently  due  to  cardiac  arrest 
have  occurred  in  patients  previously  showing 
electrocardiographic  changes.  The  use  of  periodic 
electrocardiograms  has  been  proposed  but  would 
appear  to  be  of  questionable  value  as  a predictive 
device.  Other— A single  case  described  as 
parotid  swelling. 

Mellaril' 

(Thioridazine  HCl) 

25  mg.t.i.d. 

for  moderate  to  severe  anxiety 
and  mixed  anxiety-depression 

( 

i 

SANDOZ  PHARMACEUTICALS,  HANOVER,  N.  J. 


A 

SANDOZ 


Pre-Admission  Testing- A Blue  Cross  Proposal 


By  John  C.  Troxel,  M.D.,  Senior  Vice-President^  Medical  Director^ 
Blue  Cross/Blue  Shield/Chicago 


With  the  costs  of  hospital  care  rising 
and  many  facilities  strained.  Blue  Cross  and 
Blue  Shield’s  staff,  with  members  of  the 
medical  profession,  are  constantly  examin- 
ing ways  to  encourage  more  economic  use 
of  available  facilities  and  resources  while 
providing  maximal  benefits  for  its  mem- 
bers—at  minimal  costs. 

Many  people  talk  about  the  costs  of  hos- 
pital care  but  do  nothing  about  it.  Blue 
Cross  and  Blue  Shield,  assisted  by  phy- 
sicians and  hospital  administrators,  are 
trying  to  do  something  about  it. 

Members  of  the  medical  profession.  Uti- 
lization Review,  and  Admissions  Commit- 
tees have  worked  hard  to  eliminate  un- 
necessary admissions  and  to  reduce  the 
length  of  stays  in  the  hospital.  Changing 
concepts  and  advanced  techniques  have 
also  successfully  reduced  hospital  stays  in 
special  instances.  For  example,  early  am- 
bulation and  intensive  rehabilitative  pro- 
cedures for  surgical  cases  has  not  only  re- 
duced hospital  stays  but  also  has  short- 
ened the  length  of  disability  and  improved 
the  quality  of  care. 

Thoughtful  individuals  in  health  care 
financing  have  asked  themselves  “What 
further  can  we  do  or  suggest  which  may 
shorten  hospital  stays  without  compromis- 
ing the  quality  of  patient  care?’’  By  com- 
bining our  thinking  with  that  of  practic- 
ing physicians,  pathologists,  radiologists 
and  hospital  administrators  we  have  de- 
veloped a plan  which  has  the  potential  of 
shortening  the  “front-end”  of  some  hos- 
pital stays.  The  plan  is  called  “Pre-Ad- 
mission Testing  for  Surgical  Patients” 
or  PAT,  for  short.  It  has  been  in  effect  for 
some  time  at  a score  of  Illinois  hospitals 
who  wished  to  join  the  pilot  project— and 
it  works! 

The  plan  is  based  upon  the  customary 
practice  of  physicians  to  have  certain  tests 
and  examinations  made  before  they  under- 


take surgical  procedures— tests  which  are 
designed  to  reduce  surgical  risk  and  to 
provide  the  surgeon  with  information 
which  will  aid  in  accomplishing  his  surgi- 
cal task.  The  cost  of  such  tests  has  usually 
been  met  by  Blue  Cross  after  admission  to 
the  hospital  as  an  in-hospital  benefit.  We 
now  propose  to  make  the  same  benefits 
available  when  the  tests  are  performed  as 
hospital  out-patient  services. 

It  is  not  unusual  for  pre-surgical  testing 
to  require  one,  two  or  even  more  days  in 
some  instances,  and  when  performed  after 
admission  may  account  for  some  wasted 
bed-days  if  the  testing  program  could  have 
been  accomplished  just  as  well  on  an  out- 
patient basis.  These  are  the  days  we  seek  to 
save— if  they  can  be  saved  without  detri- 
ment or  serious  inconvenience  to  the  pa- 
tient. 

PAT  does  not  provide  a new  level  of 
Blue  Cross  benefits.  It  is  only  intended  to 
pay  for  tests  on  an  out-patient  basis,  which 
we  have  been  paying  all  along  on  an  in- 
patient basis.  It  should  be  clearly  under- 
stood that  PAT  is  not  an  out-patient  diag- 
nostic benefit  program.  (Blue  Cross  has  out- 
patient diagnostic  “riders”  to  its  basic  cer- 
tificates which  eligible  groups  may  pur- 
chase if  they  wish  such  coverage  and  are 
willing  to  pay  the  additional  price.)  PAT 
will,  however,  provide  the  physician  and 
his  hospital  with  a mechanism  which  can 
make  more  efficient  use  of  hospital  beds 
and  services. 

In  order  for  any  Blue  Cross  member  hos- 
pitals to  participate  in  PAT  its  medical 
staff  first  must  approve  the  program.  The 
hospital  administration  must  then  set  up 
facilities  and  services  to  implement  the 
program  and  notify  Blue  Cross  of  its  ar- 
rangements and  the  date  it  is  to  become 
effective. 

(Continued  on  page  304) 


for  September,  1968 


295 


Do  you  have  patients 
who  try  to  hide  anguish 
behind  arrogance? 


see  many  depressed  patients  who  hide 
their  real  anxieties  behind  a smoke  screen  of  pretense. 
The  more  they  try  to  conceal  reality,  the  more 
entrenched  the  disturbances  become.  The  role  they 
assume  is  not  adequate  to  suppress  their  inner  turmoil. 
Unchecked,  the  turmoil  finds  expression  in  other 
symptoms. 

They  want  your  help  and  Aventyl  HCl  can 
help  you. 

Whether  depression  is  open  or  secretive, 
Aventyl  HCl  assists  you  in  relieving  the  symptoms 
and  the  state  of  depression  itself.  It  may  aid  in 
removing  the  emotional  distortions  and,  in  lifting 
the  depression,  help  patients  face,  accept,  or  change 
their  life  patterns. 


Eli  Lilly  and  Company,  Indianapolis,  Indiana  46206 


Helps  remove  the  symptoms, 
lift  the  depression, 
and  release  the  patient 


AventyfHCl 

Nortriptyline 

Hydrochloride 


(See  last  page  for  prescribing  information.) 


Comprehensive  Health  Planning 


(Continued  from  page  290) 
rected  to  support  the  marshaling  of  all 
health  resources— national,  State,  and  local 
—to  assure  comprehensive  health  services  of 
high  quality  for  every  person  but  without 
interference  with  existing  patterns  of  pri- 
vate professional  practice  of  medicine,  den- 
tistry, and  related  healing  arts. 

(b)  To  carry  out  such  purpose,  and  rec- 
ognizing the  changing  character  of  health 
problems,  the  Congress  finds  that  compre- 
hensive planning  for  health  services,  health 
manpower,  and  health  facilities  is  essential 
at  every  level  of  government;  that  desir- 
able administration  requires  strengthening 
the  leadership  and  capacities  of  State 
health  agencies;  and  that  support  of  health 
services  provided  people  in  their  commun- 
ities should  be  broadened  and  made  more 
flexible.” 

Examination  of  this  statement,  especially 
the  terminal  phrases  of  2 (a),  should  do 
much  to  relieve  any  fears  regarding  an  ad- 
verse impact  on  private  professional  prac- 
tice. Rather  than  discerning  intentions  to 
inhibit  free  exercise  of  medical  practice,  we 
are  inclined  to  look  in  another  direction 
for  explanation  of  this  legal  emphasis  on 
health  planning.  In  so  doing,  we  are  struck 
by  the  many  types  and  varieties  of  health 
progi'ams  initiated  since  1944-45,  a majority 
of  these  federally  sponsored  and  still  grow- 
ing, that  now  converge  locally.  Studies  seem 
to  indicate  that  the  sheer  rise  in  number 
raises  certain  administrative  and  budgeting 
problems,  of  which  duplication  and  on- 
going services  overlap  are  commonly  cited. 

Public  Law  89-749  Provisions  for  “Serv- 
ices” 

Next,  two  other  amendments  in  Public 
Law  749  represent  an  effort  to  consolidate 
categorical  programs,  or  at  least  certain  as- 
pects of  them,  beginning  with  attempts  at 
administrative  consolidation. 

Historically,  Federal  grants  allotted  to 
States  have  been  weighted  by  certain  factors, 
as;  population,  financial  need,  and  extent 
of  the  problem.  In  that  way  the  relative 
amount  each  was  to  receive  from  a single 
categorical  appropriation  was  calculated. 
Until  89-749  amended  procedures  for  cate- 
gorical grants  via  part  (d)  applied  to  Sec- 
tion 314,  each  such  categorical  authority 


operated,  as  a general  rule,  its  own  fairly 
distinct  administrative  unit  under  a sep- 
arate authorization.  Currently,  nine  sep- 
arate authorizations  are  now  affected:  Gen- 
eral Public  Health  Services  (its  base  in  the 
original  Title  VI),  Tuberculosis  Control, 
Chronic  Disease  Services,  Heart  Disease 
Control,  Cancer  Control,  Mental  Health 
Services,  Dental  Health  Services,  Radiologi- 
cal Health  Services,  and  Home  Health 
Services.  Under  the  Amendment  (d)  each 
has  now  been  combined  into  one  “block” 
grant,  for  administrative  purposes.  The  law 
directs  that  at  least  15%  of  any  state’s  al- 
lotment must  be  remitted  to  the  state  men- 
tal health  authority  for  its  mental  health 
services. 

Health  Services  Development  Project 
Grants 

Subsection  (e)  amends  Section  314  to 
provide  these  project  grants  for  Health 
Services  Development.  These  are  available 
to  cover  part  of  the  cost  of:  services  that 
meet  health  needs  of  limited  geographic 
scope  or  of  specialized  regional  or  national 
significance;  and,  new  programs  of  health 
services  with  financial  support  confined  to 
an  initial  period.  These  aie  the  so-called 
“stimulatory”  grants. 

To  qualify  as  a “new  program”  of  health 
services  one  or  more  of  the  following  con- 
ditions must  be  met: 

a.  The  measures  to  be  employed  have 
not  been  applied  beyond  a successful  de- 
velopmental stage  and  demonstration; 

b.  The  measures  have  not  been  applied 
in  the  location  identified  by  the  applica- 
tion; or 

c.  The  measures  will  be  extended  to 
serve  a population  not  now  being  served. 

Program  “fragmentation”  at  executive 
levels 

In  providing  for  Comprehensive  Health 
Planning  at  the  State  (commonly  called  the 
“A”  agency)  or  at  a local,  regional  (“B” 
agency)  level,  we  must  be  concerned  Avith 
health  matters  generally  within  the  jurisdic- 
tion covered.  Therefore,  health  missions, 
goals,  objectives  and  the  general  methods 
by  which  such  are  to  be  advanced  are  prom- 
inent features  in  plan  preparation. 


for  September,  1968 


299 


Federal  requirements  call  for  submission 
of  such  a Plan  annually.  This  has  been 
done  for  the  first  year  of  operation  in  Il- 
linois (F.  Y.  1968)  as  well  as  the  present 
fiscal  year,  ending  June  30,  1969.  As  re- 
gional or  areawide  (“B”  type  agencies) 
come  into  being,  it  is  expected  that  these, 
too,  will  prepare  such  plans. 

At  the  same  time,  it  must  be  pointed  out 
that,  as  matters  now  stand,  guidelines  set 
forth  in  the  State  “A”  Plan  (and  this  may 
be  found  to  affect  “B”  agencies  as  well) 
have  only  limited  application  over  the  full 
range  of  federally  supported  health  pro- 
grams conducted  in  several  States.  As  a 
prominent  Public  Health  official.  Dr.  R.  L. 
Smith,  states:  “It  is  obvious  that  the  health 
services  money  contained  in  Section  314 
(d)  and  (e),  which  must  be  spent  in  ac- 
cordance with  plans  made  by  the  State 
Comprehensive  Health  Planning  Agency,  is 
only  a fraction  of  the  health  services  money 
coming  from  the  Department  of  Health, 
Education,  and  Welfare  to  the  State.  Other 
funds  from  the  Public  Health  Service, 
Children’s  Bureau,  Bureau  of  Family  Serv- 
ices, Vocational  Rehabilitation  Administra- 
tion, and  the  Social  Security  Administra- 
tion also  support  health  services  in  the 
State.  However,  Public  Law  89-749  does  not 
require  that  these  other  HEW  funds  be 
spent  in  accordance  with  plans  made  by 
the  State  Comprehensive  Health  Plan- 
ning Agency.” 

“This  fragmentation  of  Federal  health 
dollars  extends  beyond  the  Department  of 
Health,  Education  and  Welfare.  Depend- 
ing on  how  they  are  counted,  there  are  40 
to  100  different  Federal  programs  funnel- 
ing  dollars  into  States  in  the  health  area. 
Each  of  these  funds  are  interrelated.  They 
are  also  interwoven  at  the  point  of  delivery 
with  State  and  local  funds,  and— largest  of 
all— with  private  dollars.  There  is  also  a 
great  deal  of  separate  planning  being  car- 
ried out  for  each  of  these  programs.” 

Dr.  Smith  then  proceeds  to  suggest:  “The 
State  Comprehensive  Health  Planning 
Agency  is  the  mechanism  through  which 
total  health  planning  for  the  State  can  be 
done,  and  it  is  the  mechanism  that  can  rec- 
ommend to  the  executors  of  State  health 
programs  the  optimum  health  services 
which  should  exist  for  the  citizens  of  the 
State.” 

Prom  a consideration  of  such  material, 
one  is  apt  to  conclude  that  were  we  with- 


out a state  health  planning  agency,  one 
might  still  want  to  consider  creation  of 
some  general  coordinating  mechanism  like 
it  to  deal  with  the  proliferation  of  health 
programs  observed  throughout  present  day 
governmental  structure.  As  it  is,  one  might 
say  of  the  current  effort  to  begin  Illinois’ 
State  Comprehensive  Health  Planning,  it 
has  begun  at  the  highest  possible  executive 
levels— gubernatorial  appointment  of  an 
Advisory  Council  accompanied  by  creation 
of  a Division  to  devise  workable  plans  for 
State  and  regional  levels  of  operation— and 
all  of  this  in  close  working  association  with 
professional  organizations,  of  which  the 
Illinois  State  Medical  Society  is  a leading 
one.  The  latter’s  very  able  Task  Eorce  on 
Health  Planning  under  the  chairmanship 
of  Dr.  V.  P.  Siegel  is  one  evidence  of  the 
way  other  involved  professional  groups 
view  the  need  for  effective  partnership  be- 
tween governmental  and  private  interests 
in  this  increasingly  complex  field  of  health. 

The  Congress  has  sometimes  been  rather 
specific  in  conveying  its  attitudes  towards 
certain  earlier  established  programs,  which 
have  included  specific  planning  functions 
as  part  of  their  operations;  for  example,  in 
that  part  of  its  Report  on  the  Bill  cover- 
ing the  relationship  of  comprehensive 
health  planning  to  other  planning  activi- 
ties under  Labor  and  Public  Welfare  (No. 
1655,  September  29,  1966  that  accompanied 
S.  3008)  we  read: 

“The  comprehensive  planning  of  the 
State  Health  Planning  Agency  with  the 
advice  of  the  Council  would  complement 
and  build  on  such  specialized  planning  as 
that  of  the  Regional  Medical  program  and 
the  Hill-Burton  program,  but  would  not 
replace  them  . . .” 

“The  State  Health  Planning  Agency  pro- 
vides the  mechanism  through  which  indi- 
vidual specialized  planning  efforts  can  be 
coordinated  and  related  to  each  other.  The 
agency  will  also  serve  as  the  focal  point 
within  the  State  for  relating  comprehen- 
sive health  plans  to  planning  in  areas  out- 
side the  field  of  health,  such  as  urban  re- 
development, public  housing,  and  so  forth.” 

The  relationship  with  Hill-Burton  pro- 
grams is  quite  close  because  of  the  activity 
of  a Hospital  Eacilities  Division  responsible 
for  continued  prosecution  of  that  program 
within  the  same  Department  as  the  Plan- 
ning Agency.  Even  here,  however,  we  note 
(Continued  on  page  334) 


300 


llUnois  Medical  Journal 


We  put 
a cow  into 
a computer* 


It  came 
out  a hog* 


Our  Farm  Management  team  converted 
a dairy  farm  to  a hog-and-corn  operation 
— and  beefed  up  the  owner’s  profits. 

Remarkable  things  like  this  can  happen 
when  an  investor  or  owner  places  a farm 
in  the  hands  of  The  Northern  Trust. 

A case  in  point:  A large  dairy  operation 
returning  less  than  $50,000  per  year.  Our 
agricultural  specialists  made  a thorough 
inspection,  evaluated  the  profitability  of 
each  operation,  and  considered  all  the 
activities  that  might  be  added. 

Using  computers,  we  determined  which 


combination  would  produce  the  optimum 
profit:  in  this  case,  hogs-corn-soybeans. 
With  modern  farm  techniques  employed 
under  our  first-hand  supervision,  net  in- 
come has  increased  over  300%. 

Success  may  not  always  be  this  phe- 
nomenal. But  the  gains  in  efficiency, 
income,  and  investment  yield  have  been 
consistent  and  substantial  for  the  many 
thousands  of  acres  we  manage. 

For  full  information,  write,  call,  or  visit 
James  Conner,  of  the  Bank’s  Farm  Man- 
agement group.  Or,  fill  out  coupon  below. 


NORTHERN 


TRUST 

COMPANY 

BANK 


NORTHWEST  CORNER  LASALLE  « MONROE 

Chicago  80690  • Financial  6-SSOO  . Member  F.O.I.C. 


Farm  Management  Division 

The  Northern  Trust  Bank 

50  S.  LaSalle  Street,  Chicago,  Illinois  60690 

Please  send  me  your  booklet,  “Farm  Management.” 


Name_ 


Address. 
City 


_State_ 


-Zip- 


Telephone  Number. 


/or  September,  1968 


SOS 


Pre-Admission  Testing 

(Continued  from  page  295) 

PAT  works  this  way:  After  the  surgical 
diagnosis  has  been  established,  the  surgical 
procedure  scheduled  and  the  patient’s  room 
reserved  by  the  hospital,  the  physician  or- 
ders those  tests  and  examinations  which  he 
considers  to  be  necessary  before  surgery  is 
undertaken.  The  patient  is  instructed  to  re- 
port at  a scheduled  time  and  specific  place 
in  the  hospital  where  the  tests  are  to  be 
completed.  The  results  of  the  tests  are  re- 
ported to  the  physician  and  are  made  a 
part  of  the  hospital  chart  at  the  time  of 
admission.  Charges  for  the  tests  are  billed 
by  the  hospital  to  Blue  Cross  as  a part  of 
the  bill  for  in-hospital  care  according  to 
the  benefit  provisions  of  the  patient’s  Blue 
Cross  certificate. 

The  time  period  prior  to  admission  dur- 
ing which  the  tests  and  examinations  are 
to  be  made  is  determined  by  the  medical 
judgment  of  the  responsible  physician. 
Obviously,  most  tests  should  be  made  as 
close  to  admission  date  as  practicable  in 
order  that  the  test  results  may  be  complete- 
ly dependable. 

When  the  pre-admission  tests  are  per- 
formed at  the  hospital  where  the  patient  is 
to  be  operated  upon,  the  only  circumstan- 
ces under  which  Blue  Cross  will  not  make 
payments  are  for  the  establishment  of  the 
diagnosis,  research,  case  finding,  surveys  or 
when  the  patient  refuses  the  operation 
which  his  physician  has  advised  and  sche- 


duled. Even  when  the  operation  must  be 
cancelled  or  postponed  for  any  reason  out- 
side the  patient’s  control.  Blue  Cross  will 
still  make  payment  for  the  tests  and  when 
the  operation  is  re-scheduled  will  make  the 
same  benefits  available  again. 

It  is  hoped  that  all  Illinois  hospitals  will 
adopt  pre-admission  testing  for  all  elective 
surgical  admissions,  not  for  such  Blue  Cross 
admissions  alone.  We  believe  that  signifi- 
cant savings  in  bed-days  and  alleviation  of 
bed  shortages  can  be  achieved  and  if  uni- 
versally adopted  would  have  the  effect  of 
creating  hundreds  of  additional  hospital 
beds  and  reducing  the  need  for  costly  new 
construction. 

PAT  should  help  to  relieve  the  peak 
loads  on  hospital  clinical  laboratory  and 
X-ray  departments  by  permitting  the  sche- 
duling of  tests  during  slack  periods.  Attend- 
ing physicians  would  be  assured  of  test  re- 
sults well  in  advance  of  the  scheduled  oper- 
ation. The  time  patients  would  need  to  be 
away  from  their  families  and  their  gainful 
employment  would  be  shortened. 

We  also  view  PAT  as  a way  of  stretching 
health  care  dollars  by  substituting  less  cost- 
ly out-patient  services  for  more  costly  in- 
patient services.  We  invite  all  Illinois  phy- 
sicians and  their  hospitals  to  consider  this 
proposal  seriously.  Blue  Cross  representa- 
tives are  available  to  meet  with  medical 
staffs  so  that  we  can  combine  our  efforts  in 
making  PAT  a successful  and  effective  pro- 
gram throughout  Illinois. 


Enrollment  in  Blue  Shield’s  Usual  and  Customary  Pro- 
gram—which  uses  the  ISMS  definition  of  usual,  customary 
and  reasonable  fees— has  increased  fivefold  since  its  in- 
ception. Starting  with  employees  of  U.  S.  Steel  in  August, 
1967,  the  program  last  July  gained  200,000  members  of 
Health  Improvement  Association,  which  consists  of  rural 
families.  The  health-insurance  coverage  is  offered  to  groups 
of  all  ages. 


Board  of  Trustees  to  Meet  Downstate 

The  ISMS  Board  of  Trustees  will  meet  in  Springfield  October  5. 
The  meeting  will  preceed  the  Annual  ISMS  Leadership  Conference 
being  held  at  the  St.  Nicholas  Hotel,  Springfield,  on  October  6. 

The  Board  is  meeting  at  this  downstate  location  under  the  new 
proposal  that  it  meet  outside  the  Chicago  area  at  least  once  a year 
to  enable  downstate  physicians  to  attend. 


304 


Illinois  Medical  Journal 


“Will  i ever 
catch  up  on 
my  work?” 


n M I®  tablets:  

■ grain) ' 

IVICrU^H  ^31  ^^W^grain) 

" " * ■ 100  mg (1V2  grains) 

brand  of 

nriephobarbital 

Aj£^endable  daytime  sedation 


MebarsP  usi  ally  cafms  the  anx- 
ious patient  withoi't  the  degree 
of  languor,  or  decrease  in  alert- 
ness often  casissd  by  other  bar- 
bituratesJ  Mebaral  is  particularly 
valuable  In  treating  anxiety-ten- 
sion states  when  minima!  hypnot- 
ic action  is  desired.^  Its  sedative 
action  is  pro^angeds  end  pre- 
dictable. 


Contraindication:  La  ge  coses  are 
contraindicated  ;n  cacects  with 
nephritis. 


Warning:  Msy  be 

-'ormmg.' 

Precautions:  As  . 

i.  . 0 "er  barb!- 

turates,  caul  cn  :c 

ab' ioacle  dur- 

ing  use  in  debilitated  senile 

patients  and  :n  ps 
monary  disease. 

bent:  v'itn  pul- 

Adverse  rear'’ 

cc.  A ;Hcugh’ 

Mebaral  isge'-e  a 

' o'e.aied 

over  long  per;:  cs. 

' p - n;'r;oipy|tV 

of  idiosyncrasy  :o 

w A:t:-'33  ;; as 

manifested  b:.:; 

: ■■  e:.c. 

tigo,  and  cuis  - 

- JC  L-C.es) 

should  be  cc:*  '‘  ■ ■ 

ri 

Dosage:  >4c' 

■ • • - .-jada- 

tion— V2  g^.  ':Z 

' y ■ icTig.') 

,and,<  at  lircec,  ‘ 
three  or  fcio'  l "- 

y ; OL  mg.). 

References:  C 

kagel.  Bet.>  l.  ■ , 

■:-ry  ''’■0  m-.i-raceii- 

tics,  ed.  S.  N'v,'  : r, 

Coi-'-aov, 

->965,  p.  363.  Co  :v 

n ,-',r,er'cAn 

Medics;  As?'c; - 

:C:  m?5. 

cago.  Amer  cso  -cl 

or.f-,'-,  1955, 

D.  15".  3.  '.’c.:- 

1 ; ; : ■ n Cur- 

reel  Use  i';*  ' _ iK, 

Ccmr.ar.y,  '1'5  p 

■ ; 'u'eri'-ing 

Winthrep  Lacc  f 
New  Yo'-c,  , 

ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 


By  Phyllis  Bredthauer,  CMA 


The  American  Association  of  Medical 
Assistants  is  only  12  years  old.  It  was 
formed  in  1956  by  a dynamic  group  of 
women  who  had  the  desire  to  continue 
their  education  and  improve  their  knowl- 
edge and  skills  while  working  as  medical 
assistants.  Few  girls  had  formal  training, 
but  learned  to  be  medical  assistants  under 
the  guidance  of  their  physician  employers. 
The  organization  is  frequently  abbreviated 
as  AAMA.  It  has  been  closely  associated 
with  the  American  Medical  Association. 
Members  of  the  AMA  helped  to  organize 
and  continue  to  guide  AAMA.  Doctors 
serve  as  advisors  not  only  to  AAMA,  but 
to  the  County  and  State  organizations  as 
well. 

The  duties  of  a medical  assistant  can  be 
quite  varied  depending  upon  the  type  of 
office  or  hospital  in  which  employed.  As  a 
good  medical  assistant,  one  should  have  a 
basic  knowledge  of  medical  terminology 
and  an  understanding  of  anatomy  and 
physiology.  One  should  be  thoroughly  ac- 
quainted with  the  spelling  and  meaning  of 
commonly  used  prefixes,  suffixes  and  root 
words  as  well  as  their  combining  forms. 
One  should  have  some  knowledge  of  the 
most  common  diseases  which  affect  the  dif- 
ferent organs  and  be  able  to  recognize 
which  part  of  the  body  is  involved  in  com- 
mon surgical  procedures. 

The  medical  assistant  should  be  aware 
of  what  constitutes  acceptable  professional 
and  personal  conduct  and  recognize  indi- 
vidual responsibilities  to  the  community. 
Personal  qualifications  should  include 
physical  fitness,  appropriate  appearance 
and  grooming,  and  good  personal  hygiene. 
A mature  and  pleasant  personality,  emo- 
tional stability,  and  unquestionable  in- 
tegrity are  requisite. 

Medicine  is  an  art  as  well  as  a science. 


Being  an  effective  medical  assistant  is  also 
an  art.  You  must  be  able  to  put  the  patient 
at  ease  and  gain  his  confidence.  The  medi- 
cal assistant  needs  to  know  how  to  handle 
appointments  of  both  a professional  and 
non-professional  nature  and  should  under- 
stand basic  telephone  techniques  regard- 
ing voice,  tone,  diction,  and  courtesy.  You 
are  expected  to  speak  properly  and  gram- 
matically, and  to  be  able  to  exercise  prac- 
tical judgment,  especially  in  an  emergency. 

An  Assistant  should  have  a broad  work- 
ing knowledge  of  the  manner  in  which 
the  law  affects  the  practice  of  medicine, 
and  also  have  a general  knowledge  of  the 
economics  of  medicine.  As  a medical  assist- 
ant, one  should  have  a general  knowledge 
of  Medical  Practice  Acts,  professional  lia- 
bility, and  the  legal  relationship  of  phy- 
sician and  patient.  One  should  know  the 
different  types  of  medical  practice,  the 
systems  of  medical  care,  and  the  basis  for 
determining  fees. 

Sometimes  the  amount  of  knowledge  and 
the  amount  of  work  seems  overpowering 
to  a prospective  medical  assistant.  How- 
ever, the  AAMA  offers  education,  counsel 
and  guidance  which  allows  one  to  increase 
one’s  efficiency  and  knowledge  and  sur- 
mount seemingly  impossible  work  loads. 
There  are  many  benefits  from  membership 
in  the  AAMA.  These  include:  publications 
like  the  AAMA  Bulletin— a professional 
journal  which  helps  you  to  keep  abreast  of 
new  aspects  of  medical  assisting  and  up  to 
date  on  AAMA  activities  throughout  the 
nation;  local  chapter  meetings  at  which 
you  may  listen  to  an  expert  on  a particular 
subject  of  interest  to  medical  assistants. 

Physicians  are  encouraged  to  have  their 
assistants  become  members  of  this  impor- 
tant group. 


306 


Illinois  Medical  Journal 


IRON  DEFICIENCY 


ik 

lakeside  LABORATORIES,  INC.,  Milwaukee,  Wisconsin  53201 


IN  BRIEF:  ACTION  AND  USES:  A single  dose  of  Imferon  (iron  dex- 
tran  injection)  will  measurably  begin  to  raise  hemoglobin  and  a 
complete  course  of  therapy  will  effectively  rebuild  iron  reserves. 
The  drug  is  indicated  only  for  specifically-diagnosed  cases  of  iron 
deficiency  anemia  and  then  only  when  oral  administration  of  iron 
is  ineffective  or  impractical.  Such  iron  deficiency  may  include: 
patients  in  the  last  trimester  of  pregnancy;  patients  with  gastro- 
intestinal disease  or  those  recovering  from  gastrointestinal  sur- 
gery; patients  with  chronic  bleeding  with  continual  and  extensive 
iron  losses  not  rapidly  replenishable  with  oral  iron;  patients 
intolerant  of  blood  transfusion  as  a source  of  iron;  infants  with 
hypochromic  anemia;  patients  who  cannot  be  relied  upon  to  take 
oral  iron. 

COMPOSITION:  Imferon  (iron  dextran  injection)  is  a well-tolerated 
solution  of  iron  dextran  complex  providing  an  equivalentof  50  mg. 
in  each  cc.  The  solution  contains  0.9%  sodium  chloride  and  has 
a pH  of  5.2-6.0.  The  10  cc.  vial  contains  0.5%  phenol  as  a pre- 
servative. 

ADMINISTRATION  AND  DOSAGE:  Dosage,  based  upon  body  weight 
and  Gm.  Hb/lOO  cc.  of  blood,  ranges  from  0.5  cc.  in  infants  to 
5.0  cc.  in  adults,  daily,  every  other  day,  or  weekly.  Initial  test 
doses  are  advisable.  The  total  iron  requirement  for  the  individual 
patient  is  readily  obtainable  from  the  dosage  chart  in  the  package 
insert.  Deep  intramuscular  injection  in  the  upper  outer  quadrant 
of  the  buttock,  using  a Z-track  technique  (with  displacement  of 
the  skin  laterally  prior  to  injection),  insures  absorption  and  will 
help  avoid  staining  of  the  skin.  A 2-inch  needle  is  recommended 
for  the  adult  of  average  size. 

SIDE  EFFECTS:  Local  and  systemic  side  effects  are  few.  Staining 
of  the  skin  may  occur.  Excessive  dosage,  beyond  the  calculated 
need,  may  cause  hemosiderosis.  Although  allergic  or  anaphylac- 
toid reactions  are  not  common,  occasional  severe  reactions  have 
been  observed,  including  three  fatal  reactions  which  may  have 
been  due  to  Imferon  (iron  dextran  injection).  Urticaria,  arthral- 
gia, lymphadenopathy,  nausea,  headache  and  fever  have  occa- 
sionally been  reported. 

PRECAUTIONS:  If  sensitivity  to  test  doses  is  manifested,  the 
drug  should  not  be  given.  Imferon  (iron  dextran  injection)  must 
be  administered  by  deep  intramuscular  injection  only.  Inject  only 
in  the  upper  outer  quadrant  of  the  buttock,  not  in  the  arm  or 
other  exposed  area. 

CONTRAINDICATIONS:  Imferon  (iron  dextran  injection)  is  contra- 
indicated in  patients  sensitive  to  iron  dextran  complex.  Since  its 
use  is  intended  for  the  treatment  of  iron  deficiency  anemia  only 
it  is  contraindicated  in  other  anemias. 

CARCINOGENICITY  POTENTIAL:  Using  relatively  massive  doses, 
Imferon  (iron  dextran  injection)  has  been  shown  to  produce  sar- 
coma in  rats,  mice  and  rabbits  and  possibly  in  hamsters,  but  not 
in  guinea  pigs.  The  risk  of  carcinogenesis,  if  any  in  man,  follow- 
ing recommended  therapy  with  Imferon  (iron  dextran  injection) 
appears  to  be  extremely  small. 

SUPPLIED:  2 cc.  ampuls,  boxes  of  10;  5 cc.  ampuls,  boxes  of  4; 
10  cc.  multiple  dose  vials. 

See  package  insert  for  complete  prescribing  Information. 


Each  10  CC.  vial  provides  as  much  iron  as  2 pints 
of  whole  blood.  And  use  of  IMFERON  rather  than 
whole  blood  for  iron  replacement  eliminates 
the  potential  dangers  of  hepatitis  and  whole  blood 
sensitivity  reactions.  Whole  blood,  of  course, 
should  be  used  if  clearly  indicated. 

IMFERON  dependably  increases  hemoglobin 
and  rapidly  replenishes  iron  reserves— 
for  iron  deficient  patients  in  whom  oral 
iron  is  intolerable,  ineffective  or  impractical, 
and  in  those  who  cannot  be  relied  upon 
to  take  oral  iron  as  prescribed. 

Precise  dosage  is  easily  calculated. 


for  September,  1968 


307 


ILLINOIS  ASSOCIATION 

OF  THE  PROFESSIONS 


FIFTH  ANNUAL  MEETING 
of  the 

ILLINOIS  ASSOCIATION  OF  THE  PROFESSIONS 

October  11,1 968 

Board  of  Directors  Dinner  Meeting 
Thursday,  October  10,  1968  - 6:00  p.m. 

Annual  Meeting 

Friday,  October  1 1,  1968  - 9:00  a.m.  - 5:00  p.m. 
Ambassador  East  Hotel,  Chicago,  Illinois 
Program— Key  Luncheon  Speaker 

Special  Guests— Deans  of  Professional  Schools  in 
Illinois 

Officers  of  Member  Organizations 
Ladies  are  most  cordially  invited  to  attend  the  meeting 
and  functions. 

Prepaid  Prescriptions 

Negotiations  are  continuing  between 
Blue  Cross  of  Illinois  and  the  Illinois  Phar- 
maceutical Association  leading  toward  the 
implementation  of  a third-party  payment 
program  for  prescription  drugs,  with  ad- 
ministration provided  by  Blue  Cross. 

It  is  estimated  that  by  1970  over  70%  of 
prescriptions  dispensed  will  be  paid  for  by 
a third  party.  With  UAW  employees 
scheduled  to  receive  prescription  drugs  by 
October  of  1969,  it  is  expected  that  such 
benefits  for  other  union  members  will 
quickly  follow. 

lAP  Membership 

Martin  Sopocy,  R.Ph.,  Chairman  of  the 
lAP  Membership  Committee,  and  his  Com- 
mittee are  currently  involved  in  a campaign 
to  retain  existing  and  obtain  new  members. 

The  theme  of  the  drive  states  one  of  the 
major  objectives  of  lAP,  “To  provide  the 
organizational  machinery  whereby  the  com- 
bined strength  and  counsel  of  all  profes- 
sions can  be  utilized  for  the  advancement 
of  professional  ideals  and  the  promotion  of 
professional  welfare.” 


A recent  survey  reveals  that  a relatively 
small  percentage  of  professional  association 
members  in  Ohio  attend  their  annual  con- 
ventions. The  survey  included  Architects 
(9%),  CPAs  (7%),  Engineers  (10%),  At- 
torneys (10%),  Dentists  (23-30%^),  M.Dls 
(20%),  Pharmacists  (16%),  Optometrists 
(33%),  and  V eterinariens  (63%). 


AAP  Launched 

Eighteen  professional  men,  representa- 
tive of  eight  professions  and  six  major  state 
associations  of  the  professions,  have  met  in 
Michigan  to  deliberate  and  subsequently 
recommend  an  organizational  structure 
that  will  permit  the  American  Association 
of  the  Professions  to  come  to  life  as  a rep- 
resentative of  the  professional  segments  of 
the  nation. 

Representing  lAP  was  George  B.  Calla- 
han, M.D.  and  C.  Dale  Greffe,  P.E.,  both 
past  presidents  of  the  Illinois  Association. 


Architecture 

Medicine 

Dentistry 

Law 

Engineering 

Pharmacy 

CPA 

Veterinary  Medicine 


308 


Illinois  Medical  Journal 


THE  VIEW  BOX 


(Continued  from  page  264) 

Diagnosis:  Solitary  bone  cyst. 

The  age  incidence  of  solitary  bone  cyst  is 
any^vhere  between  three  and  fourteen  years 
of  age.  The  usual  site  of  localization  is  a 
long  tubular  bone  rvith  the  strong  predilec- 
tion for  the  humerus.  The  patient  is  un- 
aware of  the  lesion  until  a trivial  trauma 
causes  pain  due  to  a fracture  through  the 
cyst  itself.  Radiographically  the  lesion  is 
frequently  found  lying  relatively  near  the 
epiphyseal  plate.  It  does  not  involve  the 
epiphyseal  plate  as  a rule.  The  diameter 
of  the  bone  may  be  expanded  with  consid- 
erable thinning  of  the  regional  cortex  with 
possible  fracture  at  one  area  of  the  cortex. 
As  a result  of  the  disappearance  of  the 
spongiosa  markings,  the  affected  area  ap- 
pears ratified  to  a gieater  or  lesser  degree. 
Occasionally  the  area  may  appear  trabecu- 
lated  which  is  due  to  the  presence  of  ridges 
on  the  medullary  surface  of  the  modified 
cortex  rather  than  bony  partitions  travers- 
ing and  dividing  the  cyst.  Multiple  fractures 
may  occur  and  the  cyst  will  gradually  work 
its  "way  doAsn  the  shaft  of  the  involved 
bone.  Pathologically  the  cyst  contains  fluid 
ts'hich  may  be  clear  and  yello^vish  or  else 
serosanguineous,  particularly  if  there  has 
been  a recent  fracture.  As  a rule,  unless  the 
cystic  defect  is  obliterated  by  surgery  it  will 
persist  indefinitely. 

Reference : 

Jaffe,  H.  Tumors  and  Tumorous  Conditions  of  the 
Bones  and  Joints,  pp.  63-75. 


A color  film  designed  as  a basis  for  train- 
ing courses  in  emergency  cardiopulmonary 
resuscitation  (CPR),  and  a manual  which 
sets  standards  for  instructors  in  the  CPR 
technique,  are  available  through  the  Amer- 
ican Heart  Association  and  its  affiliates. 

Entitled  “Prescription  for  Life,”  the 
48-minute  film  is  intended  for  physicians, 
nurses  and  others  qualified  to  perform 
CPR.  It  provides  detailed  anatomic  and 
physiologic  experimental  and  clinical  in- 
formation. Shorter  versions  of  the  film  are 
also  available.  Both  the  film  and  the  man- 
ual may  be  obtained  through  local  Heart 
Associations. 


Just  one  tablet  at  bedtime  • Prevents  pain- 
ful night  leg  cramps  • Permits  restful  sleep 

How  many  of  your  patients  stamp  their  feet  at  night 
and  lose  sleep  because  of  painful  leg  cramps?  Un- 
less prompted,  they  usually  fail  to  report  this  dis- 
tressing condition  and  suffer  needlessly. 

One  tablet  of  QUINAMM  at  bedtime  usually  con- 
trols distressing  night  cramps  and  permits  restful 
sleep  with  the  initial  dose. 

Prescribing  information— Composition:  Each  white,  beveled, 
compressed  tablet  contains:  Quinine  sulfate,  260  mg.,Amino- 
phylline,  195  mg.  Indications:  For  the  prevention  and  treat- 
ment of  nocturnal  and  recumbency  leg  muscle  cramps,  in- 
cluding those  associated  with  arthritis,  diabetes,  varicose 
veins,  thrombophlebitis,  arteriosclerosis  and  static  foot  de- 
formities. Contraindications:  QUINAMM  is  contraindicated  in 
pregnancy  because  of  its  quinine  content.  Side  Effects/ 
Precautions:  Aminophylline  may  produce  intestinal  cramps 
in  some  instances,  and  quinine  may  produce  symptoms  of 
cinchonism,  such  as  tinnitus,  dizziness,  and  gastrointestinal 
disturbance.  Discontinue  use  if  ringing  in  the  ears,  deafness, 
skin  rash,  or  visual  disturbances  occur.  Dosage:  One  tablet 
upon  retiring.  Where  necessary,  dosage  may  be  increased  to 
one  tablet  following  the  evening  meal  and  one  tablet  upon 
retiring.  Supplied:  Bottles  of  100  and  500  tablets. 

THE  NATIONAL  DRUG  COMPANY 

DIVISION  OF  RICHARDSON  MFRRFLL  INC. 

PHILADELPHIA,  PENNSYLVANIA  19144 


for  September,  1968 


309 


THE  BKTTMANN  AUCHIVE 


Opinions  and  Reports 

Propriety  of  Percentage  Arrangement 
Between  A Surgeon  and  A Clinic 

The  Council  looks  with  disfavor  on  this 
type  of  arrangement  as  it  tends  to  encour- 
age fee  splitting  and  rebates.  The  Council 
feels  that  the  payment  for  expenses  in- 
curred by  the  clinic  in  behalf  of  the  sur- 
geon should  be  on  a fixed  rather  than  a 
percentage  basis.  The  Council  further  be- 
lieves that  the  surgeon  should  bill  the  pa- 
tient directly.  (Judicial  Council,  1963) 

Local  Societies  Must  Combat  Fee 
Splitting 

As  has  been  done  in  former  reports,  the 
Council  wishes  to  record  its  condemnation 
of  fee  splitting  wherever  it  may  be  found, 
and  to  urge  component  societies  and  con- 
stituent associations  to  purge  their  mem- 
bership of  any  who  willfully  refuse  to  desist 
from  such  practice,  the  continuance  of 
which  can  only  bring  dishonor  and  re- 
proach on  the  medical  profession.  (House 
of  Delegates,  1924) 

Division  of  Fees  and  Acceptance 
of  Commission 

There  have  been  widespread  inquiries 
and  complaints  concerning  the  practice  of 
medicine  by  hospitals,  the  division  of  fees 
between  hospitals  and  doctors,  the  accept- 
ance of  commissions  or  rebates  by  ophthal- 
mologists from  opticians,  the  extensive  un- 
ethical instances  of  contract  practice  par- 
ticularly in  the  Pacific  Coast  states.  Con- 
cerning all  of  these  matters  it  is  sufficient 
to  say  that  wide  extent  of  an  unethical 
practice  does  not  make  it  ethical.  Ethics  has 
to  do  with  principles,  not  numbers  or  lo- 
cality. A procedure  unethical  in  one  part 
of  the  country  cannot  be  ethical  under  the 
same  circumstances  in  another.  Because  the 
percentage  of  rebate  is  large  in  compari- 
son, and  in  a year  amounts  to  a consider- 
able sum,  and  although  many  of  the  prac- 
titioners in  a specialty  may  accept  those 
rebates,  the  acceptance  is  no  more  ethical 
than  for  the  general  practitioner  to  accept 
a rebate  on  the  occasional  truss  he  may 
prescribe.  The  Judicial  Council  deplores 
such  ignoring  of  ethical  principles,  not 
only  because  of  the  extent  of  the  practice 
but  because  in  many  instances  the  plea  of 
the  financial  necessity  cannot  be  offered 
as  an  excuse.  The  Council  can  only  publi- 


on  Ethical  Relations 

cize  the  abuses  and  express  its  severe  con- 
demnation of  them.  It  has  no  power  in 
itself  of  control  or  correction.  (House  of 
Delegates,  1934) 

Division  of  Income  by  Members 
of  A Group 

The  1946  report  of  the  Judicial  Council 
states,  in  part,  that  “The  division  of  in- 
come given  to  members  of  a group  practic- 
ing jointly  or  in  a partnership  must  be  in 
proportion  to  the  value  of  the  services  con- 
tributed by  each  individual  participant.” 
The  1947  report  of  the  Council  states, 
“Since  the  principles  of  ethics  for  private 
practice  absolutely  forbid  the  splitting  of 
fees  under  any  and  all  circumstances,  the 
same  rule  applies  to  group  practice;  and 
the  group  formed  must  be  a real  partner- 
ship in  which  the  total  income  is  divided 
not  equally  but  according  to  the  individual 
income  earned  by  the  member.” 

In  order  to  clarify  its  position  with  re- 
spect to  the  division  of  gi'oup  or  partner- 
ship income  the  Judicial  Council  approves 
and  publishes  the  following  rephrasing  of 
its  1946  and  1947  reports  on  this  subject: 
The  division  of  income  among  members 
of  a group,  practicing  jointly  or  in  part- 
nership, may  be  determined  by  the  mem- 
bers of  the  group  and  may  be  based  on 
the  value  of  the  professional  medical 
services  performed  by  the  member  and 
his  other  se-rvices  and  contributions  to 
the  group.  (Judicial  Council,  1959) 

Profit-Sharing  and  Pension  Plans 

Profit-sharing  plans  which  include  lay 
employees  are  unethical. 

Retirement  Plans 

A retirement  plan  however  classified 
under  the  Internal  Revenue  Code  which 
also  covers  lay  employees  and  which  pro- 
vides that  the  contribution  made  by  a solo 
practitioner,  a group  of  physicians,  or  a 
professional  corporation  will  be  based  on 
a percentage  of  compensation  of  the  parti- 
cipants, is  ethically  acceptable  even  though 
the  contribution: 

(1)  is  limited  to  a percentage  of  net  in- 
come before  taxes,  or 

(2)  is  payable  only  when  net  income  ex- 
ceeds a specified  amount. 

(Judicial  Council,  1964) 


310 


Illinois  Medical  Journal 


You  can  treat  combined 
deficiencies  with 


Trinsicon 

— the  multifactor  hematinic 


Vitamin  B12  plus  intrinsic  factor  (15  meg. 
Bi2  activity) — helps  provide  adequate 
levels  of  this  important  vitamin. 


Folic  acid  (1  mg.) — treats  nutritional 
macrocytic  anemias  and/or  malabsorp- 
tion syndromes. 


Ascorbic  acid  (75  mg.) — augments  the 
conversion  of  folic  acid  to  its  active  form 
and  helps  iron  absorption. 

Iron  (110  mg.) — treats  hypochromic 
anemia. 


clinical  and  laboratory  studies  are  considered  essential  and  are 
recommended. 

Adverse  Reactions:  In  rare  instances,  iron  in  therapeutic  doses 
produces  gastro-intestinal  reactions,  such  as  diarrhea  or  consti- 
pation. Reducing  the  dose  and  administering  it  with  meals  will 
minimize  these  effects. 

In  extremely  rare  instances,  skin  rash  suggesting  allergy  has 
followed  oral  administration  of  liver-stomach  material.  Instances 
of  apparent  allergic  sensitization  have  also  been  reported  after 
oral  administration  of  folic  acid. 

Dosage:  One  Pulvule  twice  a day.  (Two  Pulvules  daily  produce  a 
standard  response  in  the  average  uncomplicated  case  of  perni- 
cious anemia.) 

How  Supplied:  Pulvules  Trinsicon®  (hematinic  concentrate  with 
intrinsic  factor,  Lilly),  in  bottles  of  60  and  500.  [o3256a] 


Additional  information 
available  to  physicians 
upon  request. 
Eli  Lilly  and  Company, 
Indianapolis,  Indiana  46206. 

801668 


Annual  ISMS  Leadership  Conference 

October  6 


St.  Nicholas  Hotel  - Springfield 

Jacob  E.  Reisch,  M.D.,  Secretary-Treasurer  of  the  Illinois  State  Medical  Society  has  an- 
nounced the  annual  Leadership  Conference  date  as  October  6 in  Springfield.  The  one-day 
meeting  will  provide  State  and  county  medical  society  officers,  degelates  and  other  key 
leaders  an  opportunity  to  hear  experts  speak  on  such  medically  important  issues  as  the 
Partnership  for  Health  Program,  Health  Manpower  Problems,  federal  legislation,  and 
the  1968  elections.  A brief  program  listing  follows. 

MORNING 

9:00  AM.  REGISTRATION 

10:00  A.M.  COMPREHENSIVE  HEALTH  PLANNING  LEGISLATION- 

National  and  State  Background  to  Enable  You  to  Judge 
Local  Impact!  Panel  Presentation  with  Speakers  from 
Washington,  D.C.  Office  of  Department  of  H.E.W.  and 
FRANKLIN  D.  YODER,  M.D.,  Director,  Illinois  Department 
of  Public  Health 


12:15  P.M. 


NOON 

LUNCHEON 

HEALTH  MANPOWER  PROBLEMS- 

Medicine's  Response  to  a National  Crisis 

DWIGHT  L.  WILBUR,  M.D.,  San  Francisco,  AMA  President 


2:00  P.M. 
2:30  P.M. 


3:30  P.M. 


AFTERNOON 

ELECTIONS  '68 

PHILIP  G.  THOMSEN,  M.D.,  ISMS  President 
LOWDOWN  ON  THE  HIGHER-UPS  AND  PROJECTIONS  OF  THE 
1968  PRESIDENTIAL  CONVENTIONS  & ELECTION 

ROBERT  D.  NOVAK,  Washington,  D.C.,  Co-Editor  of  Syn- 
dicated Column  INSIDE  REPORT  and  Co-Author  of  LBJ— 
The  Exercise  of  Power 
FEDERAL  FACT,  FICTION  AND  FANTASY 

Panel  discussion  by  four  prominent  Illinois  Congressmen 
and  Legislators. 


EVENING 


5:30  P.M.  FELLOWSHIP 
6:30  P.M.  DINNER 

1968-YEAR  OF  DECISIONS 

HON.  EVERETT  McKINLEY  DIRKSEN,  U.S.  Senate  Minority 
Leader 


The  1968  Leadership  Conference  will  be  the  best  yet!  Plan  to  attend  this  exciting  and  edu- 
cational day.  To  register,  clip  the  coupon  below  and  mail  to  Jacob  E.  Reisch,  M.D.,  1129 
South  Second  Street,  Springfield,  Illinois.  Luncheon  ticket  is  $3;  Dinner  ticket  is  $7. 


mail  to:  Jacob  E.  Reisch,  M.D.,  Secretary  Treasurer  Luncheon  $3 

Illinois  State  Medical  Society  Dinner  $7 

1129  South  Second  Street 
Springfield,  Illinois 

Enclosed  is  my  check  for  $ reserving  luncheon  tickets  and  

dinner  tickets.  (Make  check  payable  to  Illinois  State  Medical  Society.) 


Name 


Address 


City 


Zip 


ENDURON 

MEMCLOIHIAZIDE 


ENDURONYi: 

Each  tablet  contains 
Methyclothiazide  5 mg.  with 
Deserpidine  0.25  mg.  or  0.5  mg. 


indications:  Edema  and  mild  to  moderate  hypertension 
(Enduron),  and  mild  to  moderately  severe  hypertension 
(Enduronyl).  More  potent  agents,  if  added,  can  be  given 
at  reduced  dosage. 

Contraindications:  Sensitivity  to  thiazides;  severe  renal 
disease  (except  nephrosis)  or  shutdown;  severe  hepatic 
disease  or  impending  hepatic  coma  (hepatic  coma  due  to 
hypokalemia  has  been  reported  in  patients  on  thiazides). 
Do  not  use  Enduronyl  in  severe  mental  depression,  sui- 
cidal tendencies,  active  peptic  ulcer,  or  ulcerative  colitis. 

Warnings:  Consider  possible  sensitivity  where  there  is 
history  of  allergy  or  asthma.  If  added  potassium  is  indi- 
cated, dietary  supplementation  is  recommended.  Reserve 
enteric-coated  potassium  tablets  for  cautious  use  only 
When  necessary,  as  they  may  induce  serious  or  fatal 
small  bowel  lesions  (stenosis  with  or  without  ulceration), 
cause  obstruction,  hemorrhage,  and  perforation  often 
requiring  surgery;  discontinue  them  immediately  if  ab- 
dominal pain,  distention,  nausea,  vomiting,  or  g.i.  bleed- 
ing occurs.  Neither  Enduron  nor  Enduronyl  contains 
added  potassium. 

Precautions:  Use  thiazides  cautiously  In  severe  renal 
dysfunction,  impaired  hepatic  function  or  progressive 
liver  disease;  also  in  pregnancy  (bone  marrow  depres- 
sion, thrombocytopenia,  and  altered  carbohydrate  me- 
tabolism have  been  reported  in  certain  newborn).  In 
surgery,  thiazides  may  reduce  response  to  vasopressors, 
and  increase  response  to  tubocurarine.  Antihypertensive 
response  may  be  enhanced  following  sympathectomy. 
Watch  for  electrolyte  imbalance  (e.g.,  hyponatremia)  in 
all  patients.  In  hypokalemia  (especially  in  digitalized  pa- 
tients) give  supplemental  potassium.  In  hypochloremic 
alkalosis,  give  supplemental  chloride. 

Use  rauwolfias  with  caution  in  patients  with  history  of 
peptic  ulcer.  Rauwolfias  with  anesthetics  may  produce 
hypotension  and  bradycardia.  Discontinue  Enduronyl  two 
weeks  before  elective  surgery.  Consider  vagal  blocking 
agents  during  emergency  surgery.  In  epilepsy,  adjust 
anticonvulsant  dosage.  In  electroshock,  shorten  stimulus 
strength  and  duration.  In  occasional  patients  with  de- 
pressive tendencies,  rauwolfias  may  precipitate  severe 
mental  depression  that  usually  disappears  when  drug  is 
stopped. 

Adverse  Reactions:  Thiazide  reaction  include  blood  dys- 
crasias  (thrombocytopenia  with  purpura,  agranulocytosis, 
aplastic  anemia);  elevation  of  BUN,  serum  uric  acid  or 
blood  sugar;  anorexia,  nausea,  vomiting,  diarrhea,  head- 
ache, dizziness,  paresthesia,  weakness,  skin  rash,  photo- 
sensitivity, jaundice,  symtomatic  gout,  and  pancreatitis. 
Cutaneous  vasculitis  in  the  elderly  has  been  reported 
with  other  thiazides.  Adverse  effects  with  deserpidine  are 
qualitatively  similar  to  those  with  reserpine,  but  their  in- 
cidence is  lower.  These  include  nasal  stuffiness,  ab- 
dominal cramps  or  diarrhea,  nausea,  headache,  weight 
gain,  reduced  libido  and  potency,  peptic  ulcer  aggrava- 
tion, epistaxis,  skin  eruption,  asthma  in  susceptible  pa- 
tients, electrolyte  imbalance,  excessive  salivation,  and  a 
reversible  Parkinson’s  syndrome.  Excessive  drowsiness, 
fatigue,  weakness,  and  nightmares  may  signal  mental  de- 
pression. Thrombocytopenia,  purpura,  and  a symptom 
manifested  by  dull  sensorium,  deafness,  uveitis,  glaucoma, 
and  optic  atrophy  are  rare  allergic  reactions  to  other 
rauwolfias.  Hypotension  from  antihypertensive  agents 
may  precipitate  angina  attacks  in  susceptible  individuals. 
Usually  adverse  reactions  disappear  when  drug  is  with- 
drawn. 


Cl  Each  tablet  contains 

CLJ  I Pargyline  Hydrochloride  25  mg. 

With  Methyclothiazide  5 mg. 

indications— Moderate  to  severe  hypertension. 
Contraindications— Pheochrorr\ocytoma,  paranoid  schizo- 
phrenia, hyperthyroidism  and  advanced  renal  failure.  Not 
recommended  in  malignant  hypertension,  children  under 
12,  pregnant  patients. 

Do  not  use  with:  centrally  or  peripherally  acting  sym- 
pathomimetic drugs;  foods  high  in  tyramine  (e.g.,  aged 
and  natural  cheeses);  parenteral  reserpine  or  guanethi- 
dine;  imipramine,  amitriptyline,  desipramine,  nortripty- 
line or  their  analogues;  other  monoamine  oxidase  inhib-  | 

TM-TRADEMARK 


for  September,  1968 


Itors;  methyidopa  or  dopamine;  separate  Eutron  and 
these  agents  by  two  weeks. 

Sensitivity  to  thiazides;  severe  renal  disease  (except 
nephrosis)  or  shutdown;  severe  hepatic  disease;  impend- 
ing hepatic  coma  from  thiazide-induced  hypokalemia. 

IVam/ngs— Patients:  1.  No  other  drugs  (particularly  "cold 
preparations’’  and  antihistamines),  cheese  or  alcohol 
without  physician’s  consent,  2.  Promptly  report  ortho- 
static symptoms,  severe  headache,  other  unusual  symp- 
toms. 3.  Angina  pectoris  or  coronary  artery  disease 
patients  must  not  increase  physical  activity  with  improved 
anginal  symptoms  or  well-being. 

Physicians:  1.  Use  antihistamines,  hypnotics,  sedatives, 
tranquilizers  and  narcotics  (meperidine  contraindicated) 
cautiously  in  reduced  doses.  2.  Stop  Eutron  two  or  more 
weeks  before  elective  surgery;  in  emergency  surgery  re- 
duce premedication  (narcotics,  sedatives,  analgesics, 
etc.)  to  1/4  to  1/5;  carefully  adjust  anesthetic  dosage  to 
patient  response.  3.  Use  cautiously  in  advanced  renal 
failure.  4.  Pargyline  may  induce  hypoglycemia.  5.  Con- 
sider possible  sensitivity  reactions  when  a history  of 
allergy  or  asthma  is  present,  6.  If  potassium  is  indicated, 
dietary  supplement  is  recommended;  enteric-coated  po- 
tassium tablets  may  induce  serious  or  fatal  small  bowel 
lesions  (stenosis  with  or  without  ulceration),  cause  ob- 
struction, hemorrhage,  and  perforation  frequently  re- 
quiring surgery;  discontinue  medication  immediately  if 
abdominal  pain,  distention,  nausea,  vomiting  or  gastro- 
intestinal bleeding  occurs;  Eutron  does  not  contain 
added  potassium.  7.  Possible  systemic  lupus  erythema- 
tosus has  been  reported  for  thiazides. 

P/ecauf/o/7S— Pargyline:  Use  cautiously  at  reduced  dosage; 
caffeine,  alcohol,  antihistamines,  barbiturates,  chloral 
hydrate,  other  hypnotics,  sedatives,  tranquilizers,  nar- 
cotics. Periodically  do  urinalyses,  blood  counts,  liver 
function  tests,  etc.  Use  with  caution  in  liver  disease. 
Watch  for  orthostatic  hypotension,  especially  in  impaired 
circulation  (e.g.,  angina  pectoris,  coronary  artery  dis- 
ease, cerebral  arteriosclerosis):  also,  augmented  hypo- 
tension in  concomitant  febrile  illnesses.  Reduce  or  dis- 
continue if  hypotension  is  severe.  In  impaired  renal 
function  watch  for  cumulative  drug  effects,  elevated  BUN 
and  other  evidence  of  progressive  renal  failure;  withdraw 
drug  if  these  persist.  In  surgery  increased  central  de- 
pressant response  (hypotension  and  increased  sedative 
effect)  can  be  controlled  by  (1)  discontinuing  at  least  two 
weeks  prior;  (2)  in  emergency  surgery  lowering  dose  of 
premedication;  (3)  when  necessary,  administering  a vaso- 
pressor. Do  not  use  in  hyperactive  and  hyperexcitable 
patients.  Pargyline  may  unmask  severe  psychotic  symp- 
toms where  emotional  problems  pre-exist.  Use  cautiously 
in  Parkinsonism,  especially  with  antiparkinsonian  agents. 
In  prolonged  therapy,  examine  for  change  in  color  per- 
ception, visual  fields,  fundi  and  visual  acuity.  Also,  pro- 
longed therapy  has  made  certain  patients  refractory  to 
nerve  blocking  effects  of  local  anesthetics. 

Methyclothiazide:  Use  cautiously  in  severe  renal  dys- 
function, impaired  hepatic  function  or  progressive  liver 
disease;  also  in  pregnancy  (bone  marrow  depression, 
thrombocytopenia,  and  altered  carbohydrate  metabolism 
have  been  reported  in  certain  newborn).  In  surgery  thia- 
zide may  reduce  vasopressor  response  and  increase  tu- 
bocurarine response.  Antihypertensive  response  may  be 
enhanced  following  sympathectomy.  Watch  for  electro- 
lyte imbalance  (e.g.,  hyponatremia).  Give  supplemental 
chloride  if  hypochloremic  alkalosis  occurs  and  supple- 
mental potassium  if  hypokalemia  occurs  (especially  iti 
digitalized  patients).  Thiazides  may  decrease  serum 
P.B.I.  without  signs  of  thyroid  disturbance. 

Adverse  Reactions  — PargyWne:  Orthostatic  hypotension 
and  associated  symptoms,  mild  constipation,  fluid  reten- 
tion, edema,  dry  mouth,  sweating,  increased  appetite, 
arthralgia,  nausea,  vomiting,  headache,  insomnia,  diffi- 
cult in  micturition,  nightmares,  impotence,  delayed  ejac- 
ulation, rash,  purpura,  weight  gain,  hyperexcitability, 
increased  neuromuscular  activity  and  other  extrapy- 
ramidal  symptoms.  Drug  fever  is  extremely  rare.  Reduc- 
tion in  blood  sugar  and  hypoglycemic  effects  are  pos- 
sible. Congestive  heart  failure  has  been  reported  in  a 
few  patients  with  reduced  cardiac  reserve. 

Methyclothiazide:  Blood  dyscrasias  (thrombocytopenia 
with  purpura,  agranulocytosis,  aplastic  anemia);  eleva- 
tion of  BUN,  blood  sugar  or  serum  uric  acid  (gout  may 
be  induced);  anorexia,  nausea,  vomiting,  diarrhea,  head- 
ache, dizziness,  paresthesia,  weakness,  skin  rash,  photo- 
sensitivity, jaundice  and  pancreatitis.  Cu- 
taneous vasculitis  in  elderly  patients  has 
been  reported  with  other  thiazides. 

If  side  effects  are  severe  or  persist,  re- 
duce dosage  or  withdraw  drug.  804438R 


321 


OBITUARIES 


*Dr.  Bart  Cole,  Belleville,  died  July  14 
at  the  age  ol  49.  He  was  a past  president 
oi'  the  St.  Clair  C^ouiUy  Medical  Society, 
tlirector  and  board  member  of  Our  Lady 
of  the  Snows  Foundation,  past  district  gov- 
ernor of  the  International  Serra  Club  and 
a past  president  of  the  East  St.  Louis  Serra 
Club. 

*Dr.  Ewald  Emil  Hermann,  Highland,  a 
former  President  of  the  Madison  County 
Medical  Society  died  May  24  at  the  age 
of  73. 

*Dr.  Martin  G.  Luken,  Chicago,  died 
July  31  at  the  age  of  85.  He  served  on 
the  medical  staff  of  St.  Elizabeth’s  Hospital 
and  was  Medical  Director  of  Angel  Guard- 
ian Orphange,  a member  of  ISMS  Fifty- 
Year  Club. 

*Dr.  Mitchell  J.  Nechtow,  a Chicago  phy- 
sician for  31  years  died  July  17  at  the  age 
of  58.  He  was  chief  of  Obstetrics  and  Gyne- 
cology at  the  Norwegian  American  Hos- 
pital, Professor  of  Obstetrics  and  Gyne- 
cology at  Chicago  Medical  School. 

*Dr.  Grover  Cleveland  Otrich,  a Belle- 
ville ear,  nose  and  throat  specialist,  died 
July  15  at  the  age  of  83.  He  was  an  ISMS 
councilor  for  the  Tenth  District,  Fifty-Year 
Club  member,  a former  AMA  delegate  and 
a past  president  of  the  Central  Illinois  So- 
ciety of  Otolaryngology. 

Dr.  Samuel  Perlow,  Oak  Park,  63,  a prac- 


ticing physician  for  more  than  35  years, 
died  July  5.  He  was  a fellow  of  the  Amer- 
ican College  of  Surgeons,  a member  of  the 
International  College  of  Cardio-Vascular 
Surgery,  and  a diplomate  of  the  American 
Board  of  Surgery. 

Dr.  Nathaniel  Schaffner,  Chicago,  died 
July  18  at  the  age  of  75.  He  was  on  the 
staff  of  American  Hospital. 

*Dr.  Benjamin  Franklin  Shirer,  Batavia, 
55,  a practicing  physician  and  surgeon  for 
more  than  30  years,  died  July  23.  He  was 
past  president  of  the  medical  staff  of  Com- 
munity Hospital  and  also  of  St.  Joseph 
Mercy  Hospital  of  Aurora. 

*Dr.  Samuel  Stein,  a Chicago  physician 
for  53  years,  died  July  19  at  the  age  of  79. 
He  was  on  the  staff  of  South  Shore  Com- 
munity Hospital  and  was  a member  of 
ISMS  Fifty-Year  Club. 

Dr.  Samuel  M.  Thomas,  River  Forest,  41, 
died  July  19  in  Presbyterian-St.  Luke’s  Hos- 
pital where  he  had  been  on  the  staff. 

*Dr.  J.  Frank  Waugh,  Seattle,  90,  died 
July  15  at  the  age  of  90.  He  became  inter- 
nationally known  for  his  early  research 
in  the  use  of  X-rays  in  his  treatment  of 
skin  diseases  including  cancer.  He  was 
former  Superintendent  of  Children’s  Me- 
morial Hospital,  a member  of  the  Chicago 
Fifty-Year  Club. 

^Indicates  member  of  Illinois  State  Medical  Society. 


Potassium  Loss 

In  a patient  with  primary  hyperaldosteronism  the  rates  of  net  transport 
and  of  unidirectional  fluxes  of  sodium,  potassium,  and  water  in  the  intact 
colon  were  measured  before  and  after  removal  of  that  adrenocortical  tumor, 
by  perfusing  the  colon  with  an  isotopically  labelled  test  solution  introduced 
into  the  cecum  through  a tube  passed  by  mouth.  The  results  in  this  patient 
were  compared  with  those  in  eight  control  subjects.  Before  removal  of  the 
aldosterone-producing  tumor  the  colon  of  the  patient  secreted  potassium  at 
four  to  five  times  the  rate  in  control  subjects.  The  undirectional  flux  of 
potassium  into  the  colonic  lumen  was  greatly  enhanced  and  the  daily  loss 
of  potassium  in  the  feces  increased.  The  rates  of  potassium  transport  re- 
turned to  within  the  range  observed  in  control  subjects  after  the  removal 
of  the  tumor.  (Absorption  and  Secretion  of  Water  and  Electrolytes  by  the 
Intact  Colon  in  a patient  with  Primary  Aldosteronism.  R.  Shields,  J.  B. 
Miles,  and  C.  Gilbertson.  Birt.  Med.  Jl.  (Jan.  13)  1968;  pgs.  93-96.) 


322 


Illinois  Medical  Journal 


When  it’s  more  than  a bad  cold 


your  patient  can  feel  better 
while  she’s  getting  better 


Achrocidih 

Tetracycline  HCl— Antihistamine— Analgesic  Compound 

Each  tablet  contains:  ACHROMYCIN®  Tetracycline  HCl  125  mg.;  Phenacetin  120  mg.; 
Caffeine  30  mg.;  Salicylamide  150  mg.;  Chlorothen  citrate  25  mg. 


In  tetracycline-sensitive  bacterial  injection  complicating  respiratory  allergy,  ACHROCIDIN 
brings  the  treatment  together  in  a single  prescription— prompt  relief  of  headache  and  conges- 
tion together  with  effective  control  of  the  organisms  frequently  responsible  for  complications 
leading  to  prolonged  disability  in  the  susceptible  patient. 

For  children  and  elderly  patients  you  may  prefer  caffeine-free  ACHROCIDIN  Syrup.  Each 
5 cc  contains:  ACHROMYCIN  (Tetracycline)  equivalent  to  Tetracycline  HCl  125  mg.;  Phen- 
acetin 120  mg.;  Salicylamide  150  mg.;  Ascorbic  Acid  (C)  25  mg.;  Pyrilamine  Maleate  15  mg. 


Contraindications:  Hypersensitivity  to  any  compo- 
nent. 

Warning:  In  renal  impairment,  since  liver  toxicity  is 
possible,  lower  doses  are  indicated;  during  prolonged 
therapy  consider  serum  level  determinations.  Photo- 
dynamic reaction  to  sunlight  may  occur  in  hyper- 
sensitive persons.  Photosensitive  individuals  should 
avoid  exposure;  discontinue  treatment  if  skin  dis- 
comfort occurs. 

Precautions:  Drowsiness,  anorexia,  slight  gastric  dis- 
tress can  occur.  In  excessive  drowsiness,  consider 
longer  dosage  intervals.  Persons  on  full  dosage 
should  not  operate  vehicles.  Nonsusceptible  organ- 
isms may  overgrow;  treat  superinfection  appropri- 
ately. Treat  beta-hemolytic  streptococcal  infections 
at  least  10  days  to  help  prevent  rheumatic  fever  or 
acute  glomerulonephritis.  Tetracycline  may  form  a 
stable  calcium  complex  in  bone-forming  tissue  and 


may  cause  dental  staining  during  tooth  development 
(last  half  of  pregnancy,  neonatal  period,  infancy, 
early  childhood). 

Adverse  Reactions:  Gastrointestinal— anorexia,  nau- 
sea, vomiting,  diarrhea,  stomatitis,  glossitis,  entero- 
colitis, pruritus  ani.  maculopapular  and 

erythematous  rashes;  exfoliative  dermatitis;  photo- 
sensitivity; onycholysis,  nail  discoloration.  Kidney 
-dose-related  rise  in  BUN.  Hypersensitivity  reac- 
tions—urticaria,  angioneurotic  edema,  anaphylaxis. 
Intracranial— hxxiging  fontanels  in  young  infants. 
Tee/A— yellow-brown  staining;  enamel  hypoplasia. 
Blood— anemia,  thrombocytopenic  purpura,  neutro- 
penia, eosinophilia.  L/ver— cholestasis  at  high  dosage. 

Upon  adverse  reaction,  stop  medication  and  treat 
appropriately. 


349*8 


/or  September,  1968 


323 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  an  effort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  phy- 
sicians, the  Journal  is  publishing  synopses 
submitted  to  the  Physicians  Placement  Serv- 
ice concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  who  know  of  any  out-of-state 
physicians  seeking  an  Illinois  residence  are 
asked  to  notify  the  placement  service. 

Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addi- 
tional physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave., 
Chicago  60601. 

FRANKLIN  COUNTY:  Thompson- 

ville;  population:  550.  Trade  area,  1,750. 
Town  without  a physician  for  several  years. 
Nearest  at  West  Frankfort  and  Benton,  10 
and  12  miles.  Both  towns  have  hospitals. 
Office  space  and  housing  available.  Com- 
munity would  build  a new  building  for  an 
office.  Financial  assistance  if  desired. 
Sources  of  income:  agriculture,  mining,  and 
railroads.  Churches:  Methodist,  Baptist. 

Grade  and  high  schools.  Limited  recreation- 
al facilities.  For  further  information  con- 
tact: Mr,  Troy  C.  Lager,  Clover  Leaf  Farm, 
Thompsonville. 

FULTON  COUNTY:  Farmington;  pop- 
ulation: 3,000.  Trade  area,  10,000.  Two 
practicing  physicians.  Third  physician  died 
recently,  need  replacement.  Nearest  hospi- 
tal at  Canton,  11  miles.  Peoria  21  miles. 
Local  prescription  drug  store.  Equipment 
of  deceased  physician  available  if  desired. 
Sources  of  income:  industry,  agriculture 
and  mining.  Six  protestant  and  Catholic 
churches.  Grade  and  high  schools;  Jr.  Col- 
lege, 11  miles.  Two  country  clubs  at  near- 
by Canton,  one  at  Elmwood.  For  details 
contact: 

Miss  Dorothy  Wasson,  P.O.  Box  257, 
Farmington.  Phone:  245-4615. 

FULTON  COUNTY:  Table  Grove; 

population:  500.  Trade  area,  3,000.  Near- 
est doctors  at  Ipava  and  Astoria,  seven  and 


15  miles.  No  physician  since  1954.  Nearest 
hospitals  in  Macomb,  17  miles.  Peoria  65 
miles.  Office  space  and  houses  available. 
Financial  assistance  could  be  arranged. 
Agricultural  community.  Congregational 
Church.  Grade  and  high  schools.  Three 
nearby  golf  courses.  For  further  informa- 
tion contact:  Devere  Showden,  Clifford 
Weaver,  Wm.  Harlan  or  Don  Baily,  Table 
Grove. 

GREENE  COUNTY:  White  Hall;  pop- 
ulation: 3,000.  Trade  area,  8,000.  One  phy- 
sician, age  58.  Local  hospital  65  miles  from 
Springfield.  One  prescription  drug  store. 
Office  space  and  housing  available.  Pre- 
dominant nationality:  German.  Seven  Prot- 
estant and  Catholic  Churches.  Grade  and 
high  schools.  Golf  and  swimming  facilities. 
Office  rent:  $95.00  monthly;  heat  and  light 
furnished.  White  Hall  Hospital  used  by 
people  from  a large  area.  For  details  con- 
tact Mr.  George  Stahl,  Hospital  Adminis- 
trator, 407  N.  Main,  White  Hall.  Phone 
374-2121  (area  217). 

GRUNDY  COUNTY:  Gardner  and 

South  Wilmington;  population:  60,000. 

Trade  area,  4,000.  Towns  3 miles  apart.  No 
doctor  in  Gardner;  one  in  South  Wilming- 
ton. Nearest  hospital  at  Morris,  20  miles. 
Joliet  35  miles.  One  drug  store.  Two  doc- 
tor Sears  Medical  facility  available.  Agri- 
culture and  industry  area.  Four  Protestant 
and  Catholic  Churches.  Grade  and  high 
schools.  Two  golf  courses  within  10  miles. 
Chicago  loop  75  minutes  on  Interstate 
For  details  contact:  Mr.  James  Small,  Gard- 
ner, or  Rev.  Roger  Fish,  Jr.,  Gardner. 
Phone  815-237-8034. 

GRUNDY  COUNTY:  Minooka;  popu- 
lation: 700.  Trade  area,  1,500.  Only  doctor 
moved  to  locate  in  his  wife’s  home  town. 
Town  has  supported  a doctor  for  over  65 
years.  Midway  between  Joliet  and  Morris; 
4 miles  from  Route  66  and  1/2  mile  from 
Interstate  80.  No  doctor  within  10  miles. 
Joliet  15  miles;  population  70,000.  Agri- 
cultural community.  Many  residents  em- 
ployed at  Caterpillar  Tractor.  Churches: 
Catholic  and  Methodist.  Grade  and  high 
schools.  Nearest  golf  course  7 miles, 
swimming  pool  12  miles.  For  further  de- 
tails contact:  Mr.  Oliver  Brinckerhoff,  Vil- 
lage Clerk,  Minooka.  Phone  815-462-5161. 


324 


Illinois  Medical  Journal 


Photo  professionally  posed. 


No  injection  after  all! 

This  penicillin  produces  high,  fast  ieveis— oraiiy. 


Pen-Vee®  K is  usually  so  rapidly  and  com- 
pletely absorbed  that  therapeutic  penicillin 
levels  are  attained  within  15  to  30  minutes. 
Thus  it  can  often  obviate  the  need  for  peni- 
cillin injections.  The  higher  serum  levels 
produced  generally  last  longer  than  with  those 
of  oral  penicillin  G. 

Indications:  Infections  susceptible  to  oral  penicillin  G;  prophylaxis 
and  treatment  of  streptococcal  infections;  treatment  of  pneumococcal, 
gonococcal,  and  susceptible  staphylococcal  infections;  prophylaxis  of 
rheumatic  fever  in  patients  with  a previous  history  of  the  disease. 
Contraindications:  Infections  caused  by  nonsusceptible  organisms; 
history  of  penicillin  sensitivity. 

Warnings:  Acute  anaphylaxis  (may  prove  fatal  unless  promptly  con- 
trolled) is  rare  but  more  frequent  in  patients  with  previous  penicillin 
sensitivity,  bronchial  asthma  or  other  allergies.  Resuscitative  (epineph- 
rine, aminophylline,  pressor  amines)  and  supportive  (antihista- 
mines, methylprednisolone  sodium  succinate)  drugs  should  be 
readily  available.  Other  rare  hypersensitivity  reactions  include 
nephropathy,  hemolytic  anemia,  leucopenia  and  thrombocytoperria. 


In  suspected  hypersensitivity,  evaluation  of  renal  and  hematopoietic 
systems  is  recommended. 

Precautions:  In  suspected  staphylococcal  infections,  perform  proper 
laboratory  studies  including  sensitivity  tests.  If  overgrowth  of 
nonsusceptible  organisms  occurs  (constant  observation  is  essential), 
discontinue  penicillin  and  take  appropriate  measures.  Whenever 
allergic  reactions  occur,  withdraw  penicillin  unless  condition  being 
treated  is  considered  life  threatening  and  amenable  only  to  penicillin. 
Penicillin  may  delay  or  prevent  appearance  of  primary  syphilitic 
lesions.  Gonorrhea  patients  suspected  of  concurrent  syphilis  should 
be  tested  serologically  for  at  least  3 months.  When  lesions  of  primary 
syphilis  are  suspected,  dark-field  examination  should  precede  use  of 
penicillin.  Treat  beta-hemolytic  streptococcal  infections  with  full 
therapeutic  dosage  for  at  least  10  days  to  prevent  rheumatic  fever 
or  glomerulonephritis.  In  staphylococcal  infections,  perform  surgery 
as  indicated. 

Adverse  Reactions:  (Penicillin  has  significant  index  of  sensitiza- 
tion); Skin  rashes,  ranging  from  maculopapular  eruptions  to  exfolia- 
tive dermatitis;  urticaria;  serum  sickness-like  reactions,  including 
chills,  fever,  edema,  arthralgia  and  prostration.  Severe  and  often  fatal 
anaphylaxis  has  been  reported  (see  “Warnings"). 

Composition;  Tablets— 125  mg.  (200,000  units),  250  mg.  (400,000 
units),  500  mg.  (800,000  units);  Liquid— 125  mg.  (200,000  units)  and 
250  mg.  (400,000  units)  per  5 cc. 

Wyeth  Laboratories  Philadelphia,  Pa. 


“""^PEN-VEE’K 

(potassium  phenoxymethyl  penicillin) 


MEETING  MEMOS 


Sept.  19-22 — Annual  Meeting  of  the 
American  Medical  Writers  Association.  To 
be  held  in  Washington,  D.C.  Theme  for 
the  session  will  be,  “National  Perspectives 
in  Medical  Communications.”  The  newly 
appointed  commissioner  of  the  Food  and 
Drug  Administration  is  one  of  the  nation- 
ally known  personalities  who  will  take  part 
in  the  session. 

Sept.  28  — T h e International  College  of 
Surgeons  is  sponsoring  four  consecutive 
scientific  meetings  in  Honolulu,  Hawaii, 
at  which  members  of  the  South  American 
Federation,  as  well  as  the  North  American, 
Central  American  and  Caribbean  Federa- 
tion will  take  part. 

Sept.  30-Oct.  1 — ^AMA  is  sponsoring  the 
28th  Congress  on  Occupational  Health  at 
the  Waldorf-Astoria  Hotel  in  New  York 
City.  There  is  no  registration  fee  for  the 
Congress.  The  program,  featuring  20  dif- 
ferent speakers,  is  acceptable  for  11  elec- 
tive hours  by  the  American  Academy  of 
General  Practice. 

Oct.  3-4 — “Protecting  the  Consumer”  will 
be  the  theme  of  this  year’s  National  Con- 
gress on  Health  Quackery  being  sponsored 
by  the  AM  A and  the  National  Health 
Council.  It  will  be  held  in  Chicago  at  the 
Drake.  Advance  registration  is  required. 
Write  to:  Joseph  A.  Sabatier,  Jr.,  M.D., 
Chairman,  Committee  on  Quackery,  535  N. 
Dearborn  (AMA),  Chicago,  Illinois  60610. 
Oct.  4^— ISMS  is  sponsoring  the  11th  Con- 
ference on  Nutrition  in  Medicine  at  the 
LeClaire  Hotel,  Moline. 

Oct.  6 — ISMS  is  sponsoring  its  Annual 
Leadership  Conference  at  the  St.  Nicholas 
Hotel,  Springfield. 

Oct.  6 — Tokyo,  Japan  is  the  site  of  the 
Sixteenth  Biennial  International  Congress 
sponsored  by  the  International  College  of 
Surgeons.  Dr.  Christian  Barnard,  interna- 
tionally known  heart  surgeon,  is  one  of  the 
featured  speakers. 

Oct.  7-11 — The  1968  International  Con- 
ference on  Modern  Trends  in  Activation 
Analysis.  Sponsored  by  the  National  Bu- 
reau of  Standards,  the  program  will  pro- 
vide useful  information  for  those  who  have 
no  experience  in  activation  analysis  and 
for  those  who  have  studied  specialized 
areas  in  detail.  To  be  held  in  Gaithers- 
burg, Maryland. 


Oct.  10-11 — The  Fifth  Annual  Meeting  of 
the  Illinois  Association  of  the  Professions 
will  be  held  at  the  Ambassador  Hotel,  Chi- 
cago. Registration  is  open  to  anyone  hold- 
ing membership  in  lAP. 

Oct.  14-18 — 54th  Annual  Clinical  Con- 
gress of  the  American  College  of  Surgeons. 
Titled  “The  Forum  on  Fundamental  Surgi- 
cal Problems,”  the  meeting  will  be  held  in 
Atlantic  City,  N.J. 

Oct.  14-18 — “Who  Feeds  the  Nation,” 
will  be  the  theme  of  the  51st  Annual  Meet- 
ing of  the  American  Dietetic  Association. 
To  be  held  in  San  Francisco,  the  confer- 
ence will  feature  recent  findings  concerning 
nutrition,  diet  therapy,  food  science,  food 
service  management  and  educational  tech- 
niques. 

Oct.  21-25 — 19th  Annual  Session  of  the 
American  Association  for  Laboratory  Ani- 
mal Science.  This  session,  to  be  held  in 
Las  Vegas,  will  concentrate  on  basic  animal 
care  and  scientific  presentations  on  animal 
research. 

Oct.  28-30 — The  staff  of  the  Mayo  Clinic 
and  the  Faculty  of  the  Mayo  Foundation 
are  presenting  Clinical  Reviews.  This  pro- 
gram is  acceptable  for  credit  by  the  Amer- 
ican Academy  of  General  Practice  and 
the  College  of  General  Practice  of  Canada. 
Those  wishing  to  attend  should  communi- 
cate with  M.  G.  Brataas,  Mayo  Clinic, 
Rochester,  Minnesota  55901. 

Oct.  31-Nov.  2 — The  American  College  of 
Gastroenterology  is  sponsoring  its  Annual 
Course  in  Postgraduate  Gastroenterology. 
To  be  held  in  Boston,  Mass.  The  course  will 
cover  the  advances  in  diagnosis  and  treat- 
ment of  gastrointestinal  diseases  and  a com- 
prehensive discussion  of  diseases  of  the 
esophagus,  stomach,  pancreas,  liver  and 
gallbladder  and  colon  and  rectum. 

Jan.  6-23,  1969 — The  Department  of 
Postgraduate  Medicine  of  Albany  Medical 
College  is  now  accepting  reservations  for 
the  Tenth  Medical  Seminar  Cruise,  a 17- 
day  cruise  from  New  York.  Faculty  of  the 
college  will  present  a comprehensive  ship- 
board postgraduate  program,  covering  sub- 
jects in  medicine,  surgery,  pediatrics,  ob- 
stetrics and  gynecology.  For  more  informa- 
tion write:  Department  of  Postgraduate 
Medicine,  Albany  Medical  College,  Albany, 
New  York  12208. 


326 


Illinois  Medical  Journal 


- Medicine  and  Religion 

To  Better  Understand  Your  Catholic  Patient 

By  Rev.  John  W.  Marren 


A close  relationship  of  the  Catholic  priest 
and  the  doctor  taking  care  of  the  Catholic 
patient  will  be  very  helpful  to  the  patient 
whether  he  is  in  a hospital  or  under  private 
care. 

In  the  somewhat  brief  survey  this  article 
involves,  the  importance  of  the  priest  and 
the  sacraments  of  the  Church  are  stressed. 

In  the  spiritual  care  of  the  Catholic  pa- 
tient everything  is  naturally  much  easier 
if  the  priest  is  from  his  own  parish  or  from 
his  home  town— a priest  with  whom  he  has 
a familiar  relationship.  But  if  it  is  difficult 
to  arrange  this,  or  if  this  would  mean  a de- 
lay, the  patient  can  be  helped  by  the  priest 
who  is  chaplain  of  the  hospital  or  who  is 
from  a nearby  church.  What  is  important 
to  the  Catholic  patient  is  this:  he  needs  a 
priest  because  he  needs  the  sacramental 
ministry  of  the  Church  and  this  will  come 
to  him  through  a priest. 

Vatican  Council  II  has  stated:  “The  pur- 
pose of  the  sacraments  is  to  sanctify  men, 
to  build  up  the  body  of  Christ,  and,  finally, 
to  give  worship  to  God.  Because  they  are 
signs  they  also  instruct.  They  not  only  pre- 
suppose faith,  but  by  words  and  objects 
they  also  nourish,  strengthen  and  express 
it;  that  is  why  they  are  called  ‘sacraments  of 
faith.’  They  do  indeed  impart  grace,  but, 
in  addition,  the  very  act  of  celebrating 
them  disposes  the  faithful  most  effectively 
to  receive  this  grace  in  a fruitful  manner,  to 
duly  worship  God,  and  to  practice  charity.” 

His  life  as  a Catholic  begins  with  his  re- 
birth through  Baptism.  The  sacramental 
structure  parallels  his  natural  life  till  death 
in  such  a way  as  to  elevate  its  meaning  to 
the  supernatural. 

Consequently  Catholics  are  very  much 
concerned  about  the  Baptism  of  their  chil- 
dren and  will  be  terribly  distressed  if  one 
of  them  should  die  without  Baptism.  Real- 
izing this,  and  making  sure  that  there  can 
be  no  slipup  on  this,  a doctor  will  be  able 
to  reassure  the  expectant  mother  and  re- 
lieve her  anxiety.  Even  in  the  event  of 
something  like  a miscarriage  a doctor  will 
be  of  great  consolidation  to  his  patient  by 
making  sure  of  the  “conditional”  baptism 


of  the  fetus.  Catholic  parents  will  be  grate- 
ful to  the  doctor  who  will  alert  them  to  the 
dangerous  condition  of  an  unbaptized  in- 
fant so  that  they  will  see  to  the  baptism  of 
the  child. 

In  the  normal  course  of  life  it  is  the  Sac- 
raments of  the  Eucharist  (Communion) 
and  Penance  (Confession)  that  are  the 
sources  of  spiritual  life  to  the  Catholic. 
Whether  the  patient  is  confined  to  home  or 
is  in  the  hospital  he  should  have  the  oppor- 
tunity to  receive  these  sacraments  regularly. 
Not  only  do  we  believe  that  these  sacra- 
ments will  bring  about  a spiritually  healthy 
condition  but  we  are  also  convinced  that 
this  spiritual  condition  will  be  conductive 
to  recovery  and  better  physical  health  and 
in  this  way  contribute  to  the  “total  health 
care”  we  are  striving  for  today. 

Too  often  the  relationship  of  the  priest 
and  the  Catholic  patient  has  been  thought 
of  in  terms  of  “last  rites,”  the  Sacrament  of 
Extreme  Unction  or  the  annointings  and 
prayers  for  the  dying.  The  Vatican  Coun- 
cil said:  “Extreme  Unction  which  may  also 
and  more  fittingly  be  called  ‘annointing 
of  the  sick’  is  not  a sacrament  for  those 
only  who  are  at  the  point  of  death.  Hence, 
as  soon  as  anyone  of  the  faithful  begins  to 
be  in  danger  of  death  from  sickness  or  old 
age,  the  appropriate  time  for  him  to  re- 
ceive this  sacrament  has  already  arrived.” 
In  this  sacrament  the  prayers  that  are  said 
are  prayers  asking  God’s  help  for  the  re- 
covery of  the  sick  patient.  It  is  the  concious 
patient  to  whom  the  priest  can  be  the 
greatest  help. 

Often  it  will  be  of  help  to  the  doctor  in 
dealing  with  the  Catholic  patient  if  he 
would  suggest  a visit  to  a priest  or  even  ar- 
range it.  He  will  find  the  priest  prepared 
from  his  educational  background  to  help, 
especially  in  the  matter  of  counselling.  The 
doctor  learns  early  in  his  practice  of  medi- 
cine that  many  fears  are  based  on  hearsay 
rather  than  facts.  The  same  is  often  true  of 
the  spiritual  difficulties  of  Catholics  with  a 
“spillover”  into  their  state  of  health.  Their 
“total  health”  picture  will  be  better  for  get- 
ting the  facts  from  one  who  can  give  them. 


for  September,  1968 


327 


Clinics  for  Crippled  Children 


Twenty-six  clinics  for  Illinois’  physically 
handicapped  children  have  been  scheduled 
for  October  by  the  University  of  Illinois, 
Division  of  Services  for  Crippled  Children. 
The  Division  will  conduct  nineteen  gen- 
eral clinics  providing  diagnostic  orthopedic, 
pediatric,  speech  and  hearing  examinations 
along  with  medical,  social,  and  nursing 
service.  There  will  be  five  special  clinics  for 
children  with  cardiac  conditions  and  rheu- 
matic fever,  and  two  for  children  with 
cerebral  palsy.  Clinicans  are  selected  from 
among  private  physicians  who  are  certified 
Board  members.  Any  private  physician  may 
refer  to  bring  to  a convenient  clinic  any 
child  or  children  for  whom  he  may  want 
examination  or  consultative  services. 
October  1 Quincy— Blessing  Hospital 
October  2 Rock  Island  Cerebral  Palsy- 
Foundation  for  Crippled  Children  & 
Adults,  3808  Eighth  Avenue 
October  2 Metropolis— Massac  Memorial 

Hospital 

October  2 Hinsdale— Hinsdale  Sanitarium 
October  3 Carrollton— Boyd  Memorial 
Hospital 

October  3 Lake  County  Cardiac— Victory 
Memorial  Hospital 

October  3 Cairo— Public  Health  Building 
October  8 East  St.  Louis— Christian  Wel- 
fare Hospital 

October  8 Peoria  General— Children’s  Hos- 
pital 


October  9 Champaign  - Urbana— Mckinley 
Hospital 

October  10  Rockford— St.  Anthony’s  Hos- 
pital 

October  10  Flora— Clay  County  Hospital 

October  10  Springfield  General— St.  John’s 
Hospital 

October  11  Chicago  Heights  Cardiac— St. 
James  Hospital 

October  11  Evanston— St.  Francis  Hospital 

October  15  Belleville— St.  Elizabeth’s  Hos- 
pital 

October  16  Chicago  Heights  General— St. 
James  Hospital 

October  16  Mt.  Vernon— Good  Samaritan 
Hospital 

October  17  Elmhurst  Cardiac— Memori- 
al Hospital  of  DuPage  County 

October  17  Bloomington— St.  Joseph’s  Hos- 
pital 

October  18  Chicago  Heights  Cardiac— St. 
James  Hospital 

October  22  Peoria  General— Children’s 
Hospital 

October  29  East  St.  Louis— Christian  Wel- 
fare Hospital 

October  30  Springfield  Cerebral  Palsy 
(P.M.)— Diocesan  Center 

October  30  Aurora— C o p 1 e y Memorial 
Hospital 

October  31  Effingham  Rheumatic  Fever  & 
Cardiac— St.  Anthony  Memorial  Hospital 


Film  Reviews 


“Teaching  the  Mentally  Retarded— A 
Positive  Approach”  is  the  title  of  a film 
produced  by  the  University  of  Texas.  In 
black  and  white,  this  16  mm.,  sound,  23- 
minute  film  illustrates  the  use  of  a system 
of  teaching  based  upon  rewards  or  positive 
reinforcement.  It  follows  the  progress  made 
by  four  severely  retarded  children  during 
a 4-month  training  program  in  which  self 
care— toilet  training,  dressing,  eating— were 
emphasized.  The  film  illustrates  that  even 
the  most  seriously  retarded  can  learn  rather 
complex  skills.  Distribution  is  restricted 
to  agencies  and  institutions  serving  the  re- 
tarded and  to  professional  people  trained 
in  the  field  of  mental  retardation.  The 
film  may  be  shown  to  the  public  for  ed- 
ucational purposes  if  the  showing  is  sup- 


ervised by  a professional  person  trained  in 
behaviour  shaping  techniques.  It  is  avail- 
able on  free,  short-term  loan  from  the  Na- 
tional Medical  Audiovisual  Center  (An- 
nex), Chamblee,  Ga.  30005. 

The  Texas  Institute  for  Rehabilitation 
and  Research  has  developed  a film  avail- 
able through  the  Dept,  of  HEW,  Audio- 
Visual  Facility,  Communicable  Disease 
Center,  Atlanta,  Ga.  Entitled  “Early  Detec- 
tion of  Oral  Cancer,”  the  color  film,  run- 
ning 17  minutes,  represents  the  first  major 
effort  to  educate  the  general  public  on  the 
value  of  cytological  technique  for  the  early 
detection  of  oral  cancer.  The  end  results  of 
successful  treatment  are  explained. 


328 


Illinois  Medical  Journal 


Now  Morton  Salt  Substitute  is  making  house  calls  too. 


4 


We  tested  Morton  Salt  Substitute  for  3 
years  in  hospitals  across  the  country. 
Hundreds  of  unsolicited  letters  from 
patients  like  yours  prove  that  new 
Morton,  Salt  Substitute  is  the  first  sub- 
stitute that  tastes  like  the  real  thing. 


Because  it  is,  we’re  willing  to  put  it 
in  grocery  stores.  Now,  salt-free  dieters 
can  enjoy  it  In  their  homes.  If  your 
patients  can’t  have  the  real  . 
thing,  let  them  have  the 
next  best^thing; 
New  Morton  Salt 
Substitute. 


for  September,  1968 


329 


When  eating  fads 
of  teens  or  tots 


Lead  to  a sudden 
case  of  ‘‘trots’^ 


Parepectolin  for  quick  relief  of  acute  diarrhea 
. . . soothes  colicky  pain  with  paregoric* 

. . . consolidates  fluid  stools  with  pectin 
. . . adsorbs  irritants  with  kaolin, 
and  protects  intestinal  mucosa 


In  children,  Parepectolin  may  be  used  to  control 
diarrhea  promptly  and  prevent  dehydration, 
until  etiology  has  been  determined.  In  some 
cases,  Parepectolin  may  be  all  the  therapy  nec- 
essary. 


Parepectolin 


Each  fluid  ounce  of  creamy  white  suspension  contains: 

^Paregoric  (equivalent)  (1.0  dram)  3.7  ml. 

Contains  opium  (V4  grain)  15  mg.  per  fluid 
ounce. 

warning:  may  he  habit  forming 

Pectin (2V2  grains)  162  mg. 

Kaolin  (specially  purified)  ....  (85  grains)  5.5  Gm. 
(alcohol  0.69%) 

Usual  Children’s  Dose:  One  or  two  teaspoonfuls  three 
times  daily. 


WILLIAM  H.  RORER,  INC. 

Fort  Washington,  Pa. 


Editorial 

(Continued  from  page  274) 

up  some  experimental  models  of  out- 
patient practice  in  an  effort  to  learn  how  to 
do  our  jobs  more  efficiently,  and  to  meet 
the  critical  shortage  of  physicians  projected 
for  the  future  and  indeed,  present  today. 
Over  and  above  these  considered  goals, 
however,  we  want  to  broaden  the  student’s 
perspective.  We  want  him  to  begin  to  see 
that  medicine  is  no  longer  an  isolated  dis- 
cipline in  which  a physician  can  go  about 
seeing  individual  patients  without  thinking 
of  the  more  global  aspects  of  his  profession- 
al responsibility. 

The  new  physician  exists  in  a society  in 
which  there  are  problems  created  by  popu- 
lation growth,  urbanization,  and  cyberne- 
tics. He  should  realize  that  he  must  join  his 
technology  to  the  technology  of  other  dis- 
ciplines in  an  effort  to  work  out  solutions. 
He  must  see  the  problems  of  air  and  water 
pollution,  automobile  safety,  poor  housing 
with  its  attendant  problems,  such  as  ro- 
dents and  lead  poisoning,  as  areas  in  which 
he  has  a stake,  and  in  which  he  can  make  a 
significant  contribution.  As  a student  re- 
cently commented,  “It’s  about  time  for  the 
surgeon  to  stop  looking  at  the  all  too  fre- 
quent gunshot  wounds  as  simply  interest- 
ing surgical  challenges.”  Although  that  is 
his  primary  role,  he  must  start  to  wonder 
about  the  problems  of  society  which  bring 
about  such  violence  in  our  cities. 

It  seems  that  this  is  our  job  in  teaching 
community  medicine,  to  learn  to  treat  the 
individual  patient  with  competence,  to 
learn  to  treat  him  personally  and  with  re- 
spect, and  also,  to  see  his  problems  in  terms 
of  the  community.  This  does  not  make  the 
physician’s  burden  lighter,  it  makes  it 
heavier;  but  I submit  it  provides  him  with 
a challenge  that  can  make  his  life  more 
exciting,  more  fulfilling  and  more  mean- 
ingful than  he  has  ever  imagined. 

John  D.  Madden,  M.D. 

Medical  Director 

Woodlawn  Child  Health  Center 


Prescription  drug  industry  expenditures 
for  research  and  development  during  the 
past  10  years  average  $7  million  per  suc- 
cessful new  single  drug  entity,  according 
to  the  Pharmaceutical  Manufacturers  As- 
sociation. 


330 


Illinois  Medical  Journal 


— LETTERS  — 

To  The  Editor 
Dear  Sir: 

The  ability  of  physicians  to  maintain 
life  for  very  long  periods  in  the  unconscious 
patient  raises  the  question  as  to  ho^\’  long 
such  skills  should  be  deployed.  As  physi- 
cians we  are  eager  to  promote  the  recovery 
of  everyone  ^\’ho  can  do  so.  In  order  to  de- 
prive no  one  of  his  chances  on  this  score 
it  is  relevant  to  kno^v  the  longest  periods  of 
coma  ■which  have  been  follo^\*ed  by  useful 
survival. 

A committee  of  the  Massachusetts  Gen- 
eral Hospital  is  studying  our  own  records 
and  die  is’orld  literature  to  determine  per- 
tinent features  in  all  patients  who,  despite 
coma  for  over  5 weeks,  have  made  a useful 
recovery.  "WA  think  it  is  vital  not  to  over- 
look any  icell  documented  patient  in  this 
category.  ^\A  should  be  grateful  if  any 
reader  of  this  journal  i\ould  dra'\\’  our  at- 
tention to  any  case  published  under  a title 
which  is  not  indicative  of  survival  after 
prolonged  coma.  "UA  are  eager  to  receive 
accounts  of  such  cases  as  yet  umeported.  A 
publication  incorporating  our  o'^m  and 
odiers’  data  is  planned. 

'UA  should  be  gi  ateful  if  you  -^could  pub- 
lish this  letter  in  your  journal  either  in  a 
section  for  correspondence,  as  a special 
brief  communication,  or  in  any  other  fash- 
ion you  see  fit. 

Sincerely  yours, 

^niliam  H.  Sweet,  M.D.,  D.Sc. 
Chief,  Xeurosmgical  Service 
Chairman,  Committee  on  Man- 
agement of  the  Unconscious 
Patient 

Massachusetts  General  Hospital 
Boston,  Massachusetts  02114 
USA 


The  handicapped  worker  has  not  only 
shown  himself  to  be  a good  and  com- 
petent employee;  he  frequently  brings 
something  extra  in  the  way  of  motiva- 
tion. He  tries  harder  because  he  wants 
to  show  what  he  can  do.  As  a result, 
employment  of  the  handicapped  is  no 
longer  regarded  as  an  act  of  compas- 
sion; it  is  a matter  of  good  business 
judgment  ....  Thomas  J.  Watson,  Jr., 
chairman  of  the  board,  IBM  Corpora- 
tion. 


anticostive^ 

hematinic 


PERITINIC* 

Hematinic  with  Vitamins  and  Fecal  Softener 


A tablet-a-day  provides: 

• Elemental  Iron  (as  Ferrous  Fumarate) . 100  mg 

• Dioctyl  Sodium  Sulfosuccinate  (to 

coimteract  constipating  effect  of  iron)  100  mg 

Vitamin  Bi 7.5  mg 

Vitamin  Ba 7.5  mg 

Vitamin  Bs 7.5  mg 

Vitamin  Bia 50  mcgm 

Vitamin  C 200  mg 

Niacinamide 30  mg 

Folic  Acid 0.05  mg 

Pantothenic  Acid 15  mg 

f ^ Bottles  of  60 


anticostive,  adj.  {anti  opposed  to 
+ costive  causing  constipation.) 
Against  constipation.  Now  isn't 
that  a good  idea  in  an  ii’on-contain- 
ing  hematinic? 


LEDERLE  LABORATORIES 


A Division  of  American  Cyanami(d  Company 
Pearl  River,  New  York  10965 


4SS-7R— 6C62 


for  September,  19 f 8 


331 





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Illinois  Medical  Center 
Accepts  $3,080,340 


The  University  of  Illinois  Medical  Cen- 
ter Campus,  Chicago,  has  accepted  an  over- 
all total  of  $3,080,340  in  research  and  train- 
ing grants  for  the  month  of  July.  Out  of  56 
grants  listed,  45  grants  totaling  $2,958,989 
were  from  the  United  States  Public  Health 
Service. 

The  funds  were  allocated  as  follows: 
$387,149,  College  of  Dentistry;  $2,064,118, 
College  of  Medicine;  $215,146,  College  of 
Nursing;  $4,900,  College  of  Pharmacy;  and 
$409,027,  Student  Affairs.  The  largest  sin- 
gle grant,  $416,500,  was  awarded  to  Dr. 
William  J.  Grove,  dean  of  the  College  of 
Medicine  by  the  United  States  Public 
Health  Service  for  “Health  Professions 
Educational  Improvement  Program.” 


Mouth  Sores  May  Reflect 
Underlying  Disease 

Dentists  and  doctors  who  in  their  prac- 
tices must  make  diagnoses  involving  oral 
and  perioral  lesions  are  reminded  that 
sometimes  such  sores  are  more  than  they 
seem,  in  a set  of  close-up  photographs  of- 
fered by  Eaton  Laboratories,  Division  of 
The  Norwich  Pharmacal  Company.  The 
full-color  photos  comprise  a folder-type 
brochure,  “Oral  Manifestations  of  Systemic 
Disease.”  Each  photo  is  printed  on  an  in- 
dividual card,  easy  to  file  or  to  remove  for 
reference  and  comparison.  Diseases  with 
oral  symptoms  which  are  illustrated  in- 
clude tuberculosis,  intestinal  polyposis, 
pernicious  anemia  and  acquired  syphilis. 
In  the  future,  Eaton  expects  to  publish  ad- 
ditions to  the  series.  Copies  of  the  brochure 
are  available  from  Eaton’s  medical  sales 
representatives  or  by  writing  to  Eaton  Lab- 
oratories, Norwich,  New  York  13815. 


Hektoen  Institute  of  Medical  Re- 
search of  Cook  County  Hospital  v/ill 
present  a special  program  of  lectures 
on  Wednesday,  Sept.  25  in  conjunc- 
tion v/ith  its  twenty-fifth  anniversary. 
The  program,  to  be  held  at  Hektoen 
Auditorium,  627  S.  Wood  St.,  will  in- 
clude seven  distinguished  speakers. 
All  are  invited  to  attend. 


332 


Illinois  Medical  Journal 


Blessed  event? 


Not  entirely,  when  nausea  and 
.vomiting  occur  in  early  pregnancy. 
; Emetrol  offers  prompt  and  safe 
relief.  Local  rather  than  systemic 
action  provides  emesis  control  on  contact  with  the  hy- 
peractive G.I.  tract.*  In  a study  of  123  pregnant  women, 
the  drug  produced  measurable  improvement  in  79%  of 
patients  in  controlling  vomiting.^ 


*As  shown  by  in  vitro  studies. 

1.  Crunden,  A.  B.,  Jr.,  and  Davis,  W.  A.:  Am.  J.  Obst.  & Gynec. 
65:311  (Feb.)  1953. 


WILLIAM  H.  RORER,  INC. 
Fort  Washington,  Pa. 


Emetrol® 

phosphorated  carbohydrate 
solution 

emesis  control 


^asy  on 

the^^udget... 

on 

the51[£other 

GAGATablets  Elixir 

^ron  j^eficiency  Qydnemia 


FAMOUS 


BREON  LABORATORIES  INC. 

Subsidiary  of  Sterling  Drug  Inc. 

90  Park  Avenue,  New  York,  N.Y.  10016 


brand  of  FERFROUS 


on 

GLUCONATE 


/or  September,  1968 


333 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1968 

SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  Part  I,  Sept.  16 
SPECIALTY  REVIEW  COURSE  IN  THORACIC  SURGERY,  Sept.  16 
SPECIALTY  REVIEW  COURCE  IN  OB-GYN,  October  21 
SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  I,  October  28 
SPECIALTY  REVIEW  COURSE  IN  ORTHOPEDICS,  Nov.  18  & 
D6C  9 

SPECIALTY  REVIEW  COURSE  IN  UROLOGY,  Four  Days,  Nov.  18 
PATHOLOGY  REVIEW  COURSES  FOR  SPECIALTIES,  Request 
Dates 

SURGERY  OF  THE  HAND,  One  Week,  September  16 
PEDIATRIC  SURGERY,  One  Week,  September  30 
VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Sept. 
23 

BLOOD  VESSEL  SURGERY,  One  Week,  October  7 
MANAGEMENT  OF  COMMON  FRACTURES,  One  Week,  October 
21 

SURGERY  OF  COLON  & RECTUM,  One  Week,  November  11 
RADIOISOTOPES,  One  or  Two  Weeks,  First  Monday  Each 
Month 

BASIC  ELECTROCARDIOGRAPHY,  One  Week,  October  7 
ANESTHESIA,  Inhalation,  Endotracheal,  Regional,  Request 
Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request. 

TEACHING  FACULTY 
Attending  Staff  of 
Cook  County  Hospital 

Address: 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 




Gotta  make  a 
pit  stop  to  take 
my  cough  syrup. 


Full  speed  ahead, 
Fred.  These  solid 
Cough  Calmers 
can  control  that 
cough  for  6 to 
8 hours. 


Each  Cough  Calmer’^“  contains  the  same  active  ingredients 
as  a hali-teaspoonful  of  Robitussin-DM®:  Glyceryl  guaiaco- 
late,  50  mg.;  Dextromethorphan  hydrobromide,  7.5  mg. 
A.  H.  Robins  Company,  Richmond,  Virginia  23220 


/l'H'[^OBINS 


Comprehensive  Health  Planning 

(Continued  from  page  300) 

some  shifts  in  responsibility,  for  example: 
with  the  repeal  on  June  30,  1967  of  Sec- 
tion 318  of  the  PHS  Act,  under  which 
areawide  health  facility  planning  has  been 
conducted  heretofore,  it  has  been  deter- 
mined that  such  special  activities  are  now 
part  of  the  newly  established  comprehen- 
sive health  planning  operation;  conse- 
quently, all  applications  to  support  the 
planning  projects  for  such  operations  re- 
quire State  Planning  Agency  review  and 
approval,  prior  to  Public  Health  Service 
consideration. 

Concluding  Remarks  on  Comprehensive 
Health  Planning 

An  attempt  has  been  made  here  to  out- 
line some  principal  features  of  the  effort, 
beginning  with  summaries  of  pertinent 
legal  authorizations  contained  in  the  “Part- 
nership for  Health”  legislation,  along  with 
a brief  listing  of  what  those  of  us  with 
special  responsibilities  for  Comprehensive 
Health  Planning  have  been  attempting  to 
do  in  implementing  its  provisions.  We  have 
also  essayed  a bit  of  interpretation  apropos 
the  question  of  Congressional  “intent”  un- 
derlying Public  Law  89-749’s  passage  be- 
cause of  its  importance  to  formrdation  of 
guidelines  for  action.  As  a result,  we  be- 
lieve we  have  something  capable  of  assist- 
ing coordinated  and  well  articulated  efforts 
for  many  facets  of  health,  particular  those 
that  over  the  last  few  decades  have  become 
objects  of  federal  support.  We  also  note 
in  the  legislation  considerable  emphasis 
given  to  an  expanded  role  for  local  areas, 
thereby  enabling  optimum  participation 
in  selection  of  priorities  at  that  point  where 
all  such  health  programs  have  their  ulti- 
mate impact.  On  the  whole,  therefore,  we 
feel  reasonably  secure  in  viewing  such  de- 
velopments as  indicative  of  a healthy  trend, 
one  needed  if  we  are  to  form  a truly  ef- 
fective “Partnership”  in  this  complex  field. 


During  1967  veterans  made  an  estimated 
6,435,000  visits  to  VA  clinics  and  to  private 
physicians  on  an  approved  fee  basis  for 
outpatient  medical  care,  according  to  the 
Veterans  Administration.  This  was  a rec- 
ord number  of  treatments  for  a single  year. 


334 


Illinois  Medical  Journal 


eruLce 


or  ctidtinction 


mafi 


Professional  Protection  Exclusively  since  1899 


CHICAGO  OFFICE:  Tom  J.  Hoehn  and  E.  M.  Brcier,  Representatives 
55  East  Washington  Street,  Room  1 334,  Chicago  60602  Telephone:  31 2-782-0990 

MOUNT  PROSPECT  OFFICE:  Theodore  J.  Pandak,  Representative 
709  Hackberry  Lone  (P.  O.  Box  105)  Mount  Prospect  60056  Telephone:  312-259-2774 

ST.  CHARLES  OFFICE:  Joseph  C.  Kunches,  Representative 
1220  Wmg  Avenue,  St.  Charles  60174  Telephone:  312-584-0920 

SPRINGFIELD  OFFICE:  William  J.  Nattermann,  Representative 
1124  South  Fifth  Street,  Springfield  62703  Telephone:  217-544-2251 


Nervous 

Geriatrics 


Mental 

Custodial 


Est.  1909 

RESTHAVEN 

This  modernly  equipped  institution  located  in  the  beautiful  Fox  River  Valley  35 
miles  west  of  Chicago,  cooperates  with  physicians  to  the  fullest  extent. 

It  provides  accommodations  for  100  patients  in  single  and  double  rooms.  Rest- 
haven  accepts  patients  by  referral  and  direct  admission. 

RESTHAVEN  HOSPITAL,  600  VILLA  ST.,  ELGIN,  ILL. 

Phone:  SH  2-0327 


Long  Term 
and  Short 
Term  Care 


Day  Care 
and  Mental 
Health  Clinic 


for  September,  1968 


335 


Tuberculosis?  Influenza? 
Pneumonia?  Leukemia? 
Hodgkin’s  Disease?  Syphilis? 
Systemic  Fungal  Diseases? 
Chronic  Chest  Diseases? 
or 

HISTO? 

(Histoplasmosis— "The  Masquerader”) 


A new  aid  in  differential  diagnosis 

HISTOPLASMINJINE  TEST 

(Rosenthal) 

The  LEDERTH^™  Applicator  with  the  Blue  Handle 

Precautions— Nonspecific  reactions  are  rare,  but 
may  occur.  Vesiculation,  ulceration  or  necrosis 
may  occur  at  test  site  in  highly  sensitive  persons. 
The  test  should  be  used  with  caution  in  patients 
known  to  be  allergic  to  acacia,  or  to  thimerosal 
(or  other  mercurial  compounds). 


Ask  your  representative  for  details  or  write  Medical  Advisory  Dept., 
Lederle  Laboratories,  Pearl  River,  New  York  1 0965.  406-8 


KIDNEY  FOUNDATION  OF  ILLINOIS 

Presents  its 

4th  AJVNUAL  SYMPOSIUM 
ON  CLINICAL  ADVANCES 
IN  KIDNEY  DISEASES 

Palmer  House,  Chicago 
Wednesday,  October  16,  1968 
Guest  speakers  will  include: 

Dr.  A.  Clifford  Barger,  Harvard  Med- 
ical School;  Dr.  Neal  S.  Bricker,  Wash- 
ington University,  St.  Louis;  Dr.  Frank 
J.  Dixon,  Scripps  Clinic  and  Research 
Foundation;  Dr.  Carl  W.  Gottschalk, 
University  of  North  Carolina;  Dr.  Vic- 
tor E.  Poliak,  Michael  Reese  Hospital 
& Medical  Center;  and  Dr.  Roscoe  R. 
Robinson,  Duke  University  Medical 
Center. 

TOPICS  WILL  INCLUDE: 

The  Physiologic  Basis  of  Proteinuria 
Immunologic  Basis  of  Glomerulonephritis 
Clinical  Aspects  of  Proteinuria 
Physiology  of  Renal  Circulation 
The  Renal  Concentrating  Mechanism 
The  Kidney  and  Sodium  Metabolism 
Clinical  Significance  of  Recent  Advances  in  Renal 
Physiology 

REGISTRATION  FEE:  $15.00.  including 
luncheon.  $6.00  for  Students,  interns,  resi- 
dents. Send  registrations  to  Kidney  Foun- 
dation of  Illinois,  127  N.  Dearborn  St., 
Chicago,  ni.  60602. 

Refresher  Courses 

Over  150  Illinois  physicians  have  taken 
advantage  of  the  Medical  Refresher  Course 
sponsored  by  the  Division  of  Professional 
Services  of  the  State  of  Illinois  Department 
of  Mental  Health, 

The  program,  designed  to  prepare  phy- 
sicians holding  State  Hospital  Permits  (Illi- 
nois Temporary  Licenses)  for  the  Illinois 
Physicians  and  Surgeons  Licensure  Exam- 
ination as  well  as  for  the  test  required  by 
the  Educational  Council  for  Eoreign  Medi- 
cal Graduates,  has  been  in  operation  for 
two  years.  It  is  under  the  direction  of 
Alexander  A.  Kaluzny,  M.D. 

Six  complete  courses  have  been  given 
by  the  Department  since  the  program’s  in- 
ception in  October,  1966,  covering  17  dif- 
ferent areas  including  biochemistry,  phy- 
siology, internal  medicine,  clinical  medi- 
cine, surgery  and  sub-specialties,  pediatric 
and  pediatric  surgery,  orthopedic  and  trau- 
matology and  obstetrics. 

The  first  two  courses  were  conducted 
concurrently  in  Chicago  between  October 
1966-June  1967.  One  of  these  was  held  at 
the  Chicago  State  Hospital  and  was  at- 
tended by  32  physicians.  At  the  same  time 
another  course  was  given  at  the  Illinois 
State  Psychiatric  Institute  for  physicians 
located  within  driving  distance  of  Chicago; 
47  physicians  attended  this  session. 

Additional  courses  have  been  conducted 
in  Peoria  at  the  George  A.  Zeller  Zone 
Center  and  at  the  Manteno  State  Hospital. 
A second  course  has  also  been  conducted 
at  the  Chicago  State  Hospital. 

In  an  effort  to  offer  a similar  Medical 
Refresher  Course  to  physicians  in  southern 
Illinois,  the  sixth  and  most  recent  session 
began  last  March  in  St.  Louis.  This  course, 
which  is  being  conducted  in  conjunction 
with  Washington  University  and  the  micro- 
biology, pharmacology,  pediatrics  and  neu- 
rology departments  of  St.  Louis  Univer- 
sity, will  be  completed  in  September,  1968. 
Thirty-two  physicians  are  enrolled.  Parti- 
cipants include  members  from  Alton  State 
Hospital,  Anna  State  Hospital,  Jackson- 
ville State  Hospital,  Warren  Murray  Chil- 
dren’s Center  and  the  Mount  Vernon  Tu- 
berculosis Sanitarium. 

Active  participation  suggests  that  addi- 
tional Medical  Refresher  Courses  will  be 
sponsored  by  the  Department  of  Mental 
Health  in  the  near  future. 


336 


Illinois  Medical  Journal 


2 Approved  Group  Insurance  Plans 

for  members  of 


THE  ILLINOIS  STATE  MEDICAL  SOCIETY 


GROUP  DISABILITY  PLAN 


TOTAL  DISABILITY  CAN  BE  COSTLY 
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Advertisement 


New  Emphasis  on  Intensive 
Psychotherapy  and  Diagnosis  Developed 
in  North  Shore  Hospital 
Adolescent  Service 

An  expanded  adolescent  treatment  service 
for  emotionally  disturbed  young  people  has 
opened  at  North  Shore  Hospital.  The  core  of 
the  reorganized  service  is  intensive  psycho- 
therapy and  medical  management  offered  in  a 
structured  milieu  in  which  education,  recrea- 
tion, occupational  and  group  therapy  involve 
young  patients  in  an  intensive  effort  at  psy- 
chological growth  and  social  adjustment.  Rec- 
reational activity  includes  the  use  by  adoles- 
cent patients  of  the  hospital  lake  front  beach, 
opened  for  the  first  time  in  the  hospital’s  his- 
tory for  the  purpose. 

Intensive  diagnostic  testing  and  evaluation  is 
obligatory  for  all  patients  as  a preclude  to  for- 
mal enrollment  in  the  program.  In  addition 
to  psychodynamic  evaluation  of  character  struc- 
ture, preceptual  disorders,  neurological  and  or- 
ganic disease  and  primary  reading  disabilities 
receive  special  attention.  A search  for  in- 
born disorders  not  amendable  to  orthodox 
psychotherapy  is  made. 


Evaluation  is  based  on  a multi-disciplined,  in- 
depth  survey  conducted  from  the  point  of  view 
of  adolescent  psychiatry,  clinical  psychology, 
psychiatric  social  work,  pediatrics,  education 
and  the  hospital  milieu.  Admission  to  the  treat- 
ment program  is  based  upon  this  diagnosis. 

An  attending  or  hospital  psychiatrist  provides 
individual  psychotherapy  and  remains  in  charge 
of  the  patient.  A certified  special  education 
teacher  conducts  daily  classes  and  works  with 
counselors  and  teachers  from  the  patients' 
home  schools  so  that  school  credit  is  not  lost 
during  hospitalization.  As  indicated,  families 
will  participate  in  planning  and  treatment, 
working  with  the  hospital’s  department  of  soc- 
ial service. 

Day  and  night  hospital  care  may  be  re- 
quired, with  a wide  latitude  in  living  arrange- 
ments available.  Post-hospitalization,  counsel- 
ing in  vocational,  social  and  pedogogical  mat- 
ters may  be  arranged  by  the  hospital.  A child 
psychiatrist  is  Consulting  Clinical  Director  of 
the  program. 

Information  about  the  program  may  be  ob- 
tained from  Charles  H.  Jones,  M.D.,  Superin- 
tendent and  Psychiatrist-in-Chief,  North  Shore 
Hospital,  225  Sheridan  Road,  Winnetka,  Il- 
linois 60093,  Telephone:  (312)  446-8440 


for  September,  1968 


337 


CLASSIFIED  ADVERTISING 


Positions  & Practice  Opportunities 


PHYSICIANS  NEEDED:  General  Practitioner  with  parti- 

cular interest  in  psychiatry  or  internal  medicine.  Equal 
opportunity  employer.  Apply  Chief  of  Staff,  VAH,  Jeffer- 
son Barracks,  Missouri  63125. 


WANTED:  For  Streamwood,  Illinois,  in  Metropolitan  Chi- 
cogo  area,  a group  of  four  doctors,  as  indicated  by 
economic  survey,  to  establish  a medical  center.  For  de- 
tails write:  Streamwood  Commerce  and  Industry  Commission, 
401  E.  Irving  Park  Board,  Streamwood,  Illinois  60103. 


INTERNIST  WANTED:  Certified  or  Board  Eligible;  wanted 
for  position  of  Staff  Physician  full-time,  occupational 
medicine,  Chicago.  Emphasis  diagnostic  and  preventive 
medicine;  office  population.  Industrial  experience  unneces- 
sary; fringe  benefits.  Salary  negoticrble.  Write  Box  732 
c/o  Illinois  Medical  Journal,  360  North  Michigan  Avenue, 
Chicago,  Illinois  60601. 


EMERGENCY  ROOM  PHYSICIAN  to  join  54  doctor  multi- 
specialty group  in  thriving  university  community.  Specialties 
acceptable:  General  Practice,  Surgery,  Industrial  Medicine. 
Recently  expanded  madern  facilities.  Regular  hours,  paid 
vacations,  liberal  fringe  benefits.  Salary  negotiated.  Contact: 
Chairman  Recruitment  Committee,  Carle  Clinic,  Urbana, 
Illinois  61801. 


ANESTHESIOLOGIST(s)  WANTED:  Board  eligible  ar  certi- 
fied. Excellent  opportunity  and  income  potential  for 
qualified  individual.  Based  in  240  bed  JCAH  appraved 
General  Hospital.  New  350  bed  hospital  under  construc- 
tion. Community  of  52,000  located  in  Metropolitan  com- 
plex of  300,000.  Excellent  recreational  and  educational 
facilities.  To  arrange  visit  to  area  write:  T.  J.  Durkin, 
M.D.,  Director,  Physician  Recruitment,  St.  Anthony's  Hos- 
pital, Rock  Island,  Illinois  61201,  Area  Code  309-788-7631. 


PHYSICIANS:  To  cover  emergency  room— particularly  week- 
ends; 300  bed  hospital;  one  hour  drive  south  of  Chicago; 
Illinois  license  required,  residents  acceptable;  $300  per 
day.  Box  742  c/o  Illinois  Medical  Journal,  360  N.  Mich- 
igan Avenue,  Chicago,  Illinois  60601. 


WANTED:  Physician,  Medical  Service,  184  bed  GM&S 

closed  staff  hospital;  well  equipped  and  staffed  including 
consultants.  Pleasant  residential  recreational  area.  Southern 
lllinios  University  18,000  enrollment  located  16  miles  at 
Carbondale.  Excellent  leave,  insurance  and  retirement 
benefits.  Nondiscrimination  in  employment.  Inquire  Director, 
Veterans  Administration  Hospital,  Marion,  Illinois  62959. 


WANTED:  Experienced  chest  physician,  full-time,  for  fully 
accrediated  TB  hospitial  and  clinics  located  in  suburbs  of 
Chicago.  Apartment  available,  nominal  rent.  Excellent 
working  conditions,  retirement  pension,  full  fringe  bene- 
fits. Salary  open.  Apply— General  Administrator,  Suburban 
Cook  County  Tuberculosis  Sanitarium  District,  Hinsdale, 
Illinois. 


OPENING  FOR:  Psychiatrist,  Urolagist  and  General  Prac- 
titioner (psychiatric  or  geriatric  experience  desirable  but 
not  essential).  1,651  bed  general  medical-surgical  and 
psychiatric  hospital  with  excellent  facilities  and  progres- 
sive staff;  an  equal  opportunity  employer.  Salary:  $13,507 
through  $23,921  according  to  training  and  experience. 
Write  to  Director,  VAH,  Danville,  Illinois  61832. 


G.  P.  DESIRES  ASSOCIATE— Illinois  license;  large  general 
practice  includirvg  surgery;  (no  O.B.);  community  of  16,000; 
35  miles  N.W.  of  Chicago.  Hospital  2 miles  distant.  Box 
745  c/o  Illinois  Medical  Journal,  360  N.  Michigan  Avenue, 
Chicago,  Illinois  60601. 


OPENING  FOR  PSYCHIATRIST,  UROLOGIST  AND  GENERAL 
PRACTIONER  (psychiatric  or  geriatric  experience  desirable 
but  not  essential.)  1651  bed  general  medical-surgical  and 
psychiotric  hospital  with  excellent  facilities  and  progressive 
staff;  an  equal  opportunity  employer.  Salary:  $13,507.00 
through  $23,921.00  according  to  training  and  experience. 
Write  to  Director,  VAH,  Danville,  Illinois  61832. 


INTERNIST  WANTED:  Certified  or  Board  Eligible,  join  seven 
man  group  Southwest  Chicago  (Suburban),  excellent  Hos- 
pital, all  calls  evenly  rotated,  good  starting  salary  then 
partnership.  Contact  Administrator,  Hedges  Clinic— Frank- 
fort, Illinois. 


PHYSICIANS  NEEDED:  Full  or  part  time  for  Outpatient  Serv- 
ices, John  J.  Cochran  Veterans  Hospital,  St.  Louis,  Missouri, 
OLive  2-4100.  Nondiscrimination  in  employment. 


GENEROUS  FINANCIAL  GRANT  offered  by  Board  of  Directors 
of  White  Hall  Hospital  to  physician-surgeon  to  locate  in 
White  Hall,  Illinois.  Hospital  facilities  available  including 
Clinical  Laboratory,  X-ray,  Emergency,  Obstetrical,  and  Sur- 
gery Units.  Direct  inquiries  to  George  A.  Stahl,  Administra- 
tor, White  Hall  Hospital,  White  Hall,  Illinois  62092. 


WANTED:  GENERAL  PRACTITIONER.  Clean  Community  of 
2,200  in  Southern  Illinois.  35  miles  from  St.  Louis.  Carlyle 
Lake  Area  just  18  miles.  New  Medical  facility  completed 
August,  1968.  Excellent  opportunity  area.  Contact:  Leroy  A. 
Zimmermann,  Doctors  Committee,  Trenton  Chamber  of  Com- 
merce, Trenton,  Illinois  62293.  Phone:  618-224-9258. 


GENERAL  PRACTICE  OPPORTUNITY  for  two,  associate  or 
solo  practice.  Modern  accredited  hospital.  Unsurpassed 
educational,  cultural,  recreational  facilities  in  progressive 
college  town.  Apply  L.  R.  Montemayor  M.D.,  Secy.  Med. 
Staff,  Charleston  Com.  Mem.  Hosp.,  Charleston  Com.  Comp. 
Hosp.,  Charleston,  III.  61920.  Phone  217-345-2141. 


SURGEON,  OUTSTANDING  FINANCIAL  OPPORTUNITY,  only 
one  other  surgeon  in  county  of  40,000;  join  54  bed  hos- 
pital, lake  resort  area  near  Nortre  Dame  University;  apply 
American  Medical  Personnel,  159  E.  Chicago  Avenue,  Chi- 
cago, Illinois,  Delores  Susral,  Director. 


"WELL  ESTABLISHED  G.P.  desires  associate  to  take  over 
high  gross  practice  of  departing  partner.  Modern,  new  of- 
fice with  6 aides.  Community  hospital  affiliation.  Town  of 
8,000  35  miles  from  Chicago.  Early  partnership  considera- 
tion. Write  A.  G.  Baxter,  M.D.,  34  North  V/ater  Street, 
Batavia,  III.  60510. 


Sales  and  Rentals 


FREE:  Active  general  practice  in  western  suburb  of  Chicago 
—35  miles  from  Loop.  New  air-conditioned  offices  with 
very  reasonable  rent.  New  350  bed  hospital— open  staff. 
Excellent  schools.  Nothing  to  buy.  Leaving  for  health  rea- 
sons. Box  743  c/o  Illinois  Medical  Journal,  360  N.  Mich- 
igan Avenue,  Chicago,  Illinois  60601. 


FOR  IMMEDIATE  SALE  OR  RENTAL-Ground  level  centrally 
air-conditioned  furnished  four  room  medical  office  down- 
town Wheaton,  Illinois.  Excellent  hospital  and  convalescent 
facilities.  Call  668-0297. 


YOUNG  PSYCHIATRIST-Board  Eligible;  interested  in  a 
group  practice,  seeking  for  location,  c/o  Illinois  Medical 
Journal,  360  N.  Michigan  Ave.,  Chicago,  Illinois  60601- 
Box  747. 


Classified  Advertising  Rates 

Effective  Jan.  1,  1968  rates  are: 

30  words  or  less — 1 insertion  

.$  5.00 

3 insertions 

.$12.00 

6 insertions 

.$18.00 

12  insertions 

.$30.00 

30  to  50  words — 1 insertion  

.$  8.00 

3 insertions 

.$14.00 

6 insertions 

.$24.00 

12  insertions 

.$40.00 

A charge  of  25c  is  made  if  replies  are  sent 

to  a box  number  in  care  of  the  Journal. 

Cash  with  order.  No  general  advertising 

accepted  in  classified  colunm. 

338 


Illinois  Medical  Journal 


PUBLISHED  MONTHLY  BY:  BLUE  SHIELD  PLAN  OF  ILLINOIS  MEDICAL  SERVICE  • 425  NORTH  MICHIGAN  AVENUE  • CHICAGO.  ILLINOIS  60690 


' f Vol.  2,  No.  10  October,  1968 

— 


y _ 

S Our  New  Home 

Finishing  touches  are  being  put  on  the  new  home 
of  Blue  Cross-Blue  Shield  located  at  222  North 
Dearborn  on  the  southwest  comer  of  Dearborn 
Street  and  Wacker  Drive,  Chicago. 

It  is  the  culmination  of  years  of  pioneering,  plan- 
ning, and  hard  work,  and  was  built  to  serve  more 
than  2/2  million  Blue  Cross  and  Blue  Shield  mem- 
bers and  the  professional  community  with  greater 
efficiency. 

The  new  building  brings  together  under  one  roof 
a number  of  important  functions  formerly  carried 
out  by  our  1500  employees  housed  in  three  dif- 
ferent locations.  Our  new  facilities  will  allow  us  to 
consolidate  our  Plan  activities  and  improve  our 
service  to  you. 

The  15  story  modern  stmcture  will  be  ready  for 
occupancy  about  the  middle  of  November. 

Designed  by  Chicago  architects  C.  F.  Murphy 
Associates,  it  is  built  of  poured  concrete  and  has 
exposed  texture  of  vertical  and  horizontal  ele- 
ments, aluminum  window  frames,  and  solar-bronze 
plate  glass  windows. 

The  building’s  central  core  constmction  permits 
maximum  usable  work  space  free  of  columns,  en- 
compassing a gross  area  of  264,300  square  feet. 

The  date  we  move  from  our  present  Plan  oflBces 
to  our  new  Blue  Cross-Blue  Shield  building  has  not 
yet  been  set.  We  will  keep  you  informed. 

Reporting  Services  of 
Out-of-State  Members 


MODEL  OF  BLUE  CROSS-BLUE  SHIELD  BUILDING 
Wacker  drive  and  Dearborn  street,  Chicago. 


DB  At  the  present  time  a total  of  77  Blue  Shield 
Plans  have  over  58  million  members  and  some  of 
your  patients  may  be  members  of  out-of-state  Plans. 
|B  When  you  submit  claims  for  your  services  pro- 
|H  vided  to  out-of-state  Blue  Shield  members,  please 
complete  our  regular  Blue  Shield  Physicians  Ser- 
vice  Report  forms  and  list  the  dates  of  service,  the 


services  performed,  and  your  fee  for  each  service. 
Mail  completed  forms  directly  to  the  Blue  Shield 
Plan  listed  on  the  identification  card  of  your  patient. 

Each  Blue  Shield  Plan  processes  claims  for  its 
own  members  and  undue  delays  in  payment  can 
be  avoided  by  maihng  completed  Report  forms  di- 
rectly to  the  Plan  involved. 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 


• • • ABOUT  MEDICARE 

The  following  articles,  published  previously  in 
issues  of  this  Report,  are  being  reproduced  in 
answer  to  many  questions  we  have  received  regard- 
ing assigned  Medicare  claims  and  payments  made 
to  beneficiaries  on  itemized  statements. 

Payment  on  Itemized  Bill 

A physician  who  docs  not  accept  an  assignment 
and  submits  an  itemized  hill  to  his  Medicare  pa- 
tient, sliould  include  on  each  bill  the  patient’s  name; 
the  physician’s  name;  the  date,  place,  description  of 
EACH  service  provided  and  the  charge  for  EACH 
service.  Unusual  circumstances  or  complications 
should  be  described  if  they  are  reflected  in  the 
charge.  This  information  is  needed  before  payment 
can  be  made  to  Medicare  patients  for  covered 
services. 

The  1967  Amendment  to  Social  Security  which 
allows  a payment  to  be  made  on  an  itemized  rather 
than  a receipted  bill  is  intended  to  provide  the 
Medicare  patient  with  the  resources  to  help  pay 
his  physician’s  charges.  But,  it  oho  increases  the 
possibility  of  duplicate  payment  being  made  for  the 
same  service.  It  is  possible,  for  example,  for  a phy- 
sician to  accept  an  assignment  at  the  same  time 
his  patient  submits  an  itemized  bill  for  payment. 

A physician  who  accepts  an  assignment  will  not 
be  paid  when  the  benefit  has  already  been  paid  to 
his  patient.  Likewise,  no  payment  will  be  made  to 
his  patient  when  the  benefit  has  been  paid  to  the 
physician. 

When  a Medicare  patient’s  claim  is  received  first, 
payment  will  be  made  to  him.  When  a claim  from  a 
physician  who  accepts  an  assignment  is  received 
before  payment  is  made  to  his  patient,  payment 
will  be  made  to  the  physician. 

Therefore,  physicians  who  do  accept  assignments 
should  submit  claims  promptly  for  services  they 
have  provided.  And  to  reduce  the  possibility  of 
duplicate  claims  from  being  filed  or  duplicate  pay- 
ments from  being  made,  they  should  clearly  indi- 
cate on  their  patient’s  bills  that  they  accept  as- 
signment. 

The  AMA  on  Itemized  Bill 

At  its  clinical  meeting  in  Houston,  the  House  of 
Delegates  of  the  American  Medical  Association 
adopted  a report  of  the  Board  of  Trustees,  with 
amendments,  which  emphasized  the  responsibilities 
of  physicians  and  medical  societies  when  physicians 
bill  their  Medicare  patients  directly. 


The  position  taken  by  the  AMA  House  is  as  fol- 
lows: 

1.  “The  physician  must  report  fully  and  spe- 
cifically in  his  billing  the  nature  of  the  ser- 
vices provided  so  that  the  patient  may  be 
properly  reimbursed  by  the  Medicare  carrier 
and  should  guide  his  patient  in  his  applica- 
tion for  reimbursement. 

2.  The  physician  should  adhere  to  his  usual,  cus- 
tomary, and  reasonable  charges. 

3.  Much  of  the  misunderstanding  about  direct 
billing  may  be  eliminated  if  the  physician 
and  the  patient  will  discuss  in  advance  the 
fee,  and  that  portion  of  it  which  will  be  reim- 
bursable  through  Medicare  and  that  portion 
which  will  remain  the  responsibility  of  the 
patient. 

4.  The  physician  should  explain  to  the  patient 
that  Medicare  is  not  a full-paid  plan;  and 
that  the  patient  should  anticipate  paying  part 
of  the  fee  as  clearly  spelled  out  in  the  law. 
Physicians  whose  usual  fees  exceed  those 
which  are  customary  in  their  medical  area 
should  explain  in  advance  to  their  patients 
the  effect  this  will  have  on  Medicare  pay- 
ments. 

5.  Local  Medical  Societies  should  provide  re- 
view  mechanisms  which  are  made  freely  avail-  ^ L 
able  to  the  public: 

(1)  To  insure  that  the  interests  of  patients  W 

are  protected  in  dealing  with  Medicare  car-  w 
riers;  ^ 

(2)  To  advise  all  parties  as  to  the  propriety  of  S 
fees  which  may  be  charged  by  physicians.”  ^ 

Patient's  Signature  on  Assigned  Claims  g | 

Some  patients  have  challenged  assigned  pay- 
ments to  physicians,  especially  hospital-based  phy-  / 
sicians,  stating  that  they  did  not  make  an  assign-  | 
ment.  It  is  therefore  necessary  that  we  have  the  ^ 
patient’s  signature  on  all  assigned  claims  unless  a ^ 
blanket  SSA  1490  has  been  submitted  for  the  same  :J 
illness.  The  physician  treating  a patient  over  an 
extended  period  of  time  need  not  obtain  the  pa-  ^ 
tient’s  signature  each  time  he  accepts  an  assign- 
ment.  However,  he  can  obtain  the  patient’s  consent 
to  an  assignment  of  unpaid  charges  for  the  antici-  j 
pated  period  of  treatment  by  having  the  patient  |-j 
sign  a brief  statement  as  follows:  “I  request  that  Jl 
payments  under  the  medical  insurance  program  be  Si 
made  directly  to  Doctor on  any  un- 

paid bills  for  services  furnished  me  by  that  physi-  ^ 

cian  during  the  period  to ” i 

When  the  physician  submits  the  1490  for  payment 
on  which  he  accepts  an  assignment,  he  should  in- 
dicate in  the  patient’s  signature  space  “This  is  a || 
continuation  of  a course  of  treatment  for  which  pa-  | * 
tient’s  assignment  was  previously  obtained.”  ' ' 

J! 


(This  is  not  an  advertisement) 


tf  you’re 

self-employed, 


you  could  help  yourself 
toane)ara 

$2500  tax  deduction 
every  year. 


It's  the  law.  Legislation  known  as 
the  Keogh  Act  or  HR-10  allows 
self-employed  people  to  deduct 
contributions  to  their  own  tax-exempt 
retirement  plan.  Depending  on  the 
design  of  the  plan,  deductions  may 
now  total  up  to  $2500  a year.  And 
most  self-employed  people  qualify. 

To  find  out  how  HR-10  works  and 
who  in  Illinois  is  eligible,  just 
send  in  the  coupon  below. 


Starting  with  this  liberalized 
tax  law,  we  can  help  you  and  your 
attorney  with  the  establishment  of 
a personal  retirement  fund  that 
could  save  you  thousands  over 
the  years.  And  make  your  retirement 
richer  and  more  carefree  than 
you'd  planned  on. 

We  want  you  to  be  rich 


I 1 

J The  First  National  Bank  of  Chicago  I | 

I 38  South  Dearborn  Street  | 

I Chicago,  Illinois  60690  I 

Attn:  Trust  Department 

i Please  send  your  free  booklet,  Report  on  Our  I 

Profit  Sharing  Plan  for  Self-Employed. 

I Name I 

! Address 


I City State i 

I (ILLINOIS  RESIDENTS  ONLY)  I 

I Zip I 

I 1 


The  First  National  Bank  of  Chicago 

Member  Federal  Deposit  Insurance  Corporation 


for  October,  1968 


355 


Editor 

T.  R.  Van  Dellen,  M.D. 

Managing  Editor 
Richard  A.  Ott 

Medical  Progress  Editor 

Harvey  Kravitz,,  M.D. 


Jacob  E.  Reisch,  M.D., 

Chairman 

J.  Ernest  Breed,  M.D. 

Editorial 

Edwin  F.  Hirsch,  M.D. 

Chairman 

James  H.  Hutton,  M.D. 

Samuel  A.  Levinson,  M.D. 


Executive  Administrator 

Roger  N.  White 

Director  of  Business  Services 

Roland  I.  King 

Advertising  Manager 
John  A.  Kinney 

Committee 

Darrell  H.  Trumpe,  M.D. 
Warren  W.  Young,  M.D. 
Board 

Charles  Mrazek,  M.D. 
Clarence  J.  Mueller,  M.D. 
Frederick  Steigmann,  M.D. 
Frederick  Stenn,  M.D. 

Arkell  M.  Vaughn,  M.D. 


ILLINOIS  state  medical  SOCIETY 


360  N.  Michigan  Ave.,  Chicago,  Illinois  60601 


OFFICERS 

Philip  G.  Thomsen,  President 

13826  Lincoln  Avenue,  Dolton,  60419 

Edward  W.  Cannady,  President-Elect 

4601  State  Street,  East  St.  Louis,  62205 

Casper  Epsteen,  1st  Vice-President 

25  E.  Washington  St.,  Chicago,  60602 

Carl  E.  Clark,  2nd  Vice-President 

225  Edward  Street,  Sycamore,  60178 


TRUSTEES 

Frank  J.  Jirka,  Chairman 

1507  Keystone  Ave.,  River  Forest,  60305 

Joseph  L.  Bordenave,  1st  District 

1665  South  Street,  Geneva,  60134 

William  A.  McNichols,  Jr.,  2nd  District 

101  W.  First  Street,  Dixon,  61021 

William  E.  Adams,  3rd  District 

55  E.  Erie  Street,  Chicago,  60611 

J.  Ernest  Breed,  3rd  District 

55  E.  Washington  Street,  Chicago,  60602 

James  B.  Hartney,  3rd  District 

410  Lake  Street,  Oak  Park,  60302 

Frank  J.  Jirka,  3rd  District 

1507  Keystone  Ave.,  River  Forest,  60305 

William  M.  Lees,  3rd  District 

6518  N.  Nokomis,  Lincolnwood,  60646 

Warren  W.  Young,  3rd  District 

10816  Parnell  Ave.,  Chicago,  60628 


Jacob  E.  Reisch,  Secretary-Treasurer 
1129  South  2nd  Street,  Springfield,  62704 

Maurice  M.  Hoeltgen,  Speaker 

1836  West  87th  Street,  Chicago,  60620 

Paul  W.  Sunderland,  Vice-Speaker 

216  N.  Sangamon  Street,  Gibson  City, 
60936 


Paul  P.  Youngberg,  4th  District 

1520  7th  Street,  Moline,  61265 

Darrell  H.  Trumpe,  5th  District 

St.  John’s  Sanatorium,  Springfield,  62700 

J.  Mather  Pfeiffenberger,  6th  District 

State  8c  Wall  Streets,  Alton,  62004 

Arthur  F.  Goodyear,  7th  District 

142  E.  Prairie  Avenue,  Decatur,  62523 

Wm.  H.  Schowengerdt,  8lh  District 

301  E.  University  Avenue,  Champaign, 
61821 

Charles  K.  Wells,  9th  District 

117  N.  10th  Street,  Mt.  Vernon,  62824 

Willard  C.  ScrivTier,  10th  District 

4601  State  Street,  East  St.  Louis,  62205 

Joseph  R.  O’Donnell,  11th  District 

444  Park,  Glen  Ellyn,  60137 

Newton  DuPuy,  Trustee-at-Large 

1842  Grove  Ave.,  Quincy,  62301 


356 


Illinois  Medical  Journal 


A once-popular  treatment  for  back  pains 
was  to  have  the  seventh  son  of  a seventh  son 
stand  or  walk  on  the  patient's  back. 


The  pain  of  earache  was  allegedly  relieved 
by  holding  a hot  roasted  onion  to  the  ear. 


For  headache,  a sovereign  remedy  was 
to  wear  a snakeskin  round  one's  head. 


A realistic 
approach 

to  pain 


relief 


Empirin 


Compound  with  Codeine 
Phosphate  gr.  1/2  No.  3 

Each  tablet  contains: 

Codeine  Phosphate  gr.  1/2  (Warning- 

May  be  habit  forming),  Phenacetin  gr.  2 1 / 2, 

Aspirin  gr.  3 1 / 2,  Caffeine  gr.  1/2. 

keeps  the  promise 
of  pain  relief  ^ 

B.W.  & Co.'  narcotic  products  are 

Class  "B",  and  as  such  are  available  on  oral 

prescription,  where  State  law  permits. 

.31^  BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC. 

.1^1  Tuckahoe.  N.Y.  J 


3 

Pink  Puffers  and  Blue  Bloaters 

It  is  usually  possible  to  separate  most 
patients  with  severe  obstructive  pulmon- 
ary disease  into  two  clinical  categories— 
the  Pink  Puffers  and  the  Blue  Bloaters. 
According  to  Scadding^  the  terms  'Blue 
Bloater'  and  'Pink  Puffer'  originated  with 
Dr.  A.  C.  Dornhorst  of  St.  George's  Hos- 
pital in  London.  To  quote  Dr.  Scadding, 
"The  Blue  Bloaters  are  most  characteris- 
tically those  who  have  started  with  long 
continued  chronic  bronchitis  punctuated 
by  recurrent  inflammatory  episodes.  Af- 
ter many  years  these  episodes  are  ac- 
companied by  alveolar  hypoventilation 
and  cyanosis,  carbon  dioxide  retention 
with  associated  disorders  of  conscious- 
ness often  made  worse  by  oxygen,  and 
edema  and  raised  jucular  venous  pres- 
sure. With  appropriate  treatment  they 
may  survive  several  of  the  episodes  of 
edema  to  which  the  term  'Bloater'  refers. 
In  such  patients  emphysema  may  not  be 
a prominent  feature  at  necropsy  al- 
though during  life  severe  airway  ob- 
struction is  found." 

"The  Pink  Puffer,  considerably  less  fre- 
quent in  England,  is  the  type  of  patient 
who  starts  with  progressive  dyspnea  on 
exertion,  usually  in  middle  age,  without 
a preceding  history  of  chronic  bronchitis. 
He  has  overdistended  lungs,  often  cur- 
iously silent  to  auscultation.  In  spite  of  a 
much  reduced  ventilatory  capacity  with 
considerable  irreversible  airway  obstruc- 
tion and  greatly  increased  residual  ca- 
pacity, he  nevertheless  manages  to  main- 
tain a minute  volume  above  that  of  a 
normal  subject  at  rest  and  so  keeps  his 
PCO2  down  to  normal  levels  until  very 
shortly  before  the  end  of  his  disease. 
Moreover,  he  develops  right  ventricular 
failure,  if  at  all,  only  terminally,  very 
rarely  making  a useful  functional  recov- 
ery once  edema  has  appeared.  Such  pa- 
tients may  confidently  be  expected  to 
show  emphysema  at  necropsy."  (William 
B.  Hunt,  Jr.,  "Criteria  for  Diagnosis  of 
Asthma,  Chronic  Bronchitis  and  Emphy- 
sema, With  a Note  on  Pink  Puffers  and 
Blue  Bloaters."  Virginia  Med.  Monthly 
[Feb.]  1968;  95;  pg.  73.) 

References 

1.  J.  C.  Scadding,  Meaning  of  Diagnostic  Terms 
in  Broncho-Pulmonary  Diseases.  Brit.  M.J.  2: 
1425-1430,  1963. 


Preludin  is  indicated  only  as  an 
anorexigenic  agent  in  the  treatment 
of  obesity.  It  may  be  used  in  simple 
obesity  and  in  obesity  complicated 
by  diabetes,  moderate  hypertension 
(see  Precautions),  or  pregnancy 
(see  Warning). 

Contraindications:  Severe  coronary 
artery  disease,  hyperthyroidism, 
severe  hypertension,  nervous  insta- 
bility, and  agitated  prepsychotic 
states.  Do  not  use  with  other  CNS 
stimulants, including  MAO  inhibitors. 
Warning:  Do  not  use  during  the  first 
trimester  of  pregnancy  unless  po- 
tential benefits  outweigh  possible 
risks.  There  have  been  clinical 
reports  of  congenital  malformation, 
but  causal  relationship  has  not  been 
proved.  Animal  teratogenic  studies 
have  been  inconclusive. 
Precautions:  Use  with  caution  in 
moderate  hypertension  and  cardiac 
decompensation.  Cases  involving 
abuse  of  or  dependence  on  phen- 
metrazine  hydrochloride  have  been 
reported.  In  general,  these  cases 
were  characterized  by  excessive 
consumption  of  the  drug  for  its  cen- 
tral stimulant  effect,  and  have 
resulted  in  a psychotic  illness 
manifested  by  restlessness,  mood  or 
behavior  changes,  hallucinations  or 
delusions.  Do  not  exceed  recom- 
mended dosage. 

Adverse  Reactions:  Dryness  or  un- 
pleasant taste  inthe  mouth, urticaria, 
overstimulation,  insomnia,  urinary 
frequency  or  nocturia,  dizziness, 
nausea,  or  headache. 

Dosage:  One  25  mg.  tablet  b.i.d.  or 
t.i.d.  Or  one  75  mg.  Endurets  tablet 
a day,  taken  by  midmorning. 
Availability:  Pink,  square,  scored 
tablets  of  25  mg.  for  b.i.d.  or  t.i.d. 
administration,  in  bottles  of  100  and 
1000. 

Pink,  round  Endurets®  prolonged- 
action  tablets  of  75  mg.  for  once-a- 
day  administration,  in  bottles  of 
100  and  1000. 

Under  license  from 
Boehringer  Ingelheim  G.m.b.H. 

(B)R3-46-S60-B 

For  complete  details,  please  see 
full  prescribing  information. 

Preludin’ 

phenmetrazine 

hydrochloride 

Geigy  Pharmaceuticals 
Division  of 

Geigy  Chemical  Corporation 
Ardsley,  New  York  10502 


362 


Illinois  Medical  Journal 


Abstracts  of  Board  Actions 

Meeting  July  20-21,  1968 

These  abstracts  are  published  so  that  members  of  the 
Illinois  State  Medical  Society  may  keep  advised  of  the  actions 
of  the  Board  of  Trustees.  It  covers  only  major  actions  and  is 
not  intended  as  a detailed  report.  Full  minutes  of  the 
meetings  are  available  upon  any  member’s  request  to  the 
headquarters  office  of  the  ISMS. 

DR.  THOMSEN  MEETS  WITH  NURSES 

Dr.  Thomsen,  ISMS  president,  and  Dr.  Jirka,  Chairman  of 
the  Board,  reported  that  they  had  attended  and  taken  part  in 
a meeting  held  with  representatives  of  the  nursing  profes- 
sion. They  stated  that  the  nurses  desired  to  establish  a 
better  rapport  with  the  ISMS  and  desired  the  cooperation  of 
the  doctors  in  the  many  things  they  were  being  asked  to  do, 
particularly  regarding  emergency  room  care.  Also  discussed 
were  the  Nurse’s  activities  in  the  intensive  care  treatment 
of  coronary  case  patients.  Further  report  and  recommenda- 
tion will  be  forthcoming. 

APPROVAL  OF  HANDBOOK  ON  MEDICAL  CERTIFICATION 

The  Illinois  Department  of  Public  Health,  Division  of 
Vital  Statistics,  asked  for  approval  of  the  contents  of  a 
proposed  physician’s  handbook  on  medical  certification. 
The  ISMS  Committee  on  Vital  Statistics  reviewed  the  manual 
and  several  suggestions  for  its  improvement  were  adopted. 
The  committee  recommended  approval  of  this  handbook  based 
upon  a careful  review  of  the  contents.  As  recommended  by  the 
Executive  Committee  the  Handbook  was  approved. 

LACK  OF  COUNTY  HEALTH  CENTERS  CITED 

Dr.  Yoder,  Illinois  Director  of  Public  Health,  commented 
on  the  distribution  of  local  health  departments  throughout 
the  State,  calling  special  attention  to  the  counties  where 
there  were  no  local  health  centers  organized.  The  ISMS 
should  help  establish  a local  health  department  whenever 
possible  and  then  participate  to  set  the  policies  for  their 
activities.  The  Board  voted  to  support  the  Health  Depart- 
ment's campaign  for  developing  additional  county  health 
departments. 

HOSPITAL  LAB  SERVICES 

Counsel  asked  Dr.  Yoder  to  comment  on  the  use  of  hospital 
laboratories  by  chiropractors,  calling  attention  to  the 
legal  ramifications  of  this  practice.  Dr.  Yoder  indicated 
that  he  first  needed  to  know  from  legal  counsel  whether  there 
was  anything  they  could  do  by  regulation.  If  so,  they  were 
certainly  willing  to  try.  Dr.  Yoder  stated  that  his  Depart- 
ment would  be  glad  to  cooperate  with  the  State  Medical  So- 
ciety. Mr.  Pfeifer  indicated  his  belief  that  hospital  lab- 
oratories should  adopt  a rule  to  the  effect  that  they  would 
only  make  examinations  for  those  persons  who  used  the  re- 
sults in  their  practice.  It  was  his  recommendation  that  con- 
tact be  made  with  the  Health  Department  and  the  possibility 
of  establishing  such  a rule  considered. 


for  October,  1968 


365 


ABILITY  TO  PRACTICE  OPINION 

Mr.  Pfeifer,  legal  counsel,  reported  as  to  what  actions 
a county  medical  society  could  take  regarding  an  incompetent 
physician.  He  stated  that  the  county  society,  or  even  the 
state  society,  had  no  power  to  hold  a hearing  or  to  revoke  or 
suspend  a license — this  was  entirely  within  the  purview  of 
the  Department  of  Registration  and  Education.  On  the  other 
hand,  the  local  society  had  the  power  and  certainly  the 
moral  obligation,  in  the  event  an  incompetent  individual 
practiced  in  the  area,  to  make  a discreet  investigation, 
and  report  to  the  state  society.  He  further  indicated  that 
the  Department  of  Registration  and  Education  was  attempting 
to  do  a better  job  in  this  field  and  had  asked  for  coopera- 
tion from  the  state  society. 

TESTIMONY  FOR  DEPARTMENT  OF  REGISTRATION 
AND  EDUCATION 

A letter  from  the  Department  of  Registration  & Education 
has  been  received  soliciting  cooperation  of  the  state  so- 
ciety with  regard  to  medical  testimony.  It  was  suggested 
the  procedure  to  be  followed  in  this  event  be  as  follows: 
when  the  Department  of  Registration  has  a problem  where  they 
feel  that  they  do  need  medical  testimony,  that  they  notify 
the  State  Society  and  then  in  turn,  the  state  society  contact 
the  local  society  where  the  individual  concerned  was  a mem- 
ber, and  attempt  to  obtain  additional  information  from  him. 
In  the  event  medical  testimony  should  be  warranted,  the 
state  society  would  attempt  to  provide  the  Department  of 
Registration  & Education  Division  with  the  names  of  physi- 
cians who  might  be  willing  to  testify  and  the  Department 
could  contact  these  physicians.  This  matter  will  be  investi- 
gated and  pursued  further  for  report  to  the  Board. 

MEDICARE  AND  IDPA  ASSIGNMENTS  IN  CLARK  COUNTY 

Doctors  in  Clark  county  have  not  been  accepting  assign- 
ments in  relation  to  Medicare  patients  jointly  eligible  for 
payments  under  Public  Aid.  This  position  is  backed  by  both 
the  House  of  Delegates  and  by  the  action  of  the  ISMS  Advisory 
Committee  to  the  IDPA  and  also,  in  principle,  by  the  Usual 
& Customary  Fees  Committee  of  the  Society.  Board  approval 
was  requested  for  setting  up  a testing  area  in  Clark  County 
in  cooperation  with  the  Department  of  Public  Aid  and  the 
Social  Security  Administration. 

The  Clark  County  procedure  would  call  for  the  Department 
of  Public  Aid  to  pay  the  annual  $50  Medicare  deductible. 
Medicare  would  pay  the  doctor  the  usual  80%  of  the  allow- 
able charge  without  the  requirement  for  an  assignment.  The 
physician  would  write  off  the  balance  as  a charitable  serv- 
ice. This  request  for  a test  area  was  granted  and  it  was 
suggested  that  a report  be  presented  to  the  House  of  Dele- 
gates at  its  next  meeting. 


( Continued  on  page  581 ) 


366 


Illinois  Medical  Journal 


president’s  page 


Philip  G.  Thomsen,  M.D. 


As  we  study  your  vigorous  response  to  the 
ISMS  Survey  on  Major  Issues  that  you  re- 
ceived in  August,  one  basic  result  already 
is  clear: 

You  have  given  us  plently  of  grist  for  con- 
structive programs  and  action  in  the  weeks 
ahead. 

About  3,000  of  you  answered  the  survey 
—a  total  that  is  all  the  more  remarkable  in 
a top  vacation  month  like  August.  Some  of 
you  offered  thoughtful  observations  and 
ideas  below  your  checkmarks.  Your  eager 
cooperation  on  this  project  will  stimulate  us 
to  serve  you  better. 

Dr.  Matthew  B.  Eisele,  chairman  of  our 
Committee  on  Public  Relations,  will  ana- 
lyze the  results  in  the  November,  December 
and  January  issues  of  IMJ.  The  series  will 
be  divided  into  legislative,  socio-economic 
and  professional  topics. 

Curiousity  has  prompted  me  to  make  a 
little  analysis  of  my  own.  I compared  some 
results  in  terms  of  the  age  brackets  you 
marked  on  the  survey’s  last  page. 

On  some  questions,  the  opinions  of  young 
and  old  were  almost  identical.  But  a not- 
able difference  occurred  on  this  question: 

“To  relieve  the  shortage  of  G.  P.’s,  should 
the  ISMS  demand  two  to  three  years  of  gen- 
eral practice  as  a prerequisite  to  specialized 
training?” 


Answering  “yes”  were  57  percent  of  the 
physicians  over  55  years  old,  but  only  37 
per  cent  in  the  40-55  bracket  and  22. 1 per 
cent  in  the  under-40  group.  Since  more  than 
half  the  doctors  answering  that  question  are 
in  the  40-55  group,  the  “yesses”  averaged 
out  at  4l  per  cent. 

But  on  the  question  of  payments  under 
Medicare,  general  satisfaction  was  expressed 
by  65  per  cent  in  both  the  under-40  and 
over-55  bracket— and  by  68  per  cent  in  the 
40-55  group. 

Please  study  the  complete  survey  analyses 
in  the  coming  IMJ  issues.  Meanwhile  exam- 
ine this  Reference  Issue— and  hold  on  to  it. 
Within  its  covers  you’ll  find  the  most  sig- 
nificant details  on  the  structure  of  profes- 
sional medicine  in  Illinois.  You’ll  see  who 
is  doing  what  . . . which  committee  or 
agency  is  responsible  for  a particular  facet 
of  medicine  . . . and  similar  information.  I 
know  this  issue  will  serve  you  constantly 
and  well. 


for  October,  1968 


369 


ISMS  ORGANIZATION 

History  of  Founding  and  Expansion 


Twenty-nine  Physicians  met  in  Springfield 
June  4,  1850,  to  organize  on  a permanent  basis 
the  Illinois  State  Medical  Society,  which  had  been 
started  informally  10  years  earlier.  The  founders 
were  concerned  with  the  solution  of  ethical,  scien- 
tific, legislative  and  economic  problems.  The  first 
Constitution  and  Bylaws  and  the  first  Code  of 
Medical  Ethics  were  adopted;  the  first  legislative 
committee  was  appointed,  and  a resolution  out- 
lining the  beginnings  of  interprofessional  relations 
was  approved. 

The  Legislative  Committee  was  instructed  to 
“memorialize  the  legislature  at  its  next  session, 
praying  the  enactment  of  a statute  providing  for 
the  registration  of  Births,  Deaths  and  Marriages.” 
The  resolution  ruled  that  “members  of  the  Society 
will  discourage  the  sale  of  patent  or  secret  nos- 
trums on  the  part  of  Druggists  and  Apothecaries 
throughout  the  State,  and  will  patronize  insofar 
as  practicable,  only  those  who  abstain  from  the 
sale  of  such  patent  or  secret  nostrums.” 

The  first  full  time  secretary  of  the  Society  was 
Dr.  Harold  M.  Camp  who  served  for  over  35 
years  until  his  death  in  1958.  The  first  executive 
administrator,  Robert  L.  Richards,  was  employed 
at  the  time  the  office  was  moved  to  Chicago  in 
1960  and  served  until  February,  1966.  After  an 
interim  service  by  Dr.  George  F.  Lull,  Mr.  Roger 
N.  White  was  selected  as  Executive  Administrator 
in  May,  1968. 

The  Society  published  the  early  transactions  in 


book  form  presenting  not  only  the  minutes  of  the 
House  of  Delegates,  but  also  all  scientific  papers 
given  at  each  annual  convention.  In  1898  a new 
era  of  communications  began,  for  at  that  time, 
the  Illinois  Medical  Journal  was  established  and 
became  the  first  “official  organ  of  the  Society.” 

Dr.  G.  N.  Kreider  was  its  first  editor  and  served 
until  1913,  followed  by  Dr.  Clyde  D.  Pence  with 
Dr.  Henry  G.  Olds  as  the  first  managing  editor. 
Dr.  Charles  G.  Whalen  became  editor  in  1919  and 
he  and  Dr.  Olds  served  until  they  died  in  1940. 
Dr.  Camp  followed  Dr.  Whalen  and  Dr.  Theodore 
R.  Van  Dellen  is  the  editor  today. 

Dr.  Whalen  spearheaded  many  important  activi- 
ties in  medicine,  and  has  been  called  “the  outstand- 
ing champion  of  the  medical  profession  in  its 
economic  contacts.”  He  has  been  credited  as  one 
of  the  first  medical  editors  to  blast  “the  socializa- 
tion of  medicine  in  this  country.”  In  1922  he  wrote 
extensively  on  state  medicine,  workmen’s  compen- 
sation, compulsory  health  insurance,  free  hospital- 
ization and  federal  aid. 

The  first  Fifty  Year  Club  in  the  United  States 
was  announced  by  the  Illinois  Medical  Journal  in 
1938. 

The  fourth  largest  medical  society  in  the  coun- 
try has  developed  from  these  embryonic  begin- 
nings. This  edition  of  the  Illinois  Medical  Journal 
offers  you  an  opportunity  to  contrast  the  extensive 
services  available  to  the  membership  today  with 
those  offered  in  the  past. 


/or  October,  1968 


381 


LIST  OF  OFFICERS  AND  PLACES  OF  MEETING 
SINCE  ORGANIZATION  OF  THE  SOCIETY 


Year 

President 

Secretary 

Treasurer 

Meeting  Place 

1840 

John  Todd 

David  Prince 

Springfield 

1850 

Rudolph  Rouse 

Edwin  G.  Meek 

Springfield 

1850 

William  B.  Herrick 

Edwin  G.  Meek 

Jno.  Halderman 

Springfield 

1851 

Samuel  Thompson 

H. 

Shoemaker 

R.  Rouse 

Peoria 

1852 

Rudolph  Rouse 

E. 

S.  Cooper 

Edw.  Dickenson 

Jacksonville 

1853 

Daniel  Brainerd 

H. 

A.  Johnson 

A.  B.  Chambers 

Chicago 

1854 

C.  N.  Andrews 

H. 

A.  Johnson 

N.  S.  Davis  ■ 

LaSalle 

1855 

N.  S.  Davis 

E. 

Andrews 

J.  V.  Z.  Blaney 

Bloomington 

1856 

H.  Noble 

N. 

S.  Davis 

J.  V.  Z.  Blaney 

Vandalia 

1857 

C.  Goodbreak 

H. 

A.  Johnson 

J.  V.  Z.  Blaney 

Chicago 

1858 

H.  A,  Johnson 

N. 

S.  Davis 

J.  W.  Freer 

Rockford 

1859 

David  Prince 

N. 

S.  Davis 

J.  W.  Freer 

Decatur 

1860 

Wm.  M.  Chambers 

N. 

S.  Davis 

J.  W.  Freer 

Paris 

1863 

A.  McFarland 

N. 

S.  Davis 

J.  H.  Hollister 

Jacksonville 

1864 

A.  H.  Luce 

N. 

S.  Davis 

J.  H.  Hollister 

Chicago 

1865 

J.  M.  Steele 

N. 

S.  Davis 

J.  H.  Hollister 

Bloomington 

1866 

F.  F.  Haller 

N. 

S.  Davis 

J.  H.  Hollister 

Decatur 

1867 

H.  Noble 

N. 

S.  Davis 

J.  H.  Hollister 

Springfield 

1868 

S.  T.  Trowbridge 

N. 

S.  Davis 

J.  H.  Hollister 

Quincy 

1869 

S.  T.  Trowbridge 

T. 

D.  Fitch 

J.  H.  Hollister 

Chicago 

1870 

J.  V.  Z.  Blaney 

T. 

D.  Fitch 

J.  H.  Hollister 

Dixon 

1871 

G.  W.  Albin 

T. 

D.  Fitch 

J.  H.  Hollister 

Peoria 

1872 

J.  0.  Hamilton 

T. 

D.  Fitch 

J.  H.  Hollister 

Rock  Island 

1873 

D.  W.  Young 

T. 

D.  Fitch 

J.  H.  Hollister 

Bloomington 

1874 

T.  F.  Worrell 

T. 

D.  Fitch 

J.  H.  Hollister 

Chicago 

1875 

J.  H.  Hollister 

T. 

D.  Fitch 

Wm.  E.  Quine 

Jacksonville 

1876 

T.  D.  Washburn 

N. 

S.  Davis 

J.  H.  Hollister 

Urbana 

1877 

T.  D.  Fitch 

N. 

S.  Davis 

J.  H.  Hollister 

Chicago 

1878 

J.  L.  White 

N. 

S.  Davis 

J.  H.  Hollister 

Springfield 

1879 

E.  P.  Cook 

N. 

S.  Davis 

J.  H.  Hollister 

Lincoln 

1880 

Ephraim  Ingalls 

N. 

S.  Davis 

J.  H.  Hollister 

Belleville 

1881 

G.  W.  Jones 

S. 

J.  Jones 

J.  H.  Hollister 

Chicago 

1882 

Robert  Boal 

S. 

J.  Jones 

J.  H.  Hollister 

Quincy 

1883 

A.  T.  Darrah 

s. 

J.  Jones 

J.  H.  Hollister 

Peoria 

1884 

E.  Andrews 

s. 

J.  Jones 

Walter  Hay 

Chicago 

1885 

D.  S.  Booth 

s. 

J.  Jones 

Walter  Hay 

Springfield 

1886 

Wm.  A.  Byrd 

s. 

J.  Jones 

Walter  Hay 

Bloomington 

1887 

Wm.  T.  Kirk 

D. 

W.  Graham 

Walter  Hay 

Chicago 

1888 

Wm.  O.  Ensign 

D. 

W.  Graham 

Walter  Hay 

Rock  Island 

1889 

C.  W.  Earle 

D. 

W.  Graham 

T.  W.  Mcllvaine 

Jacksonville 

1890 

John  Wright 

D. 

W.  Graham 

T.  W.  Mcllvaine 

Chicago 

1891 

Jno.  P.  Mathews 

D. 

W.  Graham 

Geo.  N.  Kreider 

Springfield 

1892 

Charles  C.  Hunt 

D. 

W.  Graham 

Geo.  N.  Kreider 

V andalia 

1893 

E.  Fletcher  Ingals 

D. 

W.  Graham 

Geo.  N.  Kreider 

Chicago 

1894 

Otho  B.  Will 

J. 

B.  Hamilton 

Geo.  N.  Kreider 

Decatur 

1895 

Daniel  R.  Brower 

J. 

B.  Hamilton 

Geo.  N.  Kreider 

Springfield 

1896 

D.  W.  Graham 

J. 

B.  Hamilton 

Geo.  N.  Kreider 

Ottawa 

1897 

A.  C.  Corr 

J. 

B.  Hamilton 

Geo.  N.  Kreider 

East  St.  Louis 

1898 

J.  N.  G.  Carter 

E. 

W.  Weis 

Geo.  N.  Kreider 

Galesburg 

1899 

J.  T.  Pitner 

E. 

W.  Weis 

Geo.  N.  Kreider 

Cairo 

1900 

H.  N.  Moyer 

E. 

W.  Weis 

Geo.  N.  Kreider 

Springfield 

1901 

G.  N.  Kreider 

E. 

W.  Weis 

E.  J.  Brown 

Peoria 

1902 

J.  T.  McAnally 

E. 

W.  Weis 

E.  J.  Brown 

Quincy 

1903 

M.  L.  Harris 

E. 

W.  Weis 

E.  J.  Brown 

Chicago 

1904 

C.  E.  Black 

E. 

W.  Weis 

E.  J.  Brown 

Bloomington 

1905 

W.  E.  Quine 

E. 

W.  Weis 

E.  J.  Brown 

Rock  Island 

1906 

H.  C.  Mitchell 

E. 

W.  Weis 

E.  J.  Brown 

Springfield 

1907 

J.  F.  Percy 

E. 

W.  Weis 

E.  J.  Brown 

Rockford 

1908 

W.  L.  Baum 

E. 

W.  Weis 

E.  J.  Brown 

Peoria 

1909 

382 

J.  W.  Pettit 

E. 

W.  Weis 

E.  J.  Brown 

Quincy 

Illinois  Medical  Journi 

Year 

President 

Secretary 

Treasurer 

Meeting  Place 

1910 

J.  L.  Wiggins 

E. 

W.  Weis 

E.  J.  Brown 

Danville 

1911 

A.  C.  Cotton 

E. 

W.  Weis 

E.  J.  Brown 

Aurora 

1912 

W.  K.  Newcomb 

E. 

W.  Weis 

E.  J.  Brown 

Springfield 

1913 

L.  H.  A.  Nickerson 

E. 

W.  Weis 

A.  J.  Markley 

Peoria 

1914 

Charles  J.  Whalen 

W. 

H.  Gilmore 

A,  J.  Markley 

Decatur 

1915 

A.  L.  Brittin 

W. 

H.  Gilmore 

A.  J.  Markley 

Springfield 

1916 

C.  W.  Lillie 

W. 

H.  Gilmore 

A.  J.  Markley 

Champaign 

1917 

W.  L.  Noble 

W. 

H.  Gilmore 

A.  J.  Markley 

Bloomington 

1918 

E.  B.  Coolley 

W. 

H.  Gilmore 

A.  J.  Markley 

Springfield 

1919 

E.  W.  Fiegenbaum 

W. 

H.  Gilmore 

A.  J.  Markley 

Peoria 

1920 

J.  W.  Van  Derslice 

W. 

H.  Gilmore 

A.  J.  Markley 

Rockford 

1921 

W.  F.  Grinstead 

W. 

H.  Gilmore 

A.  J.  Markley 

Springfield 

1922 

Charles  Humiston 

W. 

H.  Gilmore 

A.  J.  Markley 

Chicago 

1923 

E.  P.  Sloan 

W. 

D.  Chapman 

A.  J.  Markley 

Decatur 

1924 

E.  H.  Ochsner 

W. 

D.  Chapman 

A.  J.  Markley 

Springfield 

1925 

L.  C.  Taylor 

H. 

M.  Camp 

A.  J.  Markley 

Quincy 

1926 

J.  C.  Krafft 

H. 

M.  Camp 

A.  J.  Markley 

Champaign 

1927 

Mather  Pfeiffenberger 

H. 

M.  Camp 

A.  J.  Markley 

Moline 

1928 

G.  Henry  Mundt 

H. 

M.  Camp 

A.  J.  Markley 

Chicago 

1929 

J.  E.  Tuite 

H. 

M.  Camp 

A.  J.  Markley 

Peoria 

1930 

F.  O.  Fredrickson 

H. 

M.  Camp 

A.  J.  Markley 

Joliet 

1931 

Wm.  D.  Chapman 

H. 

M.  Camp 

A.  J.  Markley 

East  St.  Louis 

1932 

R.  R.  Ferguson 

H. 

M.  Camp 

A.  J.  Markley 

Springfield 

1933 

John  R.  Neal 

H. 

M.  Camp 

A.  J.  Markley 

Peoria 

1934 

Philip  H.  Kreuscher 

H. 

M.  Camp 

A.  J.  Markley 

Springfield 

1935 

Charles  D.  Center* 

(Past  President-Elect) 

1935 

Charles  S.  Skaggs 

H. 

M.  Camp 

A.  J.  Markley 

Rockford 

1936 

Chas.  B.  Reed 

H. 

M.  Camp 

A.  J,  Markley 

Springfield 

1937 

Rolland  L.  Green 

H. 

M.  Camp 

A.  J.  Markley 

Peoria 

1938 

R.  K.  Packard 

H. 

M.  Camp 

A.  J.  Markley 

Springfield 

1939 

S.  E.  Munson 

H. 

M.  Camp 

A.  J.  Markley 

Rockford 

1940 

Jas.  H.  Hutton 

H. 

M.  Camp 

A.  J.  Markley 

Peoria 

1941 

J.  S.  Templeton 

H. 

M.  Camp 

A.  J.  Markley 

Chicago 

1942 

Chas.  H.  Phifer 

H. 

M.  Camp 

H.  M.  Camp 

Springfield 

1943 

E.  H.  Weld 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1944 

G.  W.  Post** 

H. 

M.  Camp 

^ H.  M.  Camp 

Chicago 

1945 

E.  P.  Coleman 

H. 

M.  Camp 

H.  M.  Camp 

1946 

E.  P.  Coleman 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1947 

R.  S.  Berghoff 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1948 

I.  H.  Neece 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1949 

Percy  E.  Hopkins 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1950 

Walter  Stevenson 

H. 

M.  Camp 

H.  M.  Camp 

Springfield 

1951 

Harry  M.  Hedge 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1952 

C.  Paul  White 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1953 

Leo  P.  A.  Sweeney 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1954 

Willis  I.  Lewis 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1955 

Arkell  M.  Vaughn 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1956 

F.  Garm  Norbury 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1957 

F.  Lee  Stone 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1958 

Lester  S.  Reavley 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1959 

Raleigh  C.  Oldfield 

H. 

M.  Camp 

H.  M.  Camp 

Chicago 

1960 

Joseph  T.  O’Neill 

George  F.  Lull 

George  F.  Lull 

Chicago 

1961 

H.  Close  Hesseltine 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1962 

Edwin  S.  Hamilton 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1963 

George  F.  Lull 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1964 

Harlan  English 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1965 

Edward  A.  Piszczek 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1966 

Burtis  E.  Montgomery 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1967 

Caesar  Portes 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1968 

Newton  DuPuy 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1969 

Philip  G.  Thomsen 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

*Died  before  induction  into  office 

**Died  in  office.  Term  completed  by  Robert  S.  Bergboff,  First  Vice  President 
‘“Meeting  cancelled  1945 

for  October,  1968 


383 


Principles  Of  Medical  Ethics 


Preamble:  These  principles  are  intended  to  aid 
physicians  individually  and  collectively  in  main- 
taining a high  level  of  ethical  conduct.  They  are 
not  laws  but  standards  by  which  a physician 
may  determine  the  propriety  of  his  conduct  in 
his  relationship  with  patients,  with  colleagues, 
with  members  of  allied  professions,  and  with  the 
public. 

Section  1 — The  principal  objective  of  the  medi- 
cal profession  is  to  render  service  to  humanity 
with  full  respect  for  the  dignity  of  man.  Physicians 
should  merit  the  confidence  of  patients  entrusted 
to  their  care,  rendering  to  each  a full  measure  of 
service  and  devotion. 

Section  2 — Physicians  should  strive  continually 
to  improve  medical  knowledge  and  skill,  and 
should  make  available  to  their  patients  and  col- 
leagues the  benefits  of  their  professional  attain- 
ments. 

Section  3 — physician  should  practice  a method 
of  healing  founded  on  a scientific  basis;  and  he 
should  not  voluntarily  associate  professionally  with 
anyone  who  violates  this  principle. 

Section  4 — The  medical  profession  should  safe- 
guard the  public  and  itself  against  physicians 
deficient  in  moral  character  or  professional  compe- 
tence. Physicians  should  observe  all  laws,  uphold 
the  dignity  and  honor  of  the  profession  and 
accept  its  self-imposed  disciplines.  They  should 
expose,  without  hesitation,  illegal  or  unethical  con- 
duct of  fellow  members  of  the  profession. 

Section  5 — A physician  may  choose  whom  he 
will  serve.  In  an  emergency,  however,  he  should 
render  service  to  the  best  of  his  ability.  Having 
undertaken  the  care  of  a patient,  he  may  not 
neglect  him;  and  unless  he  has  been  discharged  he 
may  discontinue  his  services  only  after  giving 


adequate  notice.  He  should  not  solicit  patients. 

Section  6 — ^A  physician  should  not  dispose  of  his 
services  under  terms  or  conditions  which  tend  to 
interfere  with  or  impair  the  free  and  complete 
exercise  of  his  medical  judgment  and  skill  or  tend 
to  cause  a deterioration  of  the  quality  of  medical 
care. 

Section  7 — In  the  practice  of  medicine  a physician 
should  limit  the  source  of  his  professional  income 
to  medical  services  actually  rendered  by  him,  or 
under  his  supervision,  to  his  patients.  His  fee 
should  be  commensurate  with  the  services  rendered 
and  the  patient’s  ability  to  pay.  He  should  neither 
pay  nor  receive  a commission  for  referral  of  pa- 
tients. Drugs,  remedies  or  appliances  may  be 
dispensed  or  supplied  by  the  physician  provided 
it  is  in  the  best  interests  of  the  patient. 

Section  8 — ^A  physician  should  seek  consultation 
upon  request,  in  doubtful  or  difficult  cases;  or 
whenever  it  appears  that  the  quality  of  medical 
service  may  be  enhanced  thereby. 

Section  9 — ^A  physician  may  not  reveal  the 
confidences  entrusted  to  him  in  the  course  of 
medical  attendance,  or  the  deficiencies  he  may 
observe  in  the  character  of  patients,  unless  he 
is  required  to  do  so  by  law  or  unless  it  becomes 
necessary  in  order  to  protect  the  welfare  of  the 
individual  or  of  the  community. 

Section  10 — ^The  honored  ideals  of  the  medical 
profession  imply  that  the  responsibilities  of  the 
physician  extend  not  only  to  the  individual,  but 
also  to  society  where  these  responsibilities  deserve 
his  interest  and  participation  in  activities  which 
have  the  purpose  of  improving  both  the  health 
and  the  well-being  of  the  individual  and  the 
community. 


384 


Illinois  Medical  Journal 


Constitution  And  Bylaws 
May  1968 

Adopted,  1903 
As  Amended,  1968 


CONSTITUTION 


ARTICLE  I.  NAME 

1 he  name  and  title  of  this  organization  shall  be 
the  Illinois  State  Medical  Society. 

ARTICLE  II.  PURPOSES  OF  THE  SOCIETY 
The  purposes  of  this  Society  are  to  promote  the 
science  and  art  of  medicine,  to  protect  the  public 
health,  to  elevate  the  standards  of  medical  educa- 
tion and  to  unite  the  medical  profession  behind 
these  purposes;  to  promote  similar  interests  in  the 
component  societies  and  to  unite  with  similar 
organizations  in  other  states  and  territories  of  the 
United  States  to  form  the  American  Medical 
Association.  The  Society  shall  inform  the  public 
and  the  profession  concerning  the  advancements 
in  medical  science  and  the  advantages  of  proper 
medical  care. 

ARTICLE  III.  COMPONENT  SOCIETIES 
Component  societies  shall  consist  of  those  county 
medical  societies  which  hold  charters  from  this 
Society. 

ARTICLE  IV.  COMPOSITION  OF  THE 
SOCIETY 

The  Society  shall  consist  of  active  members  and 
such  other  members  as  the  Bylaws  may  provide. 

ARTICLE  V.  HOUSE  OF  DELEGATES 
Section  1.  The  House  of  Delegates  shall  be  the 
legislative  body  of  the  Illinois  State  Medical 
Society,  and  unless  otherwise  herein  provided,  its 
deliberations  shall  be  binding  upon  the  officers, 
including  the  Board  of  Trustees.  The  House  of 
Delegates  shall  set  the  basic  policy  and  philosophy 
of  the  Society. 

Section  2.  The  House  of  Delegates  shall  elect  the 
general  officers,  except  as  otherwise  provided  in 
the  Bylaws. 


ARTICLE  VI.  BOARD  OF  TRUSTEES 

The  Board  of  Trustees,  whose  duties  are  executive 
and  judicial,  shall  have  charge  of  all  property  and 
all  financial  affairs  of  the  Society,  and  shall  per- 
form such  other  duties  as  are  prescribed  by  law 
governing  the  directors  of  corporations,  or  as  may 
be  prescribed  in  the  Bylaws. 

ARTICLE  VII.  CONVENTIONS  AND 
MEETINGS 

The  Society  shall  hold  an  annual  convention  during 
which  there  shall  be  a business  meeting  of  the 
House  of  Delegates  and  general  scientific  meetings 
which  shall  be  open  to  all  registered  members. 

ARTICLE  VIII.  OFFICERS 

The  officers  of  this  Society  shall  be  a president,  a 
president-elect,  a first  vice  president,  a second 
vice  president,  a secretary-treasurer,  a speaker 
and  vice  speaker  of  the  House  of  Delegates,  sixteen 
trustees  and  one  trustee  at  large,  and  such  other 
officers  as  the  Bylaws  may  provide. 

ARTICLE  IX.  THE  SEAL 

This  Society  shall  have  a common  seal  with  power 
to  break,  change  or  renew  the  same  when  neces- 
sary. 

ARTICLE  X.  AMENDMENTS 

The  House  of  Delegates  may  amend  this  Constitu- 
tion at  any  annual  business  meeting  of  the  House 
of  Delegates  provided  that  the  amendment  shall 
have  been  proposed  at  the  preceding  annual  busi- 
ness meeting,  and  that  two-thirds  of  the  members 
of  the  House  of  Delegates  seated  concur  in  the 
amendment. 


BYLAWS 


CHAPTER  I.  MEMBERSHIP 
Section  1.  Members. 

A.  Active  Members.  The  active  members  of  this 
Society  shall  consist  of  regular  members, 
emeritus  members,  retired  members,  provi- 
sional members,  intern  members  and  resi- 
dency members.  Active  members  shall  enjoy 
full  privileges  which  include  membership  in 
the  American  Medical  Association. 


B.  Special  Members.  The  special  members  of 
this  Society  shall  be  distinguished  because  of 
their  contributions  to  the  science  and  art  of 
medicine. 

( 1 ) Distinguished  Members.  Distinguished 
members  shall  be: 

a.  Physicians  of  Illinois  or  other 
states,  or  foreign  countries  who 
have  risen  to  prominence  in  the 
profession;  or 


/or  October,  196S 


385 


b.  Teachers  of  medicine  or  of  the 
sciences  allied  to  medicine,  not 
eligible  for  active  membership;  or 

c.  Members  of  associated  arts  or 
sciences  who  have  made  signifi- 
cant contributions  to  medicine. 

(2)  Election.  Special  members  may  be 
nominated  by  any  member  of  the 
House  of  Delegates,  and  may  be  elected 
by  the  House  at  any  annual  convention 
by  a two-thirds  vote. 

(3)  Privileges.  Special  members  shall  not 
be  entitled  to  hold  office  nor  to  vote, 
and  shall  not  be  considered  as  mem- 
bers in  determining  the  number  of 
delegates  to  the  American  Medical 
Association,  but  they  may  participate 
in  all  other  Society  activities. 

Section  2.  Qualifications  for  Membership. 

A.  Every  physician  duly  licensed  and  registered 
in  the  State  of  Illinois  to  practice  medicine  in 
all  its  branches  who  is  a graduate  of  a medi- 
cal school  approved  in  the  United  States  or 
Canada,  a resident  of  the  State  of  Illinois,  a 
citizen  of  the  United  States,  who  is  of  good 
moral  character  and  professional  standing, 
and  a member  of  his  component  medical 
society,  shall  be  eligible  for  regular  mem- 
bership. 

B.  Provisional  membership  shall  be  available  to 
any  Illinois  physician  who  has  made  a dec- 
laration of  intention  to  become  a citizen  of 
the  United  States,  who  has  received  a license 
in  this  State  to  practice  medicine  in  all  of  its 
branches,  and  who — with  the  exception  of 
United  States  citizenship — possesses  all  of  the 
qualifications  for  membership  prescribed  by 
these  Bylaws.  Provisional  membership  shall 
terminate  one  year  after  the  expiration  of 
the  minimum  period  of  time  within  which 
such  member  could  have  perfected  his  citizen- 
ship. After  obtaining  full  citizenship  and 
prior  to  the  expiration  of  his  provisional 
membership,  such  member  may  be,  upon  ap- 
plication to  his  component  medical  society, 
transferred  to  regular  membership. 

C.  The  following  shall  also  be  eligible  if  ap- 
proved and  recommended  by  the  component 
medical  society: 

(1)  Every  physician  serving  as  a full  time 
employee  at  the  headquarters  of  the 
American  Medical  Association; 

(2)  Physicians  serving  as  medical  officers 
in  the  United  States  Governmental 
Services,  who  are  members  of  a com- 
ponent society,  so  long  as  they  are  en- 
gaged actively  in  their  respective  serv- 
ice, and  thereafter,  if  they  have  been 
retired  on  account  of  age  or  physical 
disability,  or  after  long  and  honorable 


service  under  the  provision  of  an  Act 
of  Congress; 

D.  Physicians  otherwise  eligible  for  membership, 
and  licensed  in  one  of  the  States  of  the 
Union,  but  not  licensed  in  Illinois,  and  who 
are  not  engaged  in  the  active  practice  of 
medicine,  but  otherwise  employed  in  an  allied 
medical  activity  which  does  not  require  licen- 
sure, shall  be  eligible  for  membership  if  ap- 
proved and  recommended  by  the  component 
medical  society  and  approved  by  the  Board 
of  Trustees. 

Section  3.  Emeritus  Members.  A member  to  be 
elected  to  emeritus  membership  shall: 

(1)  currently  be  in  good  standing, 

(2)  have  been  a member  in  good  standing  for 
35  years, 

(3)  have  reached,  or  will  have  reached  before 
the  next  fiscal  year,  the  age  of  70  years, 
and 

(4)  have  made  written  application  to  and  have 
been  recommended  by  his  component  so- 
ciety for  emeritus  status. 

Such  membership  shall  become  effective  Jan- 
uary 1 of  the  year  following  election.  Emeritus 
members  shall  have  all  the  rights  and  privileges 
of  membership  without  the  payment  of  dues  to  the 
component  or  state  society. 

Credit  for  membership  in  other  American  Medi- 
cal Association  constituent  societies  shall  be 
accorded  transferees,  provided  they  have  been 
members  of  this  Society  for  at  least  five  years. 
Section  4.  Retired  Members.  A member  who  has 
been  in  good  standing  but  who  by  reason  of  age 
or  incapacity,  has  retired  from  active  practice,  may 
upon  application  to  and  upon  recommendation  of 
his  component  society,  be  made  a retired  member, 
without  payment  of  dues  to  the  component  or  state 
society. 

Section  5.  Intern  Members.  Any  person  who  is  a 
graduate  of  a medical  school  approved  in  the 
United  States  or  Canada,  who  is  of  good  moral 
character  and  professional  standing  and  who  is 
serving  an  internship  in  any  hospital  in  the  State 
of  Illinois  approved  by  the  American  Medical 
Association,  is  eligible  for  intern  membership 
upon  the  recommendation  of  any  two  members 
of  this  Society  who  are  also  members  of  his  hos- 
pital staff. 

The  physician’s  intern  membership  shall  cease 
at  the  end  of  the  year  in  which  his  internship 
training  terminates,  and  if  he  wishes  to  become  a 
member  of  this  Society,  he  must  apply  for  a 
residency  or  regular  membership  through  his 
component  society. 

Dues  for  intern  membership  shall  be  minimal. 
Section  6.  Residency  Members.  After  being 
licensed  to  practice  medicine,  a physician  serving 
full  time  as  a resident  in  a residency  approved  by 
the  American  Medical  Association,  is  eligible  for 
full  membership. 


386 


Illinois  Medical  Journal 


Dues  for  residency  members  shall  be  minimal. 

A residency  member  must  be  a graduate  of  a 
medical  school  approved  in  the  United  States  or 
Canada,  have  a degree  of  Doctor  of  Medicine  or 
its  equivalent,  and  must  be  a member  in  good 
standing  of  his  component  society. 

The  physician’s  residency  membership  shall 
cease  at  the  end  of  the  year  in  which  his  residency 
training  terminates,  and  if  he  wishes  to  become  a 
member  of  this  Society,  he  must  apply  for  regular 
membership  through  his  component  society. 

Section  7.  Tenure  of  Membership.  The  name  of  a 
physician  on  the  properly  certified  roster  of  mem- 
bers of  a component  society  which  has  paid  its 
annual  assessments,  shall  be  prima  facie  evidence 
of  membership  in  this  Society,  and  afford  all  the 
rights  and  privileges  pertaining  thereto. 

Section  8.  Withdrawal  of  Privileges.  No  person 
who  is  under  sentence  of  suspension  or  expulsion 
from  a component  society,  shall  be  entitled  to  any 
of  the  rights  or  benefits  of  this  Society,  nor  shall 
he  be  permitted  to  take  part  in  any  of  the  pro- 
ceedings until  he  has  been  reinstated. 

CHAPTER  n.  ANNUAL  CONVENTIONS 
Section  1.  Date.  The  Board  of  Trustees  shall  de- 
termine the  date  for  the  annual  convention. 

Section  2.  Meeting  Place.  The  meeting  place  for 
the  annual  convention  shall  be  determined  by  the 
House  of  Delegates  from  a list  of  cities  extending 
invitations,  subject  to  investigation  of  the  facilities 
and  approval  by  the  Board  of  Trustees. 

Section  3.  Scientific  Meetings. 

A.  With  the  consent  of  the  House  of  Delegates 
or  the  Board  of  Trustees  any  special  group 
may  conduct  its  meeting  in  connection  with 
the  annual  convention  of  this  Society. 

B.  For  the  transaction  of  scientific  business, 
there  shall  be  one  or  more  sections  as  may  be 
determined  from  year  to  year  by  the  Board 
of  Trustees. 

C.  Section  officers  shall  be  appointed  by  the 
president  of  the  Society  from  nominees  rec- 
ommended by  the  section,  or  if  there  are  no 
nominees,  from  a list  submitted  by  the  chair- 
man of  the  Committee  on  Scientific  Assembly. 

D.  The  officers  of  the  sections  shall  arrange  the 
scientific  program  for  the  section  in  coopera- 
tion with  the  Committee  on  Scientific 
Assembly. 

E.  All  registered  members  may  attend  and 
participate  in  the  proceedings  and  discus- 
sions of  the  general  scientific  meetings  and 
of  the  section  meetings. 

F.  The  general  scientific  meetings  may  recom- 
mend to  the  House  of  Delegates  the  appoint- 
ment of  committees  or  commissions  for  scien- 
tific investigation  of  special  interest  and  im- 
portance to  the  profession  and  to  the  public. 

G.  All  papers  read  before  the  Society  or  any 


section  thereof,  shall  become  the  property  of 
the  Society.  Each  paper  shall  be  deposited 
with  the  secretary  when  read,  and  presenta- 
tion of  a paper  to  the  Illinois  State  Medical 
Society  shall  be  considered  tantamount  to  the 
assurance  on  the  part  of  the  writer  that  such 
paper  has  not  already  been  published. 

H.  The  Board  of  Trustees  shall  be  entirely 
responsible  for  the  annual  convention. 

CHAPTER  m.  THE  HOUSE  OF 
DELEGATES 

Section  1.  Composition.  The  voting  membership 
of  the  House  of  Delegates  shall  consist  of: 

(1)  Delegates  elected  by  the  component  so- 
cieties 

(2)  The  president 

(3)  The  president-elect 

(4)  The  secretary-treasurer 

(5)  The  speaker  of  the  House  (or  the  vice 
speaker  when  presiding)  and 

(6)  The  trustees. 

Non-voting  members  shall  be  the  vice  presidents, 
the  vice  speaker  (when  not  presiding),  the  past 
trustees,  past  speakers,  past  presidents,  general 
officers  of  the  AMA  and  delegates  from  the  Illi- 
nois State  Medical  Society  to  the  AMA. 

Section  2.  Meetings.  The  House  of  Delegates  shall 
meet  at  the  time  and  place  of  the  annual  conven- 
tion of  the  Society,  and  shall  fix  its  hours  of  meet- 
ing so  that  they  shall  not  conflict  with  the  general 
scientific  meetings  of  the  Society.  If  the  interests 
of  the  Society  and  the  profession  require,  the 
House  of  Delegates  may  meet  in  advance  of  the 
general  scientific  meetings. 

Section  3.  Quorum.  Fifty  delegates  representing 
not  less  than  twenty  component  societies  shall  con- 
stitute a quorum  for  the  transaction  of  business. 

Section  4.  Special  Meetings.  Special  meetings  of 
the  House  of  Delegates  may  be  called  by  the  presi- 
dent or  a majority  of  the  Board  of  Trustees,  or 
shall  be  called  on  petition  of  twenty  component 
societies. 

When  a special  meeting  is  thus  called,  the  secre- 
tary shall  mail  a notice  to  the  last  known  address 
of  each  member  of  the  House  of  Delegates  at  least 
ten  days  before  the  special  meeting  is  to  be  held. 
The  notice  shall  specify  the  time  and  place  of  the 
meeting  and  the  purpose  for  which  the  meeting  is 
called.  The  meeting  shall  not  consider  any  busi- 
ness except  that  for  which  it  was  called. 

Section  5.  Delegates.  Each  component  society  shall 
be  entitled  to  send  to  the  House  of  Delegates  each 
vear,  one  delegate  for  each  75  members,  and  one 
for  a major  fraction  thereof;  but  each  component 
society  which  has  made  its  annual  report  and  paid 
its  assessment  as  pro\fided  for  in  this  Constitution 
and  Bvlaws,  shall  be  entitled  to  one  delegate. 

The  number  of  delegates  to  which  any  com- 
ponent society  is  entitled  shall  be  determined  by 


for  October,  1968 


387 


the  number  of  active  members  of  the  component 
society  on  the  membership  rolls  of  the  Illinois 
State  Medical  Society  as  of  December  31  of  the 
preceding  year. 

The  term  of  office  of  a delegate  shall  begin 
January  1 following  his  election,  and  shall  be  for 
two  years,  or  until  his  successor  has  been  elected. 
Component  societies  with  one  delegate  only,  may 
elect  for  one  year. 

Section  6.  Registration.  Before  being  seated  at  any 
annual  or  special  session,  each  delegate  or  his 
alternate  shall  deposit  with  the  Reference  Com- 
mittee on  Credentials  a certificate  signed  by  the 
president  and/or  the  secretary  of  the  component 
society,  stating  that  the  delegate  or  alternate  has 
been  regularly  elected  to  the  House  of  Delegates. 

A delegate  or  his  alternate  may  be  seated  with- 
out credentials,  provided  he  is  properly  identified 
by  his  county  society  and  so  certified  to  the  secre- 
tary of  the  Illinois  State  Medical  Society. 

When  a delegate  and  his  alternate  are  unable  to 
attend  a specified  meeting,  the  appropriate  authori- 
ties of  the  component  society  concerned  may  ap- 
point a substitute  delegate  and  a substitute  alter- 
nate who  on  presenting  proper  credentials,  shall 
be  eligible  to  regular  membership  in  the  House  of 
Delegates. 

A delegate  whose  credentials  have  been  accepted 
by  the  Reference  Committee  on  Credentials  and 
whose  name  has  been  placed  on  the  roll  of  the 
House,  shall  remain  a delegate  until  final  adjourn- 
ment of  that  meeting.  If  a delegate,  once  seated, 
is  unable  to  be  present  for  reasons  acceptable  to 
the  Committee  on  Credentials,  an  alternate  may  be 
certified  by  that  Committee.  After  the  alternate 
has  been  seated,  he  cannot  be  replaced. 

Section  7.  AMA  Delegates  and  Alternate  Dele- 
gates. The  House  of  Delegates  shall  elect  repre- 
sentatives to  the  House  of  Delegates  of  the  Ameri- 
can Medical  Association  in  accordance  with  the 
Constitution  and  Bylaws  of  that  body. 

Section  8.  District  Divisions.  The  House  of  Dele- 
gates shall  divide  the  state  into  districts,  specifying 
which  counties  each  district  shall  include. 

Section  9.  Committees.  The  House  of  Delegates 
may  authorize  the  appointment  of  ad  hoc  com- 
mittees by  the  president,  who  shall  first  consult 
with  the  president-elect. 

The  president  shall  have  authority  to  designate 
to  serve  on  ad  hoc  committees,  members  of  the 
Society  who  are  not  members  of  the  House  and 
who  may  be  present  and  permitted  to  participate 
in  the  debate  when  the  report  of  the  committee 
is  considered. 

CHAPTER  IV.  ELECTION  OF  OFFICERS 
Section  1.  Officers.  The  officers  of  this  Society 
shall  consist  of  the  president,  president-elect,  first 
and  second  vice  presidents,  secretary-treasurer, 
speaker  and  vice  speaker,  sixteen  trustees  and  one 


trustee-at-large. 

Section  2.  Elections.  All  elections  shall  be  by 
ballot  except  when  there  is  only  one  candidate  for 
a given  office,  then  election  may  be  by  voice  vote. 

The  majority  of  votes  cast  shall  be  necessary  to 
elect. 

The  election  of  officers,  delegates  and  alternate 
delegates  to  the  AMA,  shall  follow  the  comple- 
tion of  action  on  current  and  old  business  at  the 
final  session  of  the  House  of  Delegates. 

Section  3.  Terms  of  Office.  The  president-elect, 
vice  presidents,  secretary-treasurer,  the  speaker 
and  vice  speaker  shall  be  elected  annually  by  the 
House  of  Delegates  to  serve  for  a term  of  one 
year. 

Members  of  the  Board  of  Trustees  shall  be 
elected  by  the  House  of  Delegates  to  serve  for  a 
term  of  three  years. 

The  speaker  and  vice  speaker  shall  not  be 
elected  for  more  than  three  consecutive  terms  to 
their  respective  offices;  they  shall  be  elected  from 
the  membership  of  the  House  of  Delegates. 

The  president-elect  shall  be  inducted  into  the 
office  of  president  by  the  retiring  president  during 
the  final  session  of  the  House  of  Delegates.  After 
assuming  office  at  the  adjournment  of  the  annual 
business  meeting,  he  shall  continue  in  office  until 
his  successor  has  been  elected  and  installed.  Fol- 
lowing his  retirement  as  president,  he  shall  auto- 
matically become  a trustee-at-large  for  a term  of 
one  year. 

CHAPTER  V.  DUTIES  OF  OFFICERS 
Section  1.  The  President.  The  president  of  the 
Illinois  State  Medical  Society  shall  lead  the  Society 
in  all  its  functions.  He  shall  deliver  an  annual 
address  at  such  time  as  may  be  arranged,  and 
perform  such  other  duties  as  custom  and  parlia- 
mentary usage  may  require. 

The  president  shall  appoint  the  ad  hoc  com- 
mittees of  the  House  of  Delegates.  He  may  seek 
the  advice  of  the  officers  and  trustees. 

He  shall  preside  at  the  general  scientific  meetings 
of  the  Society  or  designate  one  of  the  vice  presi- 
dents to  substitute  for  him. 

Section  2.  The  Vice  Presidents.  The  vice  presidents 
shall  act  for  and  perform  such  duties  for  the  presi- 
dent as  he  shall  direct.  They  shall,  when  so  act- 
ing, implement  and  advance  the  programs  and  poli- 
cies of  the  president. 

In  the  event  of  the  president’s  death,  resignation 
or  removal  from  office,  the  first  vice  president  shall 
succeed  to  the  presidency. 

In  the  event  of  a vacancy  in  the  office  of  first 
vice  president,  the  president  shall  fill  the  office  by 
appointment. 

Section  3.  Successor  to  President-Elect.  In  the 
case  of  death,  resignation,  or  removal  from  office 
of  the  president-elect,  the  office  shall  be  filled  by 
the  House  of  Delegates  at  the  next  annual  con- 


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Illinois  Medical  Journal 


vention  by  election  at  a time  recommended  by  the 
Reference  Committee  on  Rules  and  Order  of 
Business. 

Section  4.  The  Speaker.  The  speaker,  who  shall  be 
versed  in  parliamentary  procedure,  shall  preside  at 
the  meetings  of  the  House  of  Delegates  and  shall 
perform  such  duties  as  custom  and  parliamentary 
usage  require. 

He  shall  appoint  the  reference  committees. 

He  shall  be  an  ex-officio  member  of  the  Com- 
mittee on  Constitution  and  Bylaws. 

Section  5.  The  Vice  Speaker.  The  vice  speaker 
shall  preside  for  the  speaker  in  the  latter’s  absence 
or  at  his  request.  In  case  of  death,  resignation  or 
inability  of  the  speaker  to  perform  his  duties,  the 
vice-speaker  shall  serve  during  the  unexpired  term. 

Section  6.  The  Secretary-Treasurer.  In  addition 
to  the  rights  and  duties  ordinarily  devolving  on 
the  secretary  of  a corporation  by  law,  custom  or 
parliamentary  usage,  and  those  granted  or  im- 
posed in  other  provisions  of  the  Constitution  and 
these  Bylaws,  the  secretary-treasurer  shall  be  the 
official  custodian  of  all  securities  and  the  income 
therefrom,  owned  by  the  Society,  subject  to  the 
direction  and  disposition  of  the  Board  of  Trustees. 
He  shall  be  a member  of  the  Finance  Committee 
of  the  Board  of  Trustees. 

The  Board  of  Trustees  may  select  a bank  or 
trust  company  to  act  as  custodian  in  the  place  of 
the  secretary-treasurer,  of  all  or  any  part  of  such 
securities  and  to  act  as  agent  of  the  Society  in 
collecting  the  income  therefrom. 

The  secretary-treasurer  shall  give  bond  in  such 
sum  as  may  be  fixed  by  the  Board  of  Trustees, 
the  premium  on  such  bond  to  be  paid  by  the 
Society.  He  shall  perform  such  other  duties  as  may 
be  directed  by  the  House  of  Delegates  or  by  the 
Board  of  Trustees. 

In  the  event  of  a vacancy  in  the  office  of  the 
secretary-treasurer,  the  Board  of  Trustees  shall  fill 
the  vacancy  until  the  next  annual  election. 

CHAPTER  VI.  THE  BOARD  OF  TRUSTEES 
Section  1.  Composition.  The  Board  of  Trustees 
shall  consist  of  sixteen  trustees  elected  by  the 
House  of  Delegates  [six  shall  be  chosen  from 
district  number  three,  and  one  from  each  of  the 
other  ten  districts  (see  map  attached),  these  dis- 
tricts of  the  geographical  area  as  of  May,  1946], 
and  one  trustee-at-large  (the  retiring  president, 
who  shall  serve  a term  of  one  year),  the  presi- 
dent, the  president-elect,  the  speaker  and  secre- 
tary-treasurer. 

The  vice  presidents  and  vice  speakers  shall  at- 
tend the  meetings  (including  executive  sessions), 
with  the  right  of  discussion,  but  without  the  right 
to  vote. 

Section  2.  The  duties  of  the  Board  of  Trustees  are 
executive,  custodial  and  judicial. 

A.  Executive  Duties.  The  Board  of  Trustees 


shall  implement  all  mandates  from  the  House 
of  Delegates  except  in  matters  of  property 
or  finance  when  it  shall  have  sole  authority. 

The  Board  of  Trustees  may  request  a re- 
port from  any  committee  in  the  interim  be- 
tween meetings  of  the  House  of  Delegates. 

B.  Custodial  Duties.  The  Board  of  Trustees  shall 
have  charge  and  control  of  all  property  of 
whatsoever  nature  belonging  to  the  Society, 
and  of  all  funds  from  whatsoever  source 
belonging  to  the  Society. 

No  person  shall  expend  or  use  for  any 
purpose  money  belonging  to  the  Society  with- 
out the  approval  of  the  Board  of  Trustees. 

All  money  received  by  the  Board  of  Trus- 
tees and  its  agents,  resulting  from  the  duties 
assigned  them,  shall  be  paid  into  the  treasury 
of  the  Society,  and  all  orders  on  the  treasury 
for  disbursement  of  money  shall  be  approved 
by  the  Board. 

The  Board  of  Trustees  shall  formulate  rules 
governing  the  expenditure  of  money  to  meet 
the  necessary  running  expenses  and  fixed 
charges  of  the  Society. 

All  acts  of  the  House  of  Delegates  in- 
volving the  expenditure,  appropriation  or  use 
in  any  manner  of  money,  or  the  acquisition 
or  disposal  in  any  manner  of  property  of  any 
kind  belonging  to  the  Society,  must  be  ap- 
proved by  the  Board  of  Trustees  before  same 
shall  become  effective. 

Funds  may  be  appropriated  to  encourage 
scientific  investigation,  medical  education  or 
any  other  purpose  deemed  proper  and  ap- 
proved by  the  Board  of  Trustees. 

C.  Judicial  Duties.  The  Board  of  Trustees  shall 
be  the  board  of  censors  of  the  Society.  It 
shall  have  jurisdiction  over  all  questions  of 
ethics  and  in  the  interpretation  of  the  laws 
of  the  Society.  It  shall  consider  all  questions 
involving  the  rights  and  standing  of  members, 
whether  in  relation  to  other  members,  to 
component  societies,  or  to  this  Society. 

All  questions  of  an  ethical  nature  before 
the  House  of  Delegates  or  the  general  scien- 
tific meetings,  shall  be  referred  to  the  Board 
of  Trustees  without  discussion.  The  Board 
shall  hear  and  decide  all  questions  of  pro- 
cedure affecting  the  conduct  of  members  on 
which  an  appeal  is  taken  from  the  decision 
of  a component  society. 

The  decision  of  the  Board  of  Trustees  shall 
be  final  except  that  an  appeal  may  be  taken 
by  a member  charged  with  misconduct  as 
provided  for  in  the  Constitution  and  Bylaws 
of  the  American  Medical  Association. 

Section  3.  Executive  Administrator.  The  Board  of 
Trustees  shall  employ  an  executive  administrator 
(who,  when  he  shall  be  a physician,  may  be 
designated  as  the  executive  vice-president)  whose 
duties  shall  be  determined  by  the  Board.  He 


for  October,  1968 


389 


shall  be  responsible  to  the  chairman  of  the  Board. 
The  Board  shall  review  at  each  of  its  meetings 
the  interim  activities  of  the  administrator.  The 
Board  shall  also  employ  such  other  people  as  are 
needed  for  the  conduct  of  the  affairs  of  the  Society. 

Section  4.  Meetings.  The  Board  of  Trustees  shall 
meet  daily  during  the  annual  convention  of  the 
Society,  and  at  such  other  times  as  necessity  may 
require,  subject  to  the  call  of  the  chairman,  or  on 
the  petition  of  the  majority  of  the  Trustees. 

Section  5.  Organization. 

A.  Chairman.  The  Board  of  Trustees  shall  meet 
on  the  last  day  of  the  annual  convention  and 
elect  from  among  its  members  a chairman. 
He  shall  hold  office  for  one  year  and  may 
succeed  himself  for  one  additional  year. 

B.  Duties  of  the  Chairman.  The  chairman  of  the 
Board  of  Trustees  shall  prepare  an  agenda 
and  shall  preside  at  all  meetings  of  the  Board. 
He  shall  make  an  annual  report  to  the  House 
of  Delegates.  He  shall  be  chairman  of  the 
Executive  Committee.  He  shall  present  the 
report  of  the  actions  of  the  Executive  Com- 
mittee to  the  Board. 

C.  Committees.  The  Board  shall  form  the  fol- 
lowing committees  within  itself: 

(1)  Executive  Committee 

(2)  Finance  Committee 

(3)  Policy  Committee 

(4)  Ethical  Relations  Committee 

(5)  Committee  on  Committees 

(6)  Committee  on  Constitution  and  By- 
laws 

(7)  Journal  (Publications)  Committee 

(8)  Advisory  Committee  to  Woman’s  Auxi- 
liary 

(9)  Such  others  as  deemed  necessary. 

D.  Duties  of  the  Committees. 

(1)  Executive  Committee.  The  Executive 
Committee  shall  consist  of  the  presi- 
dent, the  president-elect,  the  chairman 
of  the  Board,  the  chairman  of  the  Fi- 
nance Committee,  the  chairman  of  the 
Policy  Committee,  the  secretary-treas- 
urer and  the  trustee-at-large. 

It  may  be  given  authority  to  act  by 
the  Board  of  Trustees. 

In  matters  of  routine  administra- 
tion, special  plans,  policy,  endorsement 
or  expenditure  it  shall  report  to  and 
request  approval  of  the  Board.  It  shall 
receive  the  reports  of  the  Finance  and 
Policy  Committees  and  make  recom- 
mendations concerning  them  to  the 
Board.  It  shall  furnish  a report  of  its 
actions  to  the  Board  at  each  meeting. 

(2)  Finance  Committee.  The  Finance  Com- 
mittee shall  consist  of  the  secretary- 
treasurer  of  the  Society  and  three 
members  of  the  Board  appointed  by 


the  chairman.  It  shall  develop  for  ' 
approval  of  the  Board  through  the  ^ 
Executive  Committee,  a budget  for  the 
fiscal  year.  It  shall  supervise  the 
financial  transactions  of  the  Society.  It 
shall  make  recommendations  to  the  ; 
Board  for  the  control  and  investment  ^ 
of  the  funds  of  the  Illinois  State  ! 
Medical  Society.  ^ 

The  Medical  Benevolence  Committee 
shall  be  a subcommittee  of  the  Fi- 
nance Committee.  It  shall: 

(a)  Examine  applications  to  the  So- 
ciety for  assistance  to  determine 
eligibility  for  assistance. 

(b)  Keep  the  names  of  the  benefi- 
ciaries confidential  and  known 
only  to  the  committee. 

(c)  Recommend  to  the  Finance  Com- 
mittee the  allotment  for  each 
recipient,  and 

(d)  If  funds  available  become  in- 
adequate to  meet  disbursements, 
request  the  Board  of  Trustees  to 
appropriate  sufficient  funds  to 
support  the  program  until  the 
next  budget  appropriation. 

(3)  Policy  Committee.  The  Policy  Com- 
mittee shall  consist  of  three  members 
of  the  Board  appointed  by  the  chair- 
man. It  shall  continually  review  past  ’ 
and  current  proceedings  of  the  House 
of  Delegates  to  determine  the  estab- 
lished policies  of  the  Illinois  State  j 
Medical  Society. 

(4)  The  Ethical  Relations  Committee.  The  ^ 
Ethical  Relations  Committee  shall  be 
Constituted  and  function  as  stipulated 
in  Chapter  XII.  Discipline.  Part 
2 Illinois  State  Medical  Society  pro- 
cedures, Section  7. 

(5)  The  Committee  on  Committees.  The 
Committee  on  Committees  shall  re- 
view annually  the  purpose,  activity 
and  structure  of  all  committees,  and 
shall  recommend  such  changes  in  ex- 
isting committees  or  propose  such  ad- 
ditional committees  as  appear  to  be 
required  for  the  efficient  conduct  of 
the  business  of  the  Society. 

The  activities  of  the  Committee  on 
Committees  shall  be  reviewed  by  the 
Executive  Committee  and  approved  by 
the  Board  of  Trustees. 

(6)  The  Committee  on  Constitution  and 
Bylaws.  The  Committee  on  Con^jtu- 
tion  and  Bylaws  shall: 

(a)  Receive  from  individual  mem- 
bers, county  societies,  com- 
mittees, the  Board  of  Trustees, 

I , 

TlJinnis  Medical  Joufnal 


390 


and  the  House  of  Delegates,  all 
suggestions  and  proposals  for 
modification  of  the  Constitution 
and  Bylaws; 

(b)  Prepare  for  the  consideration  of 
the  House  of  Delegates,  all 
changes  in  the  Constitution  and 
Bylaws;  and 

(c)  Maintain  constant  surveillance  of 
both  documents  to  keep  them 
current,  effective  and  consistent 
with  the  policies  of  the  House  of 
Delegates. 

(7)  The  Journal  Committee.  The  Journal 
Committee  shall  be  composed  of  mem- 
bers of  the  Board  of  Trustees,  and 
shall  be  responsible  for  the  production 
of  the  Illinois  Medical  Journal. 

It  shall  recommend  to  the  Board  of 
Trustees  all  policies  governing  the  ed- 
itorial, business  and  production  as- 
pects of  the  Journal.  It  shall  supervise 
the  editor  in  the  selection  and  pre- 
paration of  all  copy,  and  it  shall  es- 
tablish standards  for  the  editorial  con- 
tent. 

It  shall  establish  advertising  policies, 
rates,  standards,  and  shall  review  all 
new  accounts  prior  to  acceptance,  and 
shall  approve  reprint  and  circulation 
policies. 

It  shall  conduct  a periodic  review  of 
the  printer’s  contract  and  solicit  bids 
as  indicated.  It  shall  establish  the 
format,  cover,  type  faces  and  general 
layout  of  the  Journal. 

(8)  Advisory  Committee  to  the  Woman’s 
Auxiliary.  The  Advisory  Committee 
to  the  Woman’s  Auxiliary  shall  con- 
sist of  the  president  elect  as  chair- 
man, the  president  and  the  chairman 
of  the  Board  of  Trustees. 

The  Committee  shall  provide  advice 
and  assistance  to  the  president  of  the 
Woman’s  Auxiliary  in  her  program  for 
the  year,  and  shall  assist  her  in  in- 
terpreting the  activities  of  the  Illinois 
State  Medical  Society. 

Section  6.  Quorum.  Ten  members  of  the  Board  of 
Trustees  shall  constitute  a quorum  for  the  trans- 
action of  business. 

Section  7.  County  Societies.  The  Board  of  Trustees 
shall  have  authority  to  organize  the  physicians 
of  two  or  more  counties  into  societies  to  be 
suitably  designated,  and  these  societies,  when  or- 
ganized and  chartered,  shall  be  entitled  to  all 
rights  and  privileges  provided  for  component  so- 
cieties until  such  counties  shall  be  organized  sep- 
arately. 

Section  8.  Publications.  The  Board  of  Trustees 


shall  provide  and  superintend  the  publication  and 
the  distribution  of  all  proceedings,  transactions  and 
memoirs  of  the  Society,  and  shall  have  authority 
to  appoint  an  editor  and  such  assistants  as  it  deems 
necessary. 

Section  9.  Bonding.  The  Board  of  Trustees  shall 
provide  at  the  expense  of  the  Society,  adequate 
bond  for  those  officers  and  employees  of  the 
Society  it  considers  require  bonding. 

Section  10.  Duties  of  Trustees.  Each  trustee  shall 
be  the  organizer,  consultant,  advisor,  administrator 
and  speaker  for  the  members  of  his  district,  and 
represent  the  Society  as  well  as  the  members  of  his 
district  at  the  Board  meetings. 

Each  trustee  should  visit  the  societies  in  his 
district  at  least  once  a year.  He  shall  make  an 
annual  report  of  his  work  and  the  condition  of  the 
profession  in  each  society  in  his  district  to  the 
Board  of  Trustees  and  to  the  House  of  Delegates. 

Where  his  district  is  composed  of  more  than 
one  county,  the  trustee  shall  be  an  ex-officio  mem- 
ber of  the  district  Ethical  Relations  Committee, 
Grievance  Committee,  and  Prepayment  Plans  and 
Organizations  Committee.  He  shall  report  to  the 
Board  of  Trustees  the  actions  of  the  component 
societies  on  reports  of  these  committees. 

The  necessary  traveling  expenses  incurred  by 
such  trustee  in  the  line  of  the  duties  herein  im- 
posed, may  be  allowed  by  the  Board  of  Trustees 
upon  presentation  of  a properly  itemized  state- 
ment. 

Section  11.  Vacancies.  If  during  the  interval  be- 
tween two  annual  conventions,  sickness,  death,  or 
removal  from  the  state  or  district,  or  any  other 
reason  prevents  a trustee  from  attending  the 
duties  of  his  district,  or  if  he  shall  be  absent  from 
two  consecutive  meetings  of  the  Board,  his  office 
may  be  declared  vacant  at  the  discretion  of  the 
Board.  The  Board  shall  have  the  authority  to  fill 
the  vacancy  for  the  period  between  the  date  at 
which  the  office  was  declared  vacant  and  the  next 
annual  meeting  of  the  House  of  Delegates. 

Section  12.  The  Benevolence  Fund.  Each  year  the 
Board  shall  appropriate  from  the  funds  of  this 
Society  such  sum  or  sums  as  it  may  deem  proper 
to  be  held  in  a fund  to  be  known  as  ‘"The  Benevo- 
lence Fund.”  This  fund  is  established  and  shall  be 
used  only  for  the  assistance  or  relief  of  needy 
members  of  this  Society,  their  widows,  widowers, 
or  minor  children.  The  assets  shall  be  held  in  the 
treasury  of  this  Society  in  a separate  fund.  Dona- 
tions or  bequests  to  the  Benevolence  Fund  auto- 
matically become  a part  of  these  assets. 

Section  13.  Audit  and  Financial  Statement.  The 
Board  of  Trustees  shall  employ  annually  a certi- 
fied public  accountant  to  audit  all  accounts  of  the 
Society,  and  present  a statement  of  same  in  its 
annual  report  to  the  House  of  Delegates. 

This  report  shall  also  specify  the  character  and 


for  October,  1968 


391 


cost  of  all  publications  of  the  Society  during  the 
year,  and  the  amount  of  all  other  property  be- 
longing to  the  Society  under  its  control,  with  such 
suggestions  as  it  may  deem  necessary. 

CHAPTER  VII.  DISTRICT  COMMITTEES 
Each  trustee  district  which  is  composed  of  more 
than  one  county,  shall  have  an  Ethical  Relations 
Committee,  a Grievance  Committee,  a Committee 
on  Prepayment  Plans  and  Organizations,  and  such 
other  committees  as  required  to  provide  to  each 
component  society,  those  services  the  component 
society  may  not  be  able  to  provide  for  itself.  Dis- 
trict committees  shall  function  only  at  the  request 
of  a component  society  within  the  district. 

Complaints  initially  received  by  district  com- 
mittees shall  be  referred  immediately  to  the  com- 
ponent society  for  action. 

District  committees  shall  be  governed  by  the 
procedural  rules  and  regulations  governing  the 
counterpart  state  society  committee  or  by  these 
Bylaws. 

Reports  of  findings  and  recommendations  of  these 
district  committees  shall  be  made  to  the  compon- 
ent society  which  requested  action. 

The  district  trustee  shall  include  a summary 
of  the  activities  of  each  of  these  committees  and 
the  findings  in  general,  in  his  annual  report  to  the 
House  of  Delegates. 

The  committee  members  shall  be  elected,  sub- 
ject to  the  general  rules  on  composition  of  com- 
mittees contained  in  Section  5,  Chapter  IX,  of 
these  Bylaws,  at  a meeting  of  the  delegates  of  the 
district  called  by  the  trustee  of  the  district,  before 
or  during  the  annual  convention  of  the  Illinois 
State  Medical  Society.  Chairmen  of  the  com- 
mittees shall  be  designated  by  the  trustee  of  the 
district,  and  the  trustee  shall  be  an  ex-officio  mem- 
ber of  each  committee. 

CHAPTER  VIII.  DUES  AND  EXPENSES 

Section  1.  Annual  Dues.  Assessments  may  be 
levied  by  the  House  of  Delegates  on  each  com- 
ponent society  on  a proportional  basis.  The  amount 
of  the  dues  shall  be  fixed  by  the  House  of  Dele- 
gates and  shall  include  the  dues  and/or  assess- 
ments approved  by  the  House  of  Delegates  of 
the  American  Medical  Association. 

These  annual  dues  shall  include  the  annual  sub- 
scription to  the  Illinois  Medical  Journal  which 
shall  be  at  least  fifty  per  cent  of  the  regular  sub- 
scription price  of  the  Journal. 

Section  2.  The  Board  of  Trustees  upon  recom- 
mendation of  the  component  society,  shall  give 
50%  reduction  in  dues  to  teaching,  research  and 
administrative  personnel  in  full  time  employment 
in  the  approved  medical  schools  in  Illinois,  or 
similar  not-for-profit  institutions  in  Illinois. 

Section  3.  Physicians  in  private  practice  of  medi- 


cine may  be  given  a 50%  reduction  in  dues  during 
the  first  year  of  practice  upon  recommendation  of 
their  component  society. 

Section  4.  Physicians  approved  for  membership 
after  June  30  shall  pay  one-half  of  the  annual  dues 
for  that  year. 

Section  5.  The  Board  of  Trustees  may  authorize 
the  remission  of  dues  of  any  member  on  recom- 
mendation of  his  component  society  for  good  rea- 
son. In  such  cases  the  secretary  shall  recommend 
remission  of  dues  by  the  American  Medical  Asso- 
ciation. 

CHAPTER  IX.  COMMITTEES 
Section  1.  Committees  of  the  Illinois  State  Medi- 
cal Society.  The  committees  of  the  Illinois  State 
Medical  Society  shall  be: 

A.  Standing  committees  called  Councils 

B.  Reference  committees 

C.  Ad  hoc  committees 

D.  Board  of  Trustees  committees 

Section  2.  Standing  Committees-Called  Councils. 
The  standing  committees  of  the  Society  shall  be: 

A.  The  Judicial  Council 

B.  The  Council  on  Scientific  Services 

C.  The  Council  on  Legislation  and  Public 
Affairs 

D.  The  Council  on  Public  Relations 

E.  The  Council  on  Medical  Education 

F.  The  Council  on  Medical  Service;  and  such 
other  Councils  as  shall  be  established  from 
time  to  time  by  the  Board  of  Trustees. 

Section  3.  Organization  of  Councils. 

A.  Councils  shall  be  appointed  by  the  Board  of 
Trustees. 

B.  The  chairman  of  a Council  shall  be  desig- 
nated by  the  Board. 

C.  Each  Council  shall  have  authority  to  request 
the  Board  of  Trustees  to  appoint  sub-com- 
mittees for  any  purpose  within  the  functions 
of  the  Council.  A member  of  the  Council 
shall  be  designated  as  chairman  of  the  sub- 
committee. 

D.  These  sub -committees  may  also  request  the 
Board  to  appoint  special  committees  for  any 
purpose  relating  to  the  general  functions  of 
the  sub-committee.  A member  of  the  sub- 
committee shall  chair  the  special  committee. 

E.  Only  active  members  of  the  Illinois  State 
Medical  Society,  not  American  Medical  As- 
sociation delegates  nor  those  holding  elective 
office  in  the  Illinois  State  Medical  Society, 
may  be  appointed  to  a Council.  Any  active 
member  of  the  State  Society  may  be  a mem- 
ber of  a sub-committee  or  a special  com- 
mittee. Elective  officers  may  be  appointed  ad- 
visors to  any  committee. 

Recommendations  for  membership  on  any 


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committee  may  be  submitted  to  the  Board  of 
Trustees  by  the  House  of  Delegates,  or  in 
writing  by  any  member  of  the  Society. 

A state  committee  which  reviews  the  de- 
cisions of  a similar  committee  of  a compon- 
ent society  may  not  have  as  a member  one 
who  currently  serves  on  the  same  committee 
of  a component  society  or  district. 

F.  Each  Council,  sub-committee  or  special 
committee  shall  have  authority  to  make  rules 
to  govern  its  procedures  subject  to; 

(1)  Specific  requirements  of  the  Constitu- 
tion and  Bylaws  and  the  policies  of  the 
House  of  Delegates,  and 

(2)  Approval  of  the  Board  of  Trustees. 

G.  Each  Council  shall  submit  for  adoption,  a 
budget  for  the  ensuing  year,  and  the  Board 
of  Trustees  shall  determine  the  appropriation 
for  each  Council.  Requests  for  additional 
funds  must  be  approved  by  the  Board  be- 
fore they  are  committed. 

H.  The  president  of  the  Society,  the  speaker 
of  the  House  and  the  chairman  of  the  Board 
shall  be  ex-officio  members  of  the  various 
Councils,  and  may  attend  all  committee  meet- 
ings. 

I.  Each  Council  shall  have  members  in  suf- 
ficient quantity  so  that  each  sub-committee 
may  be  chaired  by  a different  member. 

J.  Terms  of  office  of  members  of  the  Councils 

shall  not  be  more  than  three  years,  but  may 
be  terminated  for  cause  at  any  time  at  the 
discretion  of  the  Board.  No  member  of  a 
Council  shall  serve  more  than  three  consec- 
utive terms.  Service  of  two  or  more  years  in 
an  unexpired  term  shall  be  considered  a full 
term. 

K.  Reports. 

(1)  Special  committee  reports  shall  be 
made  by  the  chairman  to  the  sub- 
committee from  which  he  was  ap- 
pointed. 

(2)  Reports  from  sub-committees  (which 
shall  contain  summaries  of  the  report 
of  special  committees)  shall  be  made 
by  the  chairman  to  the  Council  of 
which  he  is  a member. 

(3)  Reports  of  Council  activities  shall  in- 
clude recommendations  on  reports  and 
requests  from  sub-committees,  and 
shall  be  made  to  the  Board  of  Trus- 
tees by  the  chairman  of  the  Council. 

(4)  The  Chairman  of  the  Council  with  the 
approval  of  the  Board,  may  permit  any 
member  of  a committee  under  the 
Council  to  clarify  the  report  of  that 
committee  to  the  Board. 

(5)  The  Chairman  of  any  committee  may 
request  the  Board  of  Trustees  to  allow 
him,  or  any  member  of  his  committee, 
to  appear  before  the  Board. 

(6)  All  committees  shall  submit  to  the 


House  of  Delegates,  written  reports 
summarizing  all  actions,  and  may  in- 
clude recommendations  for  House  con- 
sideration. 

L.  Vacancies  on  any  committee  may  be  filled  at 
any  time  by  the  Board  of  Trustees.  Com- 
mittee membership  may  be  enlarged  or  de- 
creased or  the  committee  may  be  discharged 
by  the  Board  of  Trustees. 

M.  Committee  Meetings 

The  chairman  of  a committee,  when  he  con- 
siders it  expedient  and  with  the  consent  of 
two  thirds  of  the  members  of  the  committee, 
may  conduct  business  or  hold  meetings  by 
mail  or  by  conference  call,  provided  all 
members  of  the  committee  are  given  oppor- 
tunity to  participate,  that  minutes  of  the 
transactions  are  recorde’d,  approved  by  mem- 
bers participating,  and  circulated  among  all 
committee  members. 

Section  4.  Duties 

A.  The  Judicial  Council 

The  Judicial  Council  shall: 

(1)  Investigate 

(a)  Controversies  arising  under  this 
Constitution  and  Bylaws  and  un- 
der the  principles  of  medical 
ethics,  to  which  the  Society  is  a 
party,  and 

(b)  Controversies  between  two  or 
more  county  societies  and  their 
members. 

(2)  Investigate  all  questions  of  medical 
ethics  and  the  interpretation  of  the 
Constitution,  Bylaws  and  Policies  of 
the  Society. 

(3)  Investigate  general  professional  con- 
ditions and  all  matters  pertaining  to 
the  relations  of  physicians  to  one  an- 
other or  to  the  public. 

(4)  Receive  appeals  filed  by  appli- 
cants who  allege  that  they  have  been 
denied  membership  in  a component 
society  because  of  race,  creed,  color,  or 
ethnic  origin,  to  determine  the  facts  of 
the  case  and  to  report  the  findings  to 
the  Board  of  Trustees. 

B.  The  Council  on  Scientific  Services.  The 
Council  on  Scientific  Services  shall: 

(1)  Encourage  and  assist  in  the  develop- 
ment of  community  programs  designed 
to  maintain,  protect  and  improve  the 
health  of  residents  of  the  state  of 
Illinois. 

(2)  Cooperate  with  the  Illinois  Depart- 
ment of  Public  Health  in  the  control 
and  prevention  of  contagious  diseases. 

(3)  Formulate  and  participate  in  pro- 
grams designed  to  decrease  occupa- 
tional, environmental  and  physical 
hazards. 

(4)  Recommend  and  promulgate  standards 


for  October,  1968 


393 


for  ancillary  medical  services  and 
laboratories. 

(5)  Participate  and  advise  in  programs  de- 
signed to  reduce  morbidity  and  mor- 
tality in  diseases  peculiar  to  any  seg- 
ment of  the  people  of  Illinois. 

(6)  Work  for  the  establishment  of  mea- 
sures for  the  control  of  hazardous 
drugs  and  agents. 

(7)  Develop  and  support  legislative  mea- 
sures to  accomplish  these  aims. 

C.  The  Council  on  Legislation  & Public  Affairs. 
The  Council  on  Legislation  and  Public  Af- 
fairs shall: 

(1)  Keep  the  Society  and  its  members 
aware  of  all  state  and  federal  legisla- 
tion and  laws  affecting  the  health  of 
citizens  in  Illinois  and  the  practice  of 
medicine  in  Illinois. 

(2)  Promulgate  legislation  to  improve  the 
health  care  of  citizens  of  Illinois  and 
the  practice  of  medicine  in  Illinois. 

(3)  Cooperate  with  the  AMA  in  similar 
programs. 

(4)  Shall  develop  programs  to  educate  the 
public  and  the  Illinois  State  Medical 
Society  membership  in  the  privileges 
and  responsibilities  of  citizenship. 

D.  The  Council  on  Public  Relations 

The  Council  on  Public  Relations  shall  plan 
and  execute  programs  designed  to  enhance 
the  relationship  between  the  public  and  the 
medical  profession. 

E.  The  Council  on  Medical  Education 

The  Council  on  Medical  Education  shall: 

(1)  Study  and  evaluate  all  phases  of  med- 
ical education  including  the  develop- 
ment of  programs  approved  by  the 
House  of  Delegates  for  the  provision 
of  a continuing  supply  of  well-qualified 
physicians. 

(2)  Study  and  evaluate  education  relating 
to  the  health  professions  and  services 
important  to  medicine,  including  the 
development  of  programs  approved  by 
the  House  of  Delegates,  for  the  pro- 
vision of  a continuing  supply  of  well- 
qualified  personnel  in  these  fields. 

(3)  Carry  to  the  deans  of  the  medical 
schools  recommendations  from  the 
viewpoint  of  the  practicing  physicians. 

(4)  Study,  evaluate  and  criticize  the  post- 
graduate programs  of  the  Society  and 
other  organizations. 

(5)  Be  available  to  advise  and  cooperate 
with  the  Department  of  Registration 
and  Education  of  the  State  of  Illinois. 

(6)  Organize,  coordinate  and  administer 
the  scientific  sessions  of  the  Illinois 
State  Medical  Society  subject  to  the 
regulations  outlined  in  these  Bylaws, 
especially  those  in  CHAPTER  II,  An- 


nual Conventions.  Section  3.  Scientific 
Meetings. 

F.  The  Council  on  Medical  Service 

The  Council  on  Medical  Service  shall: 

(1)  Coordinate  committee  activities,  avoid 
duplication  in  over-lapping  of  projects, 
close  gaps  in  medical  service  program- 
ming and  serve  as  a catalyst  in  activat- 
ing new  committee  programs. 

(2)  Initiate,  explore  and  bring  to  the  atten- 
tion of  the  Board  of  Trustees  suggested 
new  policies  and  philosophies  relating 
to  medical  service  in  Illinois. 

(3)  Serve  as  an  advisory  body  to  allow 
for  the  interchange  of  ideas  between 
various  committees  of  the  Council. 

(4)  Consult  with  Council  members  as 
chairmen  of  committees  with  similar 
aims  and  objectives. 

(5)  Advise  the  staff  in  socio-economic 
issues  and  further  the  health  and  wel- 
fare of  the  public  by  seeking  continu- 
ous improvement  of  medical  service  in 
Illinois. 

(6)  Establish  liaison  with  other  Councils 
of  organized  medicine,  including  those 
of  the  AMA. 

(7)  Provide  a channel  of  communication 
between  the  Illinois  State  Medical  So- 
ciety and  the  federal  health  agencies, 
the  health  insurance  industry,  the  Blue 
Cross-Blue  Shield  Plans,  and  similar 
organizations  in  matters  of  mutual 
concern. 

Section  5.  Reference  Committees 

Reference  Committees  shall  be  appointed  by 
the  speaker  of  the  House  of  Delegates  as  out- 
lined in  Chapter  X.  REFERENCE  COM- 
MITTEES, and  as  provided  therein. 

Section  6.  Ad  hoc  Committees 

A.  Ad  hoc  committees  shall  be  appointed  by  the 
speaker  of  the  House  of  Delegates  to  accom- 
plish specific  duties. 

B.  Any  member  of  the  Society  may  be  asked  to 
serve. 

C.  The  terms  of  appointment  shall  be  for  the 
duration  of  the  task,  or  until  the  committee 
shall  be  discharged. 

D.  Ad  hoc  committees  expected  to  serve  for 
more  than  three  years,  shall  be  reorganized 
and  given  the  status  of  a sub-committee  or 
special  committee  under  the  appropriate 
Council  and  should  be  appointed  by  the 
Board  of  Trustees. 

E.  Between  meetings  of  the  House  of  Delegates 
ad  hoc  committees  shall  report  to  the  Board 
of  Trustees  keeping  it  informed  of  all  current 
activities. 

Section  7.  Board  of  Trustees  Committees 

These  committees  are  detailed  in  CHAPTER  VI. 
THE  BOARD  OF  TRUSTEES  Section  5 (D). 


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Illinois  Medical  Journal 


CHAPTER  X.  REFERENCE  COMMITTEES 
Section  1.  Appointment.  Immediately  after  the 
organization  of  the  House  of  Delegates  at  each 
annual  or  special  meeting,  the  speaker  shall  an- 
nounce the  appointment  from  among  the  members 
of  the  House,  such  committees  as  may  be  deemed 
expedient  by  the  House  of  Delegates. 

Each  committee  shall  consist  of  five  or  more 
members  unless  otherwise  provided,  the  chairman 
to  be  announced  by  the  speaker.  These  committees 
shall  serve  during  the  meeting  at  which  they  are 
appointed. 

Section  2.  Duties  of  Reference  Committees.  Ref- 
ferences,  resolutions,  measures  and  propositions 
presented  to  the  House  of  Delegates  shall  be  re- 
ferred to  the  appropriate  committee,  which  shall 
report  to  the  House  of  Delegates  before  final  ac- 
tion shall  be  taken.  A two-thirds  affirmative  vote  of 
the  House  of  Delegates  shall  be  required  to  sus- 
pend this  rule. 

Section  3.  Organization.  Each  reference  committee 
shall,  as  soon  as  possible  after  the  adjournment  of 
each  session,  or  during  the  session  if  necessary, 
take  up  and  consider  such  business  as  may  have 
been  referred  to  it,  and  shall  report  on  same  at  the 
next  session,  or  when  called  upon  to  do  so. 

Section  4.  Reference  Committees.  The  following 
committees  are  hereby  provided  for: 

A Committee  on  Credentials 
A Committee  on  Rules  and  Order  of  Business 
Tellers  and  Sergeants-at-Arms 
A Committee  on  Changes  in  the  Constitution 
and  Bylaws 

and  such  other  committees  as  the  speaker  shall 
deem  necessary  to  conduct  the  business  of  the 
House,  or  consider  the  reports  of  officers,  trus- 
tees, executive  administrator,  the  reports  of  com- 
mittees pertaining  to  administrative  activities, 
economics  activities,  scientific  activities,  public 
relations  activities  and  legislative  activities,  as 
well  as  such  resolutions,  reports,  and  proposals  as 
shall  be  brought  before  the  House  of  Delegates. 

Section  5.  The  Committee  on  Credentials  shall 
consider  all  questions  regarding  the  registration 
and  the  credentials  of  the  delegates.  It  shall  pass 
out  and  receive  the  attendance  slips  for  each  ses- 
sion of  the  House  of  Delegates,  and  perform  any 
other  duties  assigned. 

Section  6.  A Committee  on  Rules  and  Order  of 
Business  shall  consider  all  matters  regarding  rules 
governing  action,  method  of  procedure  and  order 
of  business  for  the  House  of  Delegates. 

Section  7.  The  Tellers  and  Sergeants-at-Arms  shall 

A.  Serve  the  speaker  of  the  House  of  Delegates 

B.  Distribute,  collect  and  tally  votes  when  a 
ballot  is  taken,  or  a numerical  tally  is 
required 

C.  Certify  those  in  attendance  in  closed  or 
Jor  October,  1968 


executive  sessions  of  the  House  of  Delegates. 

Section  8.  The  Committee  on  Changes  in  Consti- 
tution and  Bylaws  shall  consider  all  proposed 
amendments  to  the  Constitution  and  Bylaws. 

The  chairman  of  the  Committee  on  Constitution 
and  Bylaws,  or  his  representative,  shall  serve  in  an 
advisory  capacity  to  this  reference  committee  and 
shall  attend  all  sessions,  including  the  executive 
sessions  of  the  reference  committee,  to  assist  in 
the  preparation  of  the  report  of  the  committee  of 
the  House  of  Delegates. 

CHAPTER  XI.  COUNTY  SOCIETIES 
Section  1.  All  county  societies  now  in  affiliation 
with  this  Society,  or  those  which  may  hereafter  be 
organized  in  this  state,  which  have  adopted  princi- 
ples of  organization  in  harmony  with  this  Consti- 
tution and  Bylaws,  shall  upon  application  to  and 
approval  by  the  Board  of  Trustees,  receive  a 
charter  from  and  thereby  become  a component 
part  of  this  Society,  and  members  thereof  shall 
become  members  of  this  Society  and  the  American 
Medical  Association. 

Section  2.  Charters  shall  be  issued  only  on  ap- 
proval of  the  Board,  and  shall  be  signed  by  the 
president  and  the  secretary  of  this  Society. 

The  Board  shall  have  authority  to  revoke  the 
charter  of  any  component  society  whose  actions 
are  in  conffict  with  the  letter  and  spirit  of  this 
Constitution  and  Bylaws. 

Section  3.  Only  one  component  medical  society 
shall  be  chartered  in  any  county. 

Section  4.  Every  registered  physician  holding  the 
title  of  Doctor  of  Medicine  or  its  equivalent,  who 
either  (1)  resides  in  the  jurisdiction  of  a com- 
ponent society,  or  (2)  resides  in  a state  other  than 
Illinois  but  practices  principally  in  the  jurisdiction 
of  a component  society  and  who  is  of  good  moral 
character  and  professional  standing,  shall  be 
eligible  to  membership  in  that  component  society. 

The  component  county  society  shall  be  the  sole 
judge  of  the  qualifications  of  its  members,  subject 
only  to  the  stipulations  contained  in  the  Constitu- 
tion and  Bylaws. 

Section  5.  Any  physician  who  has  been  disciplined 
by  any  action  of  a component  society  and  believes 
he  has  not  had  a fair  trial,  shall  have  the  right  of 
appeal  to  the  Board  of  Trustees. 

Section  6.  When  a member  in  good  standing  in  a 
component  society  changes  his  residence  to  an- 
other county  in  this  state,  such  change  of  residence 
shall  terminate  his  membership  in  such  component 
society.  (This  ruling  shall  not  apply  to  members 
in  military  service  or  in  the  service  of  the  State 
or  the  United  States  government.) 

Such  member  shall  be  entitled,  upon  his  request, 
to  a statement  from  his  former  secretary  as  to  his 
standing.  This  statement  of  standing  shall  be 
issued  without  cost  to  the  applicant. 

He  shall  present  this  statement  to  the  compo- 
nent society  of  the  county  to  which  he  removes 

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ritALTH  SCIENCES  LIBRARY. 
UNIVERSITY  OF  MARYLAND 
BALTIMORE 


and  it  shall  accompany  his  application  for  mem- 
bership. The  board  of  censors  of  the  society  receiv- 
ing this  application  shall  give  this  statement  of 
prior  standing  due  consideration  before  accepting 
or  rejecting  his  application  for  membership. 

Section  7.  A physician  living  on  or  near  a county 
line,  or  practicing  partly  or  totally  in  an  adjacent 
county,  may  hold  his  membership  in  the  county 
most  convenient  for  him,  provided  he  submits 
written  authorization  to  that  society  from  the 
component  society  in  whose  jurisdiction  he  resides. 

Section  8.  The  secretary  of  each  component  so- 
ciety shall  keep  a roster  of  its  members,  in  which 
shall  be  shown  the  full  name,  address,  college  and 
date  of  graduation,  date  of  license  to  practice  in 
this  state,  and  such  other  information  as  may  be 
deemed  necessary.  In  keeping  such  a roster  the 
secretary  shall  note  any  changes  in  the  personnel 
of  the  profession  by  death  or  by  removal  to  or 
from  the  county.  When  requested,  he  shall  fur- 
nish on  blanks  supplied  him  for  the  purpose,  an 
official  report  containing  such  information  for  the 
secretary  of  this  Society  and  likewise  for  the 
trustee  of  the  district  in  which  his  county  is 
situated. 

Section  9.  The  secretary  of  each  component  society 
shall  forward  its  roster  of  officers  and  members, 
and  a list  of  delegates  and  alternate  delegates  to 
the  secretary  of  this  Society  before  the  fifteenth  of 
January  each  year. 

Section  10.  Any  component  society  which  fails  to 
pay  its  assessment  or  make  the  annual  report  re- 
quired on  or  before  March  fifteenth  shall  be  held 
as  suspended  and  none  of  its  members  shall  be  per- 
mitted to  participate  in  any  of  the  business  or 
proceedings  of  the  Society  or  of  the  House  of 
Delegates  until  such  requirements  have  been  met. 

A member  is  in  good  standing  unless  otherwise 
disqualified,  whose  dues  are  paid  on  or  before  the 
first  day  of  March  of  the  current  year.  Immediate- 
ly after  the  first  of  March,  each  delinquent  mem- 
ber shall  be  notified  that  in  consequence  of  non- 
payment of  dues,  his  membership  is  delinquent. 
If  dues  remain  unpaid  as  of  June  thirtieth  of  the 
current  year,  membership  shall  be  dropped  auto- 
matically. The  member  may  be  reinstated  by  pay- 
ing all  delinquent  dues,  provided,  in  the  interim, 
he  has  not  been  guilty  of  conduct  prejudicial  to 
membership;  but  if  two  or  more  years  have  elapsed 
since  he  was  a member  in  good  standing,  he  must 
in  addition,  make  application  as  a new  member. 

Section  11.  The  Constitution  and  Bylaws  of  the 
Illinois  State  Medical  Society  and  of  the  American 
Medical  Association,  together  with  the  Principles 
of  Medical  Ethics  of  the  American  Medical  Asso- 
ciation, shall  be  binding  upon  the  members  of  the 
component  societies. 


CHAPTER  XII.  DISCIPLINE 
PART  1.  COMPONENT  SOCIETY 
PROCEDURE 

Section  1.  Local  Ethical  Relations  Committee. 
Each  component  society  may  have,  either  by  ap- 
pointment or  election,  an  Ethical  Relations  Com- 
mittee, whose  duty  it  shall  be  to  prosecute  formal 
charges  of  unethical  conduct.  In  the  event  that  the 
county  society  does  not  have  such  a committee, 
the  district  Ethical  Relations  Committee  shall 
function  in  its  behalf. 

The  component  society  (or  district)  Ethical 
Relations  Committee  may  employ  legal  counsel. 
Such  committees  may  establish  reasonable  rules 
of  procedure,  and  they  shall  not  be  bound  by 
the  technical  rules  of  evidence  as  the  same  per- 
tain in  courts  of  law.  In  all  proceedings  before 
such  Ethical  Relations  Committees,  the  complain- 
ant, the  accused  and  all  witnesses  before  the  com- 
mittee shall  be  placed  under  oath. 

Section  2.  Offenses.  Any  member  of  a component 
society  shall  be  subject  to  censure,  suspension  or 
expulsion  by  such  component  society  when 

A.  He  has  been  adjudged  guilty  by  proper  civil 
authorities  of  a criminal  offense  involving 
moral  turpitude,  or 

B.  He  has  been  adjudged  guilty  by  his  compo- 
nent society  in  accordance  with  the  proced- 
ural requirement  of  these  bylaws: 

(1)  of  a gross  misconduct  as  a physician  or 
surgeon,  or 

(2)  of  a violation  of  the  Constitution  or  By- 
laws of  his  component  society,  or  of  the 
Illinois  State  Medical  Society,  or  of  the 
Principles  of  Medical  Ethics  promul- 
gated from  time  to  time  by  the  Ameri- 
can Medical  Association. 

Section  3.  Charges  Initially  Presented  to  the  Illi- 
nois State  Medical  Society.  Original  complaints  re- 
ceived by  the  Illinois  State  Medical  Society  should 
be  referred  directly  to  the  secretary  of  the  com- 
ponent society  of  which  the  accused  is  a member 
and  to  the  appropriate  district  Ethical  Relations 
Committee. 

Section  4.  Principles  of  Justice.  The  following 
principles  of  justice  shall  guide  the  Ethical  Rela- 
tions Committee  in  all  disciplinary  procedures. 

A.  An  accused  is  presumed  to  be  innocent  until 
he  has  been  proven  guilty. 

B.  Formal  charges  before  the  Ethical  Relations 
Committee  of  the  component  society  or  dis- 
trict Ethical  Relations  Committee  must  be 
presented  under  oath  by  the  complaining 
party. 

C.  After  formal  charges  have  been  preferred 
there  shall  be  no  evasion  of  the  fact  that  the 
respondent  is  to  be  tried;  that  the  Ethical 
Relations  Committee  before  which  he  is  cited 
to  appear  is  a trial  body  and  that  he  will 
be  on  trial  when  he  appears. 

D.  He  must  be  notified  by  certified  mail  of  the 


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specific  charges  which  are  made  against  him 
at  least  ten  days  before  the  date  set  for  his 
trial. 

E.  He  may  not  be  found  guilty  of  anything  not 
included  in  the  charges  preferred  against  him 
and  presented  to  him. 

F.  All  evidence  not  pertinent  to  the  charge  as 
made  shall  be  considered  irrelevant  and  im- 
material ...  it  shall  be  wholly  disregarded 
in  the  decision. 

G.  Testimony  not  bearing  on  the  charges  shall 
be  objected  to  and  if  sustained  by  the  trial 
body,  stricken  from  the  records. 

H.  The  respondent  shall  be  advised  of  his  rights 
by  the  trial  body,  namely:  (1)  that  he  may 
be  represented  by  any  member  of  the  society 
as  counsel  and/or  by  legal  counsel;  (2) 
that  he  or  his  counsel  may  cross  examine 
witnesses;  (3)  that  he  may  offer  in  evidence 
any  records  or  documents  that  he  deems  fit; 

(4)  that  he  may  enter  objections  as  to  testi- 
mony or  to  material  offered  in  evidence; 

(5)  that  he  may  address  the  trial  body  in 
his  own  behalf;  (6)  and  that  he  has  the 
right  of  appeal  to  the  Board  of  Trustees  of 
the  Illinois  State  Medical  Society. 

Section  5.  Records.  A comprehensive  stenographic 
record  of  the  proceedings  must  be  kept  for  ref- 
erence, and  shall  be  available  until  final  adjudica- 
tion has  been  made. 

In  the  event  of  an  appeal  being  taken  from 
the  verdict  of  the  local  or  district  Ethical  Relations 
Committee,  the  stenographic  record  shall  be  for- 
warded by  certified  mail  to  the  Board  of  Trustees 
of  the  ISMS  ten  days  prior  to  the  date  the  appeal 
is  to  be  heard.  Failure  to  provide  such  records 
shall  be  grounds  for  a verdict  of  default  against 
the  component  society. 

Section  6.  Verdict.  The  committee,  sitting  as  a trial 
body,  shall  find  the  accused  either  guilty  or  not 
guilty.  If  the  verdict  is  guilty,  the  trial  body  shall 
recommend  censure,  suspension  or  expulsion. 

The  findings  of  the  trial  body  must  be  presented 
to  the  component  county  society  for  approval  or 
rejection.  The  accused  must  be  notified  by  certi- 
fied mail  at  least  ten  days  before  the  date  set  for 
the  meeting  at  which  this  action  will  be  taken.  If 
the  findings  of  the  trial  body  are  against  the  ac- 
cused the  secretary  of  the  component  society  shall 
acquaint  the  accused,  by  certified  mail,  with  his 
right  of  appeal  within  thirty  days  to  the  Board  of 
Trustees  of  the  Illinois  State  Medical  Society. 

PART  2.  ILLINOIS  STATE  MEDICAL 
SOCIETY  PROCEDURES 

Section  7.  Illinois  State  Medical  Society  Ethical 
Relations  Committee.  The  Board  of  Trustees  shall 
appoint  from  its  members,  an  Ethical  Relations 
Committee  to  review  matters  involving  the  inter- 
pretation  of  the  Principles  of  Medical  Ethics,  vio- 
lations of  the  Constitution  and  Bylaws  of  the 


Illinois  State  Medical  Society  or  its  component 
societies,  and  charges  of  misconduct  of  members 
of  the  Society. 

It  shall  serve  as  an  appellate  body  to  review 
cases  involving  these  matters  referred  by  com- 
ponent medical  societies,  and  shall  consider  mat- 
ters of  law  (ethics)  and  procedure. 

Section  8.  Appeals  from  Component  Society  Ver- 
dicts. Appeals  received  by  the  Illinois  State  Medi- 
cal Society  Board  of  Trustees  shall  be  referred  to 
the  Ethical  Relations  Committee  of  the  Board  for 
review.  Appeals  must  be  accompanied  by  perti- 
nent data  and  transcripts  indicating  the  basis  for 
the  appeal.  Failure  to  provide  such  data  shall  be 
grounds  for  a verdict  of  default  against  the  plain- 
tifli.  The  committee  shall  notify  the  accused  and 
the  secretary  of  the  component  society  by  cer- 
tified mail  at  least  thirty  days  prior  to  the  date 
set  for  the  hearing  of  the  appeal.  The  chairman 
of  the  committee  shall  preside  over  the  hearing 
in  accordance  with  the  rules  established  by  the 
Board  of  Trustees. 

Section  9.  Verdict.  On  conclusion  of  the  hearing, 
the  Ethical  Relations  Committee  of  the  Board  of 
Trustees  shall  meet  in  executive  session  to  consider 
its  decision,  and  shall  report  in  writing  to  the 
Board  at  its  next  meeting  for  approval  or  rejection. 

Section  10.  Notification  of  Parties.  The  secretary 
of  the  Society  shall  notify  the  defendant  and  the 
secretary  of  the  component  society  wherein  the 
defendant  holds  membership,  of  the  action  of  the 
Board. 

A.  Right  of  Appeal  to  the  American  Medical 
Association.  In  case  of  findings  against  the 
accused,  and  in  support  of  the  action  taken 
by  the  component  society,  the  secretary  of 
the  state  society  shall  notify  the  accused 
within  ten  days  by  certified  mail  of  his  right 
to  appeal  to  the  Judicial  Council  of  the 
American  Medical  Association. 

B.  Error.  In  the  event  of  a decision  by  the 
Board  of  Trustees  of  improper  law  (ethics) 
and/or  procedure  by  the  trial  body  of  the 
component  society,  the  case  shall  be  re- 
manded with  recommendations  to  the  com- 
ponent society  for  reconsideration. 

CHAPTER  XIII.  MISCELLANEOUS 

Section  1.  The  fiscal  year  of  this  Society  shall  be 
from  January  1 to  December  31  inclusive. 
Section  2.  Robert’s  “Rules  of  Order,  Revised,” 
shall  be  the  guide  for  all  procedure  when  not  in 
conflict  with  the  Constitution  and  Bylaws. 

CHAPTER  XIV.  AMENDMENTS 

The  House  of  Delegates  may  amend  any  article  of 
these  Bylaws  by  a two-thirds  vote  of  the  delegates 
present  at  any  meeting,  provided  that  such  amend- 
ment shall  not  be  acted  upon  before  the  day  fol- 
lowing that  on  which  it  was  introduced. 


for  October,  1968 


S97 


Order  of  Business  of  the 
House  of  Delegates 


FIRST  SESSION 

1.  Call  to  order. 

2.  Report  of  Committee  on  Credentials, 

3.  Roll  Call. 

4.  Reading  and  approval  of  minutes  of  last 
meeting. 

5.  Appointment  of  Reference  Committees. 

6.  Reports  of  Officers. 

7.  Reports  of  the  Trustees,  the  Editor,  etc. 

8.  Reports  of  Standing  Committees. 

9.  Reports  of  Board  Committees. 

10.  Reports  of  Special  Committees. 

11.  Reading  of  Resolutions. 

12.  Unfinished  Business. 

13.  New  Business. 

14.  Recess. 


LAST  SESSION 

1.  Call  to  order 

2.  Report  of  Committee  on  Credentials 

3.  Roll  Call 

4.  Reports  of  Reference  Committees 

5.  Fixing  of  per  capita  tax  for  ensuing  year 

6.  Selection  of  meeting  place  for  next  annual 
meeting.  (Subject  to  the  investigations  of  the 
Board.) 

7.  Unfinished  business 

8.  Election  of 

(a)  officers 

(b)  trustees 

(c)  delegates  to  the  AM  A 

(d)  alternate  delegates  to  the  AM  A 

9.  Induction  of  President  Elect  into  the  office 
of  President 

10.  New  business 

11.  Adjournment  (sine  die) 


398 


Illinois  Medical  Journal 


Index  to  Constitution  and  Bylaws 


Active  Members  385 

Amendments 

to  the  Bylaws  385 

to  the  Constitution  397 

American  Medical  Association 

election  of  Illinois  Delegates  386,  388 

membership  385,  386 

Annual  Convention 

date  of  the  387 

meeting  place  387 

scientific  meetings  387 

Annual  Dues  392 

Annual  Reports  393,  395 

Audit  and  Financial  Statement  391,  392 

Benevolence,  Medical 

committee  390 

fund  391 

Board  of  Trustees 

bonding  - 391 

committees  390 

composition  390 

duties  385,  389,  390,  391 

election  by  House  of  Delegates  388 

election  of  Chairman  390 

executive  administrator  389,  390 

meetings  390 

organization  390 

publications  391 

quorum  391 

vacancies  391 

Bonding  of  Officers  and  employees  391 

Bylaws  385 

Committees 

ad  hoc  394 

Advisory  to  Woman's  Auxiliary  391 

appointment  388,  390 

Board  of  Trustees  394 

Committee  to  Study  390 

Constitution  and  Bylaws  390 

Executive  390 

Finance  390 

Journal  391 

Policy  390 

Reference  394 

Standing,  called  Councils  392 

Component  Societies  385,  395,  396 

Composition  of  the  Society  385 

Constitution  and  Bylaws 

Committee  on  390 

binding  upon  members  396 

Councils 

organization  of  392 

reports  393 

terms  of  office  393 

duties  393 

County  Societies  391,  395 

Discipline 

component  society  procedure  396 

state  medical  society  procedure  397 

District  committees  392 

District  divisions  388 


Dues  and  Expenses  392 

Duties 

of  officers  388 

of  trustees  391 

Election  of  Officers  388 

Emeritus  Members  386 

Ethical  Relations  396,  397 

Executive  Administrator  389,  390 

Executive  Committee  390 

Finance  Committee  390 

House  of  Delegates 

AMA  delegates  and  alternates  388 

appointment  of  ad  hoc  committees  388 

committees  388 

composition  387 

delegates  387,  388 

district  divisions  388 

elections  385 

order  of  business  398 

quorum  387 

registration  388 

special  meetings  387 

term  of  office  of  delegates  388 

Intern  Members  386 

journal  Committee  391 

Membership 

active  members  385 

emeritus  members  386 

intern  members  386 

qualifications  386 

residency  members  386,  387 

special  members  385 

tenure  387 

withdrawal  of  privileges  387 

Officers 

election  388 

duties  388,  389 

term  of  office  388 

Policy  Committee  390 

President  388 

Provisional  membership  386 

Publications  391 

Purposes  of  the  Society  385 

Reference  Committees 

appointment  394 

duties  394 

organization  394 

Retired  Members  386 

Residency  Members  386,  387 

Scientific  Meetings  387 

Seal  385 

Secretary-Treasurer  389 

Speaker  of  the  House  389 

Special  members 

distinguished  385 

election  386 

privileges  386 

Successor  to  President-Elect  388,  389 

Vacancies  on  Board  of  Trustees  391 

Vice-Presidents  388 

Vice  Speakers  389 

Woman's  Auxiliary  391 


for  October,  1968 


399 


Policy  Manual  of  the 
Illinois  State  Medical  Society 
May  1967 

“Policy  statements  shall  be  defined  as  guidelines  for  the  management  of  the  Illinois 
State  Medical  Society  affairs,  based  upon  prudence,  sound  judgment  and  experience.” 
“Rules  and  regulations  may  be  prepared  by  the  Board  of  Trustees  or  by  committees, 
for  use  in  the  implementation  of  policy.” 


This  manual  shall  be  a guide  for  officers,  trus- 
tees, committee  chairmen  and  headquarters  staff  to 
the  stand  taken  by  the  House  of  Delegates  of  the 
Illinois  State  Medical  Society  on  all  issues  involv- 
ing Society  policy. 

Its  statements  shall  combine  and  reconcile  the 
best  expressions  made  on  all  phases  of  policy  in- 
volving the  House  of  Delegates,  the  Board  of  Trus- 
tees and  the  various  committees. 

All  policy  statements  (except  those  involving 
the  funds  of  the  Society)  shall  have  the  approval 
of  the  House  of  Delegates,  since  the  Constitution 
and  Bylaws  provide  in  ARTICLE  V: 

“The  House  of  Delegates  shall  set  the  basic 
policy  and  philosophy  of  the  Society.” 

All  policy  statements  developed  during  the  in- 
terval between  meetings  of  the  House  shall  be  sub- 
mitted at  its  next  meeting  for  action.  The  House 
may: 

( 1 ) approve,  amend,  or  reject — 

(2)  refer  the  statement  to  the  Board  for  recon- 
sideration and  subsequent  report — 

(3)  remand  the  statement  to  the  committee 
from  which  it  came  for  further  study  and 
report. 

Policy  statements  for  the  consideration  of  the 
House  may  appear  as  a portion  of  the  annual  re- 
port of  the  Policy  Committee,  or  they  may  be 
contained  in  other  reports  to  the  House.  The  final 
statements  for  publication  in  this  Policy  Manual 
are  to  be  prepared  by  the  Policy  Committee.  Any 
member  of  the  Illinois  State  Medical  Society  may 
submit  a policy  statement  for  consideration. 

Temporary  policy  between  meetings  of  the 
House  is  determined  by  the  Board.  Committees 
may  request  Board  consideration  at  any  time. 

The  Illinois  State  Medical  Society  shall  support 
policy  statements  approved  by  the  House  of  Dele- 
gates of  the  American  Medical  Association. 

National  policy  is  the  prerogative  of  the  na- 
tional association.  Until  specific  contrary  action 
emanates  from  the  AMA  House  of  Delegates,  the 
Board  of  Trustees  and  the  officers  of  the  ISMS 
shall  consider  all  such  policy  as  binding. 

Policy  action  at  the  state  level  does  not  rescind 
official  AMA  rulings  in  Illinois,  and  the  Society 
must  recognize  such  policy  until  it  has  been 
changed  at  the  national  level. 

The  same  “chain  of  command”  should  exist  be- 
tween the  county  medical  society  and  the  ISMS 
House  of  Delegates.  Policy  established  at  the  State 


Society  level  must  prevail  until  majority  action  by 
the  House  of  Delegates  has  rescinded  or  reversed 
the  statements.  This  represents  “majority  rule”  and 
must  be  followed  closely  to  preserve  the  demo- 
cratic processes. 

Assessments 

Compulsory  assessments  of  members  of  hospital 
staffs  for  any  purpose  are  unethical  and  improper. 

Athletic  Programs 

Children  of  school  age,  through  the  9th  grade, 
should  not  participate  in  body  contact  sports. 

Elementary  school  children  develop  better  physi- 
cally if  activities  are  informal  and  not  highly  com- 
petitive. 

Medical  supervision  of  all  athletic  programs  is 
essential. 

Audits  & Surveys 

(Hospital,  nursing  homes,  etc.) 

Audits  and  surveys  which  impinge  on  personal 
privacy,  patient  care  and  local  hospital  trustee 
and  medical  decisions  as  to  management  should 
not  be  condoned. 

Autonomy  of  County  Medical  Societies 

No  ruling  of  any  county  medical  society  shall 
conflict  with  the  Principles  of  Medical  Ethics  of 
the  American  Medical  Association,  or  with  the 
Constitution  and  Bylaws  of  the  Illinois  State  Medi- 
cal Society. 

In  all  other  areas,  the  county  society  shall  be 
autonomous. 

Birth  Certificates 

Birth  certificates  should  contain  only  such  items 
as  are  pertinent  to  their  function.  Information  re- 
corded on  birth  certificates  should  not  be  provided 
to  organizations  or  individuals  for  other  than  ap- 
proved purposes. 

Budgets— (see  "Financial  Policies") 

Committee  Appointments 

The  chairman  of  the  Board  of  Trustees  and  the 
officers  of  ISMS  shall  give  the  trustees  an  oppor- 
tunity to  recommend  physicians  from  their  dis- 
tricts for  appointment  to  various  committees. 
Trustees  shall  receive  the  proposed  list  of  com- 
mittee appointments  for  their  consideration  and 
review  prior  to  the  meeting  of  the  Board  at  which 
the  final  committee  personnel  is  to  be  approved. 


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Illinois  Medical  Journal 


Elective  committees  should  serve  for  uniform 
terms  of  office — preferably  three  years.  These 
terms  of  office  should  be  held  on  a staggered  basis 
to  provide  continuity  in  the  committee  structure. 
Individual  tenure  on  any  committee  should  be 
limited  to  a maximum  of  nine  years  of  continuous 
membership — whether  elected  or  appointed. 

Physicians  appointed  to  an  Illinois  State  Medi- 
cal Society  committee  must  be  members  in  good 
standing  of  this  Society. 

Comnnunicable  Diseases 

Physicians,  especially  those  engaged  in  public 
health  work,  should  enlighten  the  public  concern- 
ing all  regulations  and  measures  for  the  prevention 
and  control  of  communicable  diseases.  When  an 
epidemic  prevails,  a physician  shall  continue  his 
labors  without  regard  to  his  own  health. 

Community  Health  Week 

The  medical  profession  shall  provide  the  scien- 
tific leadership  to  focus  attention  on  the  health 
needs  of  the  community  and  to  encourage  and 
assist  in  developing  Community  Health  Week 
activities. 

Conflict  of  Interest 

When  a case  of  conflict  of  interest  arises  and  is 
self-evident,  by  the  attitude  shown  by  the  indi- 
vidual concerned,  it  should  be  referred  to  the 
Executive  Committee  of  the  Board  of  Trustees 
of  the  ISMS  for  consideration. 

Constitution  and  Bylaws 

Final  copy  of  any  changes  made  by  the  House 
of  Delegates  in  the  Constitution  and/or  the  Bylaws 
shall  be  prepared  for  publication  by  the  Commit- 
tee on  Constitution  and  Bylaws,  in  consultation 
with  legal  counsel,  making  sure  that  the  published 
changes  reflect  the  thinking  expressed  by  the  action 
of  the  House. 

Continuing  Education 

Continuing  education  shall  be  one  of  the  basic 
purposes  of  the  Illinois  State  Medical  Society  for 
scientific  advancement,  humanization  of  medicine, 
improvement  of  medical  public  relations,  and  de- 
velopment of  cooperation  and  rapport  with  the 
public. 

Co-operation  with  the  American 
Medical  Association 

Actions  of  the  AMA  House  of  Delegates  are 
binding  upon  its  membership  at  all  levels,  county, 
state  and  national. 

(Since  all  members  of  the  Illinois  State  Medical 
Society  are  also  members  of  the  American  Medical 
Association,  this  is  universally  true  in  Illinois.  The 
right  to  disagree,  the  right  to  protest,  the  right  to 
become  “the  loyal  opposition”  is  not  questioned. 
However,  until  such  time  as  the  AMA  House  has 
reversed  its  decision,  it  is  mandatory  that  the  mem- 
bership abide  by  the  will  of  the  majority.) 

Cultists,  Association  with 
(Association  with  Osteopaths— see  '^0") 

The  Judicial  Council  of  the  American  Medical 


Association  has  ruled  that  it  is  unethical  to  asso- 
ciate VOLUNTARILY  with  an  individual  who 
practices  as  a member  of  a “cult.” 

Disaster  Control 

Any  disaster  creates  an  obvious  need  for  trained 
personnel  to  aid  the  sick  and  injured.  Local  medi- 
cal societies  should  cooperate  to  provide  medical 
self-help  programs.  County  societies  should  pro- 
vide training  for  their  membership  in  the  treatment 
of  mass  casualties,  radiological  casualties  and  in 
the  organization,  operation  and  maintenance  of 
emergency  hospitals. 

Discrimination— (see  ''Freedom  of 
Choice") 

Dues,  Recommendation  of  the  Board 
to  the  House 

The  chairman  of  the  Board  of  Trustees  shall 
place  the  question  of  dues  for  the  coming  year  on 
the  agenda  for  consideration  at  the  spring  meeting 
of  the  Board. 

Immediately  following  this  meeting,  written  no- 
tice of  the  recommendation  regarding  dues  for  the 
next  fiscal  year,  shall  be  mailed  to  all  delegates  and 
alternate  delegates  from  the  component  societies, 
and  also  to  all  presidents  and  secretaries  of  county 
medical  societies.  This  recommendation  shall  also 
be  published  in  the  Illinois  Medical  Journal  as  a 
part  of  the  annual  report  of  the  chairman  of  the 
Board. 

Education 

Primary  and  secondary  education  is  a com- 
munity problem.  In  order  to  retain  jurisdiction  of 
these  grade  schools,  finances  should  be  raised  by 
taxation  at  the  local  level. 

Ethics 

Cases  involving  ethics  shall  reach  the  state  so- 
ciety level  only  by  means  of  an  appeal.  As  outlined 
in  the  Bylaws,  the  state  society  committee  shall 
serve  only  as  an  appellate  body  to  review  such 
cases. 

Examinations 

All  physical  examinations  should  be  performed 
in  the  physician’s  office.  No  examinations  should  be 
conducted  on  a group  basis  unless  authorization 
has  been  given  by  the  local  county  medical  society 
in  a single  instance  or  for  a specific  purpose. 

This  general  statement  does  not  apply  to  the 
industrial  or  occupational  health  physician  in  his 
in-patient  activities. 

Facility  Medical  Boards  (Physicians) 

In  all  legislation  which  establishes  boards  for 
the  administration  of  medical  facilities  operated 
by  governmental  units,  at  least  one-third  of  the 
board  should  be  physicians  licensed  to  practice 
medicine  in  all  its  branches. 

Federal  Funds 

When  a federal  government  assistance  program 
is  essential  it  should  be  conducted  under  the  ad- 
ministration and  control  of  local  government.  The 
Society  does  not  favor  any  federal  assistance  pro- 


for  October,  1968 


401 


gram  which  removes  administrative  control  from 
the  state  or  local  level. 

Fee  Schedules 

No  member  or  committee  shall  be  permitted  to 
approve  a fee  schedule  for  the  Illinois  State  Medi- 
cal Society  until  it  has  been  submitted  to  and  ap- 
proved by  the  House  of  Delegates  or  the  Board  of 
Trustees. 

Individuals  covered  by  various  fee  schedules 
shall  receive  the  best  type  medical  care  in  all 
cases,  and  the  physicians  involved  shall  be  remun- 
erated according  to  the  accepted  fee  schedule.  Fees 
should  be  commensurate  with  services  rendered. 

Financial  Policies 

(also  see  "Assessments,"  etc.) 

(1)  The  Finance  Committee  is  to  make  budg- 
etary recommendations  to  the  Board  of  Trustees; 
however,  such  recommendations  must  be  approved 
by  the  Board. 

(2)  The  expenses  of  any  duly  elected  delegate 
or  alternate  delegate  attending  the  meetings  of  the 
House  of  Delegates  of  the  American  Medical  Asso- 
ciation shall  not  be  assumed  by  the  ISMS  until  he 
enters  his  official  term  of  office  set  by  the  Consti- 
tution and  Bylaws  of  the  AMA. 

(3)  The  expenses  of  any  official  representative 
of  the  ISMS  attending  any  authorized  meeting 
shall  be  determined  by  the  Finance  Committee  and 
approved  by  the  Board  of  Trustees. 

(4)  Any  new  project  authorized  by  House 
action  requiring  the  expenditure  of  funds  must  be 
accompanied  by  an  estimate  of  the  cost  and  sug- 
gested methods  of  providing  the  necessary  funds. 

(5)  Budgets  submitted  to  the  House  by  the 
Board  should  provide  for  the  ensuing  fiscal  year. 

(6)  In  addition  to  fixed  reserves,  the  develop- 
ment of  a contingency  reserve  is  desirable. 

(7)  All  financial  records  shall  be  available  at 
headquarters  office,  and  may  be  examined  by  any 
member  of  the  Society.  A semi-annual  summary 
of  the  financial  statements  of  the  Society  shall 
be  mailed  to  any  county  society  secretary  or  dele- 
gate if  requested.  A projected  budget  for  the  next 
fiscal  year  shall  be  mailed  to  the  members  of  the 
House  of  Delegates  at  least  30  days  prior  to  the 
annual  convention.  These  reports  shall  be  in  the 
format  customarily  used  in  ordinary  corporate 
practice. 

Freedom  of  Choice 

The  mutual  right  of  physicians  and  patients  to 
exercise  freedom  of  choice  in  medical  matters  shall 
be  maintained.  This  includes  the  right  of  the  pa- 
tient to  choose  the  physician  by  whom  he  will  be 
served,  and  the  right  of  the  physician  (except  in 
emergencies)  to  a corresponding  freedom  of 
choice.  All  members  of  the  Illinois  State  Medical 
Society  enjoy  the  same  rights  and  privileges  and 
are  bound  by  the  same  obligations  and  standards 
of  professional  conduct. 

Health  Care— Ancillary  Services 

All  segments  of  our  population  are  entitled  to 


and  shall  receive  the  best  health  care  available. 
The  physicians  in  Illinois  are  encouraged  to  co- 
operate in  the  implementation  of  any  national 
program  meeting  with  the  general  policy  state- 
ments of  the  Society.  (This  shall  be  interpreted 
to  include  health  aspects  in  nursing  home  care, 
use  of  recreational  facilities,  environmental  health, 
public  health,  employment  problems,  etc.,  and 
any  other  area  which  involves  the  health  of  the 
residents  of  this  State.) 

Health  Care  Costs 

The  public  should  be  educated  concerning  the 
difference  between  “health  care  costs”  and  “medi- 
cal care  costs.”  Members  of  the  profession  should 
cooperate  with  the  various  ancillary  groups  and 
should  be  able  to  explain  the  cost  factors  involved 
in  total  care. 

Health  Careers 

All  capable  and  worthy  individuals  interested  in 
medicine  as  a career  shall  be  encouraged  and  as- 
sisted by  the  Illinois  State  Medical  Society.  Those 
interested  in  paramedical  fields  shall  be  provided 
with  all  pertinent  information. 

Hospitals 

Physicians  should  sponsor  and  assist  in  the  de- 
velopment of  all  medical  staff  committees  within 
the  hospital. 

The  local  medical  profession  should  cooperate 
to  achieve  the  accreditation  of  all  eligible  hospitals, 
and  should  encourage  the  stabilization  or  reduc- 
tion of  hospital  costs  in  all  areas  where  they  have 
authority. 

Hospital  Assessments— See  Assessments 
Hospital  Committees  (Dealing  with  phy- 
sician-patient relationship) 

All  committees  dealing  with  the  review  of  phy- 
sician-patient relationship  in  hospitals  and  nurs- 
ing homes  are  urged  not  to  release  findings  to 
any  third  parties  except  by  subpoena  or  court 
order.  Any  reports  issued  by  the  committees  in- 
volved should  be  submitted  to  the  chief  of  staff 
for  his  disposition. 

Hospital  Records  and  Their  Availability 

Hospital  records  are  privileged  information  and 
the  property  of  the  patient,  kept  in  trust  by  the 
hospital.  They  are  not  to  be  released  except  on  a 
court  order. 

Upon  receipt  of  a request  signed  by  the  patient, 
an  abstract  or  a summary  shall  be  provided  when 
needed,  to  insurance  companies,  governmental 
agencies,  consulting  physicians,  etc. 

Hospital  Staff  Privileges 

The  medical  staff  of  a hospital  does  not  have 
the  privilege  or  the  right  to  make  compulsory  as- 
sessments of  members  of  the  medical  staff  for 
building  funds,  or  to  demand  an  audit  of  staff 
members’  personal  financial  records  as  a requisite 
for  staff  appointments. 

House  of  Delegates,  Special  Meetings  of 

When  a special  meeting  of  the  House  of  Dele- 


402 


Illinois  Medical  Journal 


gates  is  scheduled  which  may  involve  an  increase 
in  dues  or  a special  assessment,  the  call  for  that 
meeting  shall  contain  specific  notification  of  that 
possibility. 

Immunization  Program 

Illinois  residents  should  be  provided  all  types  of 
immunization.  Physicians  are  requested  to  provide 
this  protection  especially  to  all  children,  or  to  en- 
courage the  local  public  health  agency  to  perform 
this  function. 

Every  school  should  have  a school  health  com- 
mittee with  at  least  one  physician  as  a member. 
County  advisory  school  health  councils  should  as- 
sist in  coordination. 

Indigent,  The  Care  of  the 

Personal  medical  care  is  primarily  the  responsi- 
bility of  the  individual.  When  he  is  unable  to  pro- 
vide this  care  for  himself,  the  responsibility  should 
properly  pass  to  his  family,  the  community,  the 
county,  the  state,  and  only  when  all  these  fail,  to 
the  federal  government,  and  only  in  conjunction 
with  the  other  levels  of  government  in  the  order 
above. 

The  determination  of  medical  needs  should  be 
made  by  a physician.  The  determination  of  eligi- 
bility should  be  made  at  the  local  level  with  local 
administration  and  control.  The  principle  of  free- 
dom of  choice  should  be  preserved. 

Individual  Rights 

Since  this  Society  believes  that  a strong  America 
is  a free  America,  the  rights  of  an  individual,  or  a 
group  of  individuals,  to  openly  express  them- 
selves cannot  be  condemned  even  if  one  is  in 
complete  disagreement,  if  the  laws  of  the  land  are 
not  violated.  To  support  such  condemnation  would 
be  inconsistent  with  this  Society’s  basic  philoso- 
phy. 

Insurance  Plans 

Physicians  are  urged  to  cooperate  with  voluntary 
health  insurance  plans  approved  by  the  Illinois 
State  Medical  Society. 

Fixed  fee  schedules  should  not  be  accepted.  All 
fees  should  be  based  upon  the  usual  and  cus- 
tomary fee  concept. 

Insurance  programs  for  the  membership  of  the 
Illinois  State  Medical  Society  should  be  studied 
and  implemented  by  the  proper  committee.  Major 
medical  and  comprehensive  hospital  group  cov- 
erage should  be  part  of  this  insurance  package. 

Journal  Publication 

The  Journal  (Publications)  Committee,  with  the 
approval  of  the  Board  of  Trustees,  has  authority 
over  the  publication  policy  and  the  screening  of  all 
advertisers  and  advertising  copy  appearing  in  the 
Illinois  Medical  Journal. 

Laboratories 

All  laboratories  providing  medical  data  should 
be  under  the  direct  supervision  of  a physician. 


Lay  Employees  and  Their  Prerogatives 

Policy  is  established  by  the  House  of  Delegates. 

Staff  shall  cooperate  with  officers  and  committee 
chairmen  in  setting  up  activities  and  in  carrying 
out  all  necessary  routine. 

Staff  also  shall  keep  new  officers  and  committee 
chairmen  aware  of  policy  statements,  and  assist 
them  in  the  preparation  of  reports  to  the  House 
of  Delegates  to: 

change  existing  policy 
establish  new  policy 
request  House  approval  of  committee 
projects  and/or 
procedure  involving  policy. 

Committees  shall  be  informed  of  their  right  to 
set  up  operating  rules  and  regulations. 

Legal  Counsel 

The  legal  counsel  of  the  Illinois  State  Medical 
Society  shall  concern  himself  with  official  inquiries 
from  officers,  trustees,  committee  chairmen  and 
county  medical  societies.  Such  inquiries  shall  be 
channeled  through  the  Executive  Administrator. 

Legislation 

All  matters  pertaining  to  state  or  federal  leg- 
islation shall  be  referred  to  the  Legislative  Com- 
mittee for  consideration  and  recommendation  prior 
to  Board  of  Trustees  and/or  House  of  Delegates 
action. 

Matters  pertaining  to  federal  legislation  shall  be 
checked  against  recommendations  or  policies  of 
the  American  Medical  Association  by  the  Council 
on  Legislation  of  the  Illinois  State  Medical 
Society  prior  to  making  a recommendation  either 
to  the  Board  of  Trustees  or  to  the  House  of  Dele- 
gates. 

Before  any  legislation  is  developed  for  presen- 
tation to  the  Illinois  General  Assembly,  the  pro- 
posed law  shall  be  considered  by  the  Council  on 
Legislation,  which  shall  work  in  close  cooperation 
with  any  other  Society  committee  involved.  The 
instigating  committee  should  determine  the  con- 
tent of  the  law  and  the  Legislative  Council 
primarily  should  consider  relationship  of  the  pro- 
posed legislation  to  the  total  legislative  program. 

Mailing  List 

The  use  of  the  mailing  list  of  ISMS  members 
must  be  approved  by  special  action  of  the  Board 
of  Trustees. 

Medical  Care,  Provision  of 

Medical  care  shall  be  provided  regardless  of  the 
ability  of  the  patient  to  pay.  Physicians  shall  not 
refuse  to  render  needed  emergency  care  to  any 
patient. 

Medical  Representation  in  Government 
Planning 

In  health  programs  financed  by  government 
funding  in  an  Illinois  community,  there  shall  be 
representation  at  the  highest  policy  level  by  an 
official  representative  of  the  State  Society  and  the 


for  October,  1968 


403 


appropriate  county  medical  society  involved.  Re- 
muneration for  services  in  above  programs  shall 
follow  the  policies  of  the  Illinois  State  Medical 
Society. 

Membership  in  Paramedical  and 
Service  Organizations 

Membership  in  Chambers  of  Commerce  (city, 
state  and  national)  is  to  be  encouraged.  This  policy 
extends  to  the  individual  physician  as  well  as  to 
the  component  societies. 

Membership  in  the  Illinois  Association  of  the 
Professions  is  encouraged.  Medicine  should  be 
well  represented  among  these  allied  professional 
groups  and  the  growth  and  development  of  the  As- 
sociation is  of  concern  to  ISMS  economically,  po- 
litically and  scientifically. 

The  Society  recommends  that  physicians  affiliate 
with  service  clubs,  local  political  action  groups  and 
participate  to  the  fullest  extent  possible  in  affairs 
affecting  the  health  and  welfare  of  the  residents  of 
Illinois. 

Mental  Health 

Mental  health  planning  should  be  implemented 
at  the  community  level.  County  medical  societies 
should  be  kept  aware  of  their  responsibilities  to 
assist  in  developing  improved  mental  health  fa- 
cilities. 

A physician  licensed  to  practice  medicine  in  all 
its  branches  should  be  required  to  certify  the  dis- 
charge of  any  patient  from  a psychiatric  institu- 
tion. 

Occupational  Health 

Occupational  health  is  an  essential  ingredient  of 
employee  welfare.  The  adoption  and  development 
of  health  programs  in  industry  should  be  en- 
couraged. 

Occupational  health  will  be  advanced  through 
the  utilization  of  all  physicians  involved  in  indus- 
trial work. 

Osteopaths,  Association  with 

Voluntary  professional  associations  with  a Doc- 
tor of  Osteopathy  are  not  deemed  unethical  if 
the  Doctor  of  Osteopathy  bases  his  practice  on 
the  same  scientific  principles  as  those  adhered  to 
by  members  of  the  American  Medical  Association 
and  if  he  is  licensed  to  practice  medicine  and 
surgery  in  all  of  its  branches  in  Illinois. 

Placement  Service 

Before  the  Physicians’  Placement  Service  rec- 
ommends that  a town  in  Illinois  be  listed  as  need- 
ing a physician,  it  shall  be  established  that  the  need 
actually  exists;  that  the  community  can  support  a 
physician;  that  certain  physical  assets  (office — 
home — schools,  etc.)  are  available  for  the  physi- 
cian and  his  family. 

The  qualifications  of  the  physician  also  shall  be 
ascertained  prior  to  furnishing  him  with  the  list  of 
available  areas  in  Illinois  needing  a physician. 

Policy  Statements 

Policy  statements  shall  be  defined  as  guide 


lines  for  the  management  of  the  Illinois  State 
Medical  Society  affairs,  based  upon  prudence, 
sound  judgment  and  experience. 

Rules  and  regulations  may  be  prepared  by  the 
Board  of  Trustees  or  by  committees,  for  use  in 
the  implementation  of  policy. 

Polls,  Opinion 

The  vote  of  the  House  of  Delegates  shall  ex- 
press the  opinion  of  the  majority  of  the  Illinois 
State  Medical  Society  membership.  Since  delegates 
are  the  duly  elected  representatives  of  their  county 
medical  societies  and  their  voting  reflects  the 
thinking  of  their  constituents,  a majority  opinion 
HAS  BEEN  expressed,  and  a membership  poll 
becomes  unnecessary  except  under  very  exceptional 
conditions. 

Prepayment  Plans  and  Organizations 

It  is  not  within  the  province  of  ISMS  to  act  in 
other  than  an  advisory  capacity  when  working  with 
a “third  party  plan,”  and  its  best  efforts  should  be 
directed  toward  supplying  guidance,  education  and 
communications  between  the  membership  and  the 
prepayment  plans  and  organizations  involved. 

The  principle  of  free  enterprise  as  exemplified 
by  private  insurance  companies  and  the  “Blue” 
plans  is  to  be  endorsed. 

Press 

All  county  medical  societies  should  cooperate 
with  the  local  press.  The  public  should  be  pro- 
vided with  prompt  and  accurate  information  in  all 
health  fields;  the  source  of  this  information  should 
be  the  medical  profession. 

County  mxedical  societies  should  provide  infor- 
mation at  the  local  level;  the  State  Society  is 
responsible  for  press  releases  involving  State  So- 
ciety officers  or  any  official  statements  of  the 
Society  appearing  in  the  press. 

A code  of  ethics  applicable  to  medicine  and  the 
fourth  estate  should  be  developed.  (That  used  in 
the  Decatur  area  has  been  given  national  recogni- 
tion by  the  AMA.) 

Publication  of  Research  Data 

In  releasing  research  material  for  publication 
in  the  Illinois  Medical  Journal,  or  any  other 
media,  extreme  care  should  be  exercised.  The 
welfare  and  privacy  of  the  patient,  the  professional 
reputation  of  the  physician  should  be  of  primary 
concern. 

If  any  question  arises,  consultation  with  the 
Board  of  Trustees  is  suggested.  All  such  inquiries 
should  be  addressed  to  its  chairman. 

Public  Affairs 

No  officer  or  member  of  the  Board  of  Trustees 
should  be  permitted  (during  his  term  of  office)  to 
allow  his  name  as  an  officer  or  a member  of  the 
Board  to  be  used  in  lists  endorsing  candidates  for 
public  office.  Naturally  his  right  to  this  privilege 
as  a private  individual  is  not  affected. 


404 


Illinois  Medical  Journal 


Public  Aid 

The  “chain  of  command  and  procedure”  in  han- 
dling problems  arising  in  the  field  of  public  aid 
shall  be  from  the  county  to  the  state  society  ad- 
visory committee;  then  the  state  advisory  com- 
mittee shall  assimie  the  responsibihty  of  making 
the  medical  program  work  and  cooperating  with 
the  Illinois  Department  of  Public  Aid  to  maintain 
the  best  type  medical  care  for  the  recipients  of 
state  aid. 

The  fees  paid  by  the  state/federal  programs  to 
physicians  shall  be  based  upon  the  usual  and  cus- 
tomary fee  concept. 

An  extensive  program  of  education  should  be 
conducted  for  the  recipients  of  pubhc  aid.  This 
should  include  the  intelligent  handling  of  aU  mon- 
ies provided. 

Rehabilitation  of  aU  recipients  should  be  of  para- 
mount concern. 

Public  Safety 

Motor  vehicle  operators  should  be  licensed  on 
the  basis  of  the  appUcant’s  physical  and  mental 
capacity  to  operate  such  a vehicle  safely. 

Reference  Committee  Appointments 

Whenever  possible  at  least  two  members  shall 
be  retained  on  aU  reference  committees  for  the 
foUowing  year  in  order  to  effect  continuity  of  ex- 
perience. 

Reference  Service 

Physician  reference  service  shall  be  the  respon- 
sibility of  the  county  medical  society.  When  any 
such  request  is  received  at  the  state  society  office 
or  by  any  officer  of  the  ISMS,  it  shall  immediately 
be  referred  to  the  secretary  of  the  county  medical 
society  involved. 

Rehabilitation 

AU  physical  rehabUitation  activities  should  be 
prescribed  by  a physician  and  the  treatment  car- 
ried out  under  the  supervision  of  a physician. 

Medical  societies  should  render  assistance  to 
pubUc  and  private  agencies  regarding  rehabiUta- 
tion  faciUties  to  be  used  and  in  the  selection  of 
patients  for  these  services. 


Insurance  carriers  should  be  encouraged  to  in- 
clude rehabUitation  services  in  their  contracts. 

Relative  Value 

The  Relative  Value  Study  is  not  a fee  schedule 
and  is  to  be  used  for  information  only. 

No  co-efficient  shall  be  estabUshed  at  the  state 
level.  The  data  contained  in  the  study  may  be 
used  by  the  ISMS,  its  committees  or  by  any 
county  medical  society. 

The  study  should  be  revised  at  appropriate  in- 
tervals upon  the  recommendation  of  the  com- 
mittee with  the  approval  of  the  Board  of  Trus- 
tees. 

Upon  request,  copies  may  be  furnished  third 
party  purveyors  of  health  care  services. 

Stationery,  Use  of  Official 

No  officer,  trustee,  committee  chairman  or  staff 
director  is  to  use  the  official  stationery  of  the  Il- 
linois State  Medical  Society  for  personal  state- 
ments of  any  nature.  This  shall  pertain  especially 
to  the  endorsement  of  any  candidate  for  public  of- 
fice. 

Surveys 

The  IlUnois  State  Medical  Society  endorses  the 
principle  of  mass  surveys  and  encourages  the  use 
of  this  method  whenever  it  meets  with  the  ap- 
proval of  the  local  county  medical  society. 

Any  new  state  program  involving  more  than  one 
county  society  should  be  submitted  to  the  Board  of 
Trustees  for  im'tial  approval. 

Veterans  Administration 

It  is  our  belief  that  a Veterans  Administration 
hospital  should  admit  only  those  patients  with 
service-connected  disabilities,  except  in  those  in- 
stances where  the  veteran  is  financially  unable  to 
pay  for  his  medical  care  and  hospital  services,  as 
shown  by  a means  test. 

Woman's  Auxiliary 

Projects  in  which  the  Auxiliary  participates  shall 
be  approved  by  the  local  county  medical  society. 

Requests  for  cooperation  between  the  Auxiliary 
and  the  Illinois  State  Medical  Society  should  be 
channeled  through  the  Advisory  Committee  pro- 
vided by  the  Board  of  Trustees. 


for  October,  196S 


405 


INDEX  TO  POLICY  MANUAL 


Assessments  and/or  Dues  401 

Assessments,  Compulsory 400 

Athletic  Programs : 400 

Autonomy  of  County  Society  400 

Audits  and  Surveys  400 

Birth  Certificates  400 

Budgets  (see  “Financial  Policies”)  402 

Budget  Mailings  (See  “Financial  Policies”)  ....402 

Committee  Appointments  400 

Communicable  Diseases 401 

Community  Health  Week  401 

Conflict  of  Interest  401 

Constitution  and  Bylaws  401 

Continuing  Education  401 

Co-operation  with  the  AM  A 401 

Cultists,  Association  with  401 

Disaster  Control  401 

Discrimination  (See  “Freedom  of  Choice”) 401 

Dues,  Recommendation  to  the  House  401 

Education  401 

Ethics  401 

Examinations 401 

Facility  Medical  Boards  (Physicians)  401 

Federal  Funds 401 

Fee  Schedules  402 

Financial  Policies  402 

Financial  Records  (See  “Financial  Policies”)  ..402 

Freedom  of  Choice  402 

Government  Planning 

(See  “Medical  Representation”)  403 

Health  Care — Ancillary  Services 402 

Health  Care  Costs  402 

Health  Careers  402 

Hospitals  402 

Hospital  Assessments  (See  “Assessments”)  ....400 

Hospital  Audits  (See  “Audits  & Surveys”)  400 

Hospital  Committees  402 

Hospital  Records  402 


Hospital  Staff  Privileges  402 

House — Special  Meetings  of  402 

Immunization  Programs  403 

Indigent,  the  Care  of  the  403 

Individual  Rights  403 

Insurance  Plans 403 

Journal  Publication  403 

Laboratories 403 

Lay  Employees  and  Prerogatives  403 

Legal  Counsel  403 

Legislation  403 

Mailing  Lists  403 

Medical  Care,  Provision  of  403 

Medical  Representation  in  Government 

Planning  403 

Membership  in  Paramedical  & Service 

Organizations  404 

Mental  Health 404 

Nursing  Home  Audits  400 

Occupational  Health  404 

Osteopaths,  Association  with  404 

Placement  Service  404 

Policy  Statement — Preface  404 

Polls,  Opinion  404 

Prepayment  Plans  & Organizations  404 

Press 404 

Publication  of  Research  Data  404 

Public  Affairs  404 

Public  Aid  405 

Public  Safety  405 

Reference  Committee  Appointments  405 

Reference  Service  405 

Rehabilitation  405 

Relative  Value  405 

Stationery,  Use  of  Official  405 

Surveys  405 

Veterans  Administration  405 

Woman’s  Auxiliary  405 


40ti 


Illinois  Medical  Journal 


The  House  of  Delegates 

Officers 


President,  Philip  G.  Thomsen 

13826  Lincoln  Ave.,  Dolton  60419 
President-Elect,  Edward  W.  Cannady 
4601  State  St.,  E.  St.  Louis  62205 

Board  of  Trustees 


1st  District — Joseph  L.  Bordenave 

1665  South  St.,  Geneva  60134  1971 

2nd  District — Wm.  A.  McNichols,  Jr., 

101  W.  1st  St.,  Dixon  61021  1971 

3rd  District— Wm.  M.  Lees 


6518  N.  Nokomis,  Lincolnwood  60646  1971 
Frank  J.  Jirka 

1507  Keystone  Ave.,  River  Forest  60305  1971 


Wm.  E.  Adams 

55  E.  Erie  St.,  Chicago  60611  1970 

James  B.  Hartney 

410  Lake  St.,  Oak  Park  60302  1970 

Warren  W.  Young, 

10816  Parnell  Ave.,  Chicago  60628  ....1969 
J.  Ernest  Breed 

55  E.  Washington,  Chicago  60602  1969 

4th  District — Paul  P.  Youngberg 

1520  Seventh  St.,  Moline  61265  1970 

5th  District — Darrell  H.  Trumpe 

St.  John’s  Sanatorium,  Springfield  62707  1970 
6th  District — Mather  Pfeiffenberger 

State  & Wall  Sts.,  Alton  62002  1969 

7th  District — Arthur  F.  Goodyear 

142  E.  Prairie  Ave.,  Decatur  62523  1970 

8th  District— Wm.  H.  Schowengerdt 

301  E.  University  Ave.,  Champaign 

61820  1970 

9th  District — Charles  K.  Wells 

117  N.  10th  St.,  Mt.  Vernon  62864  1969 

10th  District — Willard  C.  Scrivner 

4601  State  St.,  E.  St.,  Louis  62205  1969 

1 1th  District — Joseph  R.  O’Donnell 

444  Park,  Glen  Ellyn  60137  1971 

Trustee-at-Large,  Newton  DuPuy 

1842  Grove  Ave.,  Quincy  62301  1969 

Past  Presidents 

Everett  P.  Coleman  1945-1946 

Newton  DuPuy 1967 

Harlan  English  1964 

Rolland  L.  Green  1937 

Edwin  S.  Hamilton  1962 

H.  Close  Hesseltine  1961 

James  H.  Hutton  1940 

Willis  I.  Lewis  1954 

George  F.  Lull  1963 

Burtis  E.  Montgomery  1966 

Edward  A.  Piszczek  1965 

Leo  P.  A.  Sweeney 1953 

Arkell  M.  Vaughn  1955 


Secretary-Treasurer,  Jacob  E.  Reisch 
1129  S.  2nd  St.,  Springfield  62704 
Speaker  of  the  House,  Maurice  M.  Hoeltgen 
1836  W.  87th  Street,  Chicago  60620 

Ex-Officio  Members 
Without  the  Right  to  Vote 

Past  Trustees 
Earl  H.  Blair 

Chicago,  Councilor  of  the  3rd  District 
Walter  C.  Bornemeier 

Chicago,  Councilor  of  the  3rd  District 
Carl  E.  Clark 

Sycamore,  Trustee  from  the  1st  District 
Willard  W.  Fullerton 

Sparta,  Trustee  from  the  10th  District 
George  E.  Giffin 

Princeton,  Trustee  from  the  2nd  District 
Lee  N.  Hamm 

Lincoln,  Trustee  from  the  5th  District 
George  A.  Hellmuth 

Chicago,  Councilor  from  the  3rd  District 
Bernard  Klein 

Joliet,  Trustee  from  the  11th  District 
Charles  O.  Lane 

West  Frankfort,  Councilor  from  the  9th  District 
Ted  LeBoy 

Chicago,  Trustee  from  the  3rd  District 
Warner  H.  Newcomb 

Jacksonville,  Councilor  from  the  6th  District 
Past  Speakers 

Walter  C.  Bornemeier,  Chicago  1961-1964 

Edward  W.  Cannady,  E.  St.  Louis  1964-1967 

General  Officers  of  the  AMA 
Walter  C.  Bornemeier 

Speaker  of  the  House  of  Delegates 
Burtis  E.  Montgomery 

Member  and  Chairman,  Board  of  Trustees 

Vice  Presidents  of  the  ISMS 

Casper  Epsteen,  First  Vice  President 

Carl  E.  Clark,  Second  Vice  President 

Vice  Speaker  of  the  ISMS  House  of  Delegates 

Paul  W.  Sunderland 

(Except  when  presiding  as  Speaker) 

Delegates  from  ISMS  to  the  AMA  House 

H.  Kenneth  Scatliff 

Walter  C.  Bornemeier 

Frank  H.  Fowler 

Arthur  F.  Goodyear 

Harlan  English 

Edward  W.  Cannady 

Maurice  M.  Hoeltgen 

Leo  P.  A.  Sweeney 

H.  Close  Hesseltine 

William  K.  Ford 

Jacob  E.  Reisch 


for  October,  1968 


407 


CHICAGO  MEDICAL  SOCIETY  DELEGATES  AND  ALTERNATES 


Anx  Plaines  Branch 

Delegates 
Joseph  C.  Sodaro 
Clair  M.  Carey 
John  S.  Hyde 
C.  Otis  Smith 
William  F.  Ashley 
Charles  J.  Weigel 

Arthur  G.  Lawrence 

Calumet  Branch 

Eugene  F.  Diamond 
Stanley  E.  Ruzich 
Robert  E.  Lee 

Douglas  Park  Branch 

John  D.  McCarthy 
Raymond  Nemecek 
Edward  A.  Razim 
Colman  J.  O’Neill 
L.  S.  Tichy 

Englewood  Branch 

Marcello  Gino 
Edward  Krol 
Frank  Kwinn 
Frank  Saletta 
Wm.  Nainis 

North  Suburban  Branch 

Howard  C.  Burkhead 
Harold  Lueth 
C.  Malcom  Rice,  Jr. 
John  L.  Savage 
William  Harridge 
Arnold  L.  Wagner 
William  G.  Cummings 
Frank  W.  Pirruccello 
Raymond  H.  Conley 
William  J.  FitzPatrick 

Irving  Park  Suburban 

George  C.  Turner 
Arthur  T.  Haebich 
Thomas  J.  Conley 
Alfred  J.  Faber 
George  Holmes 
Eugene  Broccolo 
David  Dale 
Eugene  Narsete 
Allen  Hrejsa 

Jackson  Park  Branch 

Wright  R.  Adams 
Andrew  J.  Brislen 
William  J.  Hand 
David  S.  Fox 
Loran  H.  Dill 
Charles  P.  McCartney 

408 


Alternate  Delegates 
Gustav  Hemwall 
Craig  D.  Butler 
George  Chobot 
Chester  Thrift 
Everett  Nicholas 
Michael  J.  Parent! 

A.  Everett  Joslyn,  Jr. 
Roland  Kowal 


Thaddeus  C.  Fial 
Paul  M.  Blackburn 
Nestor  S.  Martinez 


Gilbert  R.  DeMange 
Miles  Cermak 
Arthur  F.  Reimann 
Robert  F.  Cesafsky 
Paul  Zettas 


S.  Hamilton 
John  Krolikowski 
Jos.  Patka 
Kosme  Kapov 
John  Meyer 

Billy  D.  Reeves 
Willard  A.  Fry 
James  W.  Ford 
Arthur  R.  Crampton 
James  R.  Dillon 
Stanley  E.  Huff 
Harold  G.  Wedell 
Martin  M.  Fahey 
Jerome  T.  Paul 
John  W.  O’Donnell 


Justin  Fleischmann 
Frank  J.  Haufe 
Philip  H.  Heller 
Martin  P.  Meisenheimer 
Vincent  Sarley 
Sanford  Franzblau 
Kenneth  Maier 
H.  Paul  Carstens 
Alexander  Ruggie 


Julius  E.  Ginsberg 
Chester  C.  Guy 
Henrietta  Herbolsheimer 
Harry  L.  Hunter 
Daniel  J.  Pachman 
Myron  M.  Hipskind 


North  Shore  Branch 

Delegates 
George  H.  Irwin 
Burton  J.  Soboroff 
Clarence  A.  Norberg 
Chester  L.  Crean 
Philip  R.  McGuire 
Herschel  Browns 
Wm.  B.  Stromberg,  Sr. 
Willis  Diffenbaugh 
Joseph  H.  DeCaro 
William  O.  Ackley 
Philip  M.  Bedessem 

North  Side  Branch 
Michael  H.  Boley 
Roland  R.  Cross,  Jr. 
Samuel  L.  Andelman 
William  A.  Hutchison 
Coye  C.  Mason 
Vincent  C.  Freda 
Jack  Williams 
Erwin  M.  Patlak 
Clifton  L.  Reeder 
James  P.  Fitzgibbons 

Northwest  Branch 

Richard  V.  Kochanski 
N.  J.  Kupferberg 
Michael  J.  Kutza 
I.  P.  Lombardo 
Alfred  A.  Zanette 

South  Chicago  Branch 
John  M.  Coleman 
Casper  M.  Epsteen 
Morris  T.  Friedell 
Simon  Y.  Saltman 

South  Side  Branch 
Quentin  Young 
Robert  R.  Mustell 
Alfred  C.  Klinger 

Southern  Cook  County 
Cyril  Gallati 
Frederick  Weiss 
Robert  Van  Etten 

Stock  Yards  Branch 
Glenn  A.  Burckart 
Edwin  A.  Lukaszewski 

West  Side  Branch 
Eugene  T.  Hoban 
Anna  Marcus 

At-Large 

Ralph  E.  Dolkart 
Harold  A.  Sofield 
Noel  G.  Shaw 


Branch 


Alternates 
Rocco  V.  Lobraico 
Kenneth  Penhale 
Joseph  H.  Skom 

Robert  J.  Jensik 
Eugene  J.  Ranke 
John  B.  Murphy 
Samuel  T.  Gerber 
Frank  M.  Quinn 
David  T.  Petty 
George  C.  Markoutsas 

Joseph  Sherrick 
Daniel  Ruge 
Samuel  A.  Levinson 
Bernard  T.  Peele 
Vitold  R.  Silins 
Richard  Perritt 
Benjamin  F.  Lounsbury 
Gustav  L.  Kaufmann 
Joseph  Schifano 
Lydia  Nikurs 

M.  A.  Rydelski 

Alexander  Reynarowych 
J.  M.  Smialek 
Louis  A.  Wajay 


William  J.  Marshall,  Jr. 
Tibor  Czeisler 
Maynard  I.  Shapiro 
Arne  Schairer 

Jacob  M.  Epstein 
Maurice  Gleason 
Solomon  Green,  Jr. 

Branch 

Gerard  Gnade 
C.  R.  Heidenreich 
Hyman  Love 

Frank  J.  Nowak 
Joseph  M.  Ruda 


George  Rezek 
Louis  S.  Varzino 

Warren  W.  Young 
Francis  W.  Young 
Fred  A.  Tworoger 

Illinois  Medical  Journal 


DOWNSTATE  DELEGATES  AND  ALTERNATES 


County  Delegate  Alternate 
Adams  County — 6th  District 

Richard  R.  Cooper  Harold  Swanberg 

Alexander  County — 10th  District 

Howard  D.  Stuckey  Charles  L.  Yarbrough 
Bond  County — 7th  District 

Boyd  McCracken  Max  Fraenkel 

Boone  County — 1st  District 

John  H.  Steinkamp  M.  Paul  Dommers 

Bureau  County — 2nd  District 
W,  E.  Erkonen 

Carroll  County — 1st  District 

Lemuel  B.  Hussey  Wilhelm  Jawurek 

Cass-Brown  County — 6th  District 
B.  A.  DeSulis  James  J.  Hea 

Champaign  County — 8th  District 

Richard  E.  Schaede  Homer  Hindman,  Jr. 
Clarence  H.  Walton  H.  J.  Kolb 
Christian  County — 7th  District 

R.  B.  Siegert  R.  M.  Seaton 

Clark  County — 8th  District 
Eugene  P.  Johnson  George  T.  Mitchell 

Clay  County — 7th  District 
Lucius  Hutchens 
Clinton  County — 7th  District 
Wilson  L.  DuComb  Francis  H.  Ketterer 
CoLES-CuMBERLAND  CouNTY — 8th  District 
Joseph  R.  Mallory  Mack  W.  Hollowell 

Crawford  County— 8th  District 
Charles  N.  Salesman  John  W.  Long 
DeKalb  County — 1st  District 
John  W.  Ovitz  Gordon  C.  Graham 

DeWitt  County — 5th  District 


George  Castrovillo 


H.  L.  Meltzer 


Douglas  County — 8th  District 


Walter  G.  Steiner 


DuPage  County — 11th  District 


James  Taylor 


Morgan  Meyer 
James  P.  Campbell 
J.  P.  Schweitzer 
William  E.  Hill 


Arthur  P.  LeBeau 
F.  C.  Kuharich 
B.  L.  Rodkinson 
Ralph  Ryan 


Edgar  County — 8th  District 
J.  M.  Ingalls  Joseph  R.  Shackelford 

Edwards  County — 9th  District 

Andrew  Krajec  Paul  S.  Nierenberg 

Effingham  County — 7th  District 
P.  C.  Rumore  Henry  J.  Poterucha 

Fayette  County — 7th  District 

S.  W.  Moore  Mark  Greer 

Ford  County — 11th  District 
Ross  Hutchison 

Franklin  County — 9th  District 

D.  L.  Griffin  C.  E.  Ahlm 

Fulton  County — 4th  District 

Keith  H.  Frankhauser  Paul  D.  Reinertsen 

Gallatin  County — 9th  District 
John  E.  Doyle  Joseph  Bryant 

Greene  County — 6th  District 

Paul  A.  Dailey  Arthur  K.  Balwin 

Hancock  County — 4th  District 

Byron  I.  Mueller  C.  W.  Bruehsel 

Henderson  County — 4th  District 

Harold  Bock  Silvino  Lindo 

Henry-Stark  County — 4th  District 

Paul  M.  Schmidt  William  D.  Larson 

Iroquois  County— 11th  District 

R.  Kent  Swedlund  James  Dailey 


County  Delegate  Alternate 

Jackson  County — 10th  District 

Leo  J.  Brown  Robert  W.  Malony 

Jasper  County — 8th  District 

Don  L.  Hartrick  C.  O.  Absher 

Jefferson-Hamilton  County — 9th  District 
Donald  E.  Mitchell 
Jersey-Calhoun  County — 6th  District 
Bernard  Baalman  Samuel  L.  Miller 

JoDaviess  County — 1st  District 

C.  George  Ward  J.  Eric  Gustafson 

Johnson  County — 10th  District 

Kane  County — 1st  District 

Donald  Schleifer  John  Abell 

B.  F.  Shirer  J.  L.  Bordenave  , 

Wayne  N.  Leimbach  Richard  Powers 

Kankakee  County — 11th  District 

Dale  M.  Learned  H.  P.  Swartz 

Kendall  County — 11th  District 
W.  H.  Brill  Victor  Smith 

Knox  County — 4th  District 

J,  J.  Holland  H.  L.  Fleisher 

Lake  County — 1st  District 

Donald  C.  Nellins  Eugene  Pitts 

Charles  U.  Culmer  John  J.  Ring 

Earl  V.  Klaren  John  Andrews 

LaSalle  County — 2nd  District 
James  P.  Aplington 
Lawrence  County — 8th  District 

Tom  Kirkwood  Gilbert  Miller 

Lee  County — 2nd  District 
Wm.  A.  McNichols,  Jr. 

Livingston  County — 2nd  District 
Don  L.  Ervin 

Logan  County — 5th  District 

Glen  E.  Tomlinson  Wayne  J.  Schall 

McDonough  County — 4th  District 

Donald  H.  Dexter  V.  Burdette  Adams 

McHenry  County — 1st  District 
Wm.  J.  Marinis 
McLean  County— 5th  District 

L.  T.  Fruin  Paul  Theobald 

Macon  County — 7th  District 

Maurice  D.  Murfin  Carl  L.  Sandburg 

C.  Elliott  Bell  Clarence  Glenn 

Macoupin  County — 6th  District 

Joseph  J.  Grandone  William  W.  Lusk 
Madison  County — 6th  District 

E.  K.  DuVivier  James  Adams 

W.  W.  Bowers  Ben  Berman 

Marion  County — 7th  District 

Karl  Venters  Walter  P.  Plassman 

Mason  County — 5th  District 

Jack  Means  Dario  Landazuri 

Massac  County — 9th  District 
George  Green 

Menard  County — 5th  District 

Robert  Schafer  Barry  D.  Free 

Mercer  County — 4th  District 

M.  E.  Conway  Monty  P.  McClellan 

Monroe  County — 10th  District 

Joseph  A.  Werth  EdilbertoF.  Maglasang 

Montgomery  County — 5th  District 
Vincent  J.  Parlente 
Morgan  County — 6th  District 

Robert  R.  Hartman  Ernst  C.  Bone 


for  October,  1968 


409 


County  Delegate  Alternate 

Moultrie  County — 7th  District 
Ogle  County — 1st  District 

R.  W.  Zack  A.  R.  Bogue 

Peoria  County — 4th  District 
Wm.  O.  McQuiston  G.  W.  Giebelhausen 
Clarence  V.  Ward  H.  Sagent  Howard 

Fred  Z,  White  George  J.  Best 

Perry  County — 10th  District 

C.  E.  Cawvey  J.  B.  Stotlar 

Piatt  County — 7th  District 
A.  O.  Trimmer  W.  E.  Mundt 

Pike-Calhoun  County — 6th  District 

Myer  Shulman  James  E.  Goodman 

Pulaski  County — 10th  District 
A.  L.  Robinson 

Randolph  County — 10th  District 

O.  W.  Pflasterer  Louis  Mattingly 

Richland  County — 8th  District 

Charles  DeKovessey  William  A.  Moore 

Rock  Island  County — 4th  District 
C.  P.  Cunningham  John  C.  Rathe 

Theodore  Grevas  C.  S.  Costigan 

St.  Clair  County — 10th  District 
William  Walton  Lloyd  Walk 

Vivien  P.  Siegel  Harold  McCann 

Saline-Pope-Hardin  County — 9th  District 
John  Duffey  D.  A.  Lehman 

Sangamon  County — 5th  District 
C.  C.  Maher,  Jr.  Ross  Schlich 

Preston  V.  Dilts  Floyd  S.  Barringer 

A.  R.  Eveloff  Earl  W.  Donelan 

Schuyler  County — 4th  District 

Henry  C.  Zingher  Rosemary  Utter 

Shelby  County — 7th  District 

Richard  Larson  Otto  G.  Kauder 


County  Delegate  Alternate 
Stephenson  County — 1st  District 

T.  A.  Haymond  Eugene  Vickery 

Tazewell  County — 5th  District 
Rudolph  A.  Helden  Adam  Slaw 
Union  County — 10th  District 
William  H.  Whiting 
Vermilion  County — 8th  District 

E.  G.  Andracki  T.  E.  Pollard 

Wabash  County — 9th  District 

Roger  L.  Fuller  R.  A.  Richey 

Warren  County — 4th  District 

Richard  Icenogle  Russell  Jensen 

Washington  County — 10th  District 
Jerry  L.  Beguelin 
Wayne  County — 9th  District 

Charles  J.  Jannings  Edward  S.  Talaga 
White  County — 9th  District 

P.  D.  Boren  J.  A.  Stricklin 

Whiteside  County — 2nd  District 
Clarence  J.  Mueller 
Will-Grundy  County — 11th  District 

Robert  J.  Becker  James  H.  Lambert 

Bruce  J.  Wallin  Franklin  K.  Bowser 

Barry  S.  Seng  F.  Roger  Fahrner 

Williamson  County — 9th  District 
Herbert  V.  Fine 

Winnebago  County — 1st  District 

L.  P.  Johnson  Robert  E.  Heerens 

F.  A.  Munsey  F.  H.  Riordan,  III 

Harold  E.  Zenisek  E.  T.  Leonard,  Jr. 
H.  E.  LaPlante 

Woodford  County — 2nd  District 
R.  J.  Davies  J.  C.  Phifer 


OFFICERS  OF  COUNTY  MEDICAL  SOCIETIES 

1968 


Adams  County 

President:  George  Borden 

1101  Maine  St.,  Quincy  62301 
Secretary:  Ralph  F.  Davis 
WCU  Bldg.,’ Quincy  62301 
Members:  77 — District  No.  6 
Alexander  County 

President:  Howard  Stuckey 
312  Eighth  St.,  Cairo  62914 
Secretary:  Charles  L.  Yarbrough 

800 Vi  Commercial  Ave.,  Cairo  62914 
Members:  6 — District  No.  10 
Bond  County 

President:  M.  Kenneth  Kaufmann 

105  E.  College  Ave.,  Greenville  62246 
Secretary:  Charles  R.  Daisy 

308  West  College,  Greenville  62246 
Members:  6 — District  No.  7 
Boone  County 

President:  Adrian  Schreiber 
Caledonia  61011 
Secretary:  Earl  S.  Davis 

119  S.  State  St.,  Belvidere  61008 
Members:  17 — District  No.  1 


Bureau  County 

President:  W.  E.  Erkonen 

101  Park  Ave.,  East,  Princeton  61356 
Secretary:  Karl  D.  Nelson 

101  Park  Ave.,  East,  Princeton  61356 
Members:  31 — District  No.  2 

Carroll  County 

President:  B.  V.  Gunnarson 

333  Chicago  Ave.,  Savanna  61074 
Secretary:  T.  Maciejczyk 

Box  446,  Milledgeville  61051 
Members:  8 — District  No.  1 

Cass  County 

President:  Robert  A.  Spencer, 

Beardstown  62618 

Secretary:  Arthur  G.  Hyde,  Beardstown  62618 
Members:  9 — District  No.  6 

Champaign  County 

President:  George  Miller 

602  W.  University,  Urbana  61801 
Secretary:  H.  E.  Wachter 

104  W.  Clark,  Champaign  61820 
Members:  168 — District  No.  8 


410 


Illinois  Medical  Journal 


Chicago  Medical  Society 
President:  Ralph  E.  Dolkart 

310  S.  Michigan  Ave.,  Chicago  60604 
President-Elect:  Fred  A.  Tworoger 

310  S.  Michigan  Ave.,  Chicago  60604 
Secretary:  Andrew  J.  Brislen 

310  S.  Michigan  Ave.,  Chicago  60604 
Treasurer:  H.  Kenneth  Scatliff 

310  S.  Michigan  Ave.,  Chicago  60604 
Executive  Administrator:  George  F.  Lull 
310  S.  Michigan  Ave.,  Chicago  60604 
Members:  6,419 — District  No.  3 

Branch  Officers 

Aiix  Plaines  Branch 

President:  William  F.  Ashley 
720  Lake  St.,  Oak  Park  60301 
Secretary:  Chester  B.  Thrift 

507  N.  Ridgeland  Ave.  Oak.  Park  60302 

Calumet  Branch 

President:  John  H.  Uhrich 

7939  S.  Western  Ave.,  Chicago  60620 
Secretary:  Thomas  G.  Gorman 

10644  E.  Western  Ave.,  Chicago  60643 

Douglas  Park  Branch 

President:  Arthur  F.  Reimann 

3237  S.  Oak  Park  Ave.,  Berwyn  60402 
Secretary:  Charles  W.  DeBaun 

5639  S.  Catherine,  LaGrange  60525 

Englewood  Branch 

President:  Michael  E.  Carroll 

2800  W.  87th  St.,  Chicago  60652 
Secretary:  George  A.  Delong 

4301  W.  95th  St.,  Oak  Lawn  60453 

North  Suburban  Branch 
President:  Robert  P.  Hohf 

2500  Ridge  Ave.,  Evanston  60201 
Secy.-Treas.:  Lawrence  J.  Lawson,  Jr. 
636  Church  St.,  Evanston  60203 

Irving  Park  Suburban  Branch 
President:  Frank  J.  Haufe 
4500  Oakton,  Skokie  60076 
Secretary:  Philip  H.  Heller 

1173  Algonquin  Rd.,  Des  Plaines 
60016 

Jackson  Park  Branch 

President:  Lester  D.  O’Dell 

11139  S.  Halsted  St.,  Chicago  60628 
Secy.-Treas.:  Jean  A.  Spencer 

6060  S.  Drexel  Blvd.,  Chicago  60637 

North  Shore  Branch 

President:  Clarence  A.  Norberg 
2155  N.  Cleveland  Ave.,  Chicago 
60614 

Secretary:  Rocco  V.  Lobraico 

30  N.  Michigan  Ave.,  Chicago  60602 

North  Side  Branch 

President:  Irving  D.  Thrasher 

1150  N.  State  St.,  Chicago  60610 
Secy.-Treas.:  Clifton  L.  Reeder 

310  S.  Michigan  Ave.,  Chicago  60604 


Northwest  Branch 

President:  C.  L.  Jakubowski 

1530  N.  Damen  Ave.,  Chicago  60622 
Secy.-Treas.:  E.  J.  Kotanyi 

1174  N.  Milwaukee  Ave.,  Chicago 
60622 

South  Chicago  Branch 

President:  Morris  T.  Friedell 

7531  S.  Stony  Island  Ave.,  Chicago 
60649 

Secy.-Treas.:  Jere  Friedheim 
2015  E.  79th  St.,  Chicago  60649 
South  Side  Branch 

President:  Vernon  R.  DeYoung 

2851  South  Parkway,  Chicago  60616 
Secretary:  Donald  L.  Chatman 
8540  S.  University  Ave.,  Chicago  60619 
Southern  Cook  County  Branch 
President:  Laszlo  Koos 

13000  Maple  Ave.,  Blue  Island  60406 
Secy.-Treas.:  John  E.  Driscoll 

18109  Dixie  Hwy.,  Homewood  60430 
Stock  Yards  Branch 

President:  Glenn  A.  Burckart 
11110  S.  Sawyer,  Chicago  60655 
Secy.-Treas.:  Edwin  J.  Lukaszewski 
1213  W.  51st  St.,  Chicago  60609 
West  Side  Branch 

President:  Eugene  T.  Hoban 

6429  W.  North  Ave.,  Oak  Park  60302 
Secy.-Treas.:  Anna  A.  Marcus 

5852  W.  North  Ave.,  Chicago  60639 
Christian  County 

President:  F.  W.  Siegert 
217  Locust  St.,  Pana  62557 
Secretary:  J.  W.  Murphy 

301  S.  Webster  St.,  Taylorville  62568 
Members:  19 — District  No.  7 
Clark  County 

President:  Eugene  P.  Johnson,  Casey  62410 
Secretary:  Charles  C.  Moore,  Jr. 

Martinville  Clinic,  Martinville  62442 
Members:  6 — District  No.  8 
Clay  County 

President:  William  T.  Kamp 
433  E.  7th  St.,  Flora  62839 
Secretary:  Donald  L.  Bunnell 
433  E.  7th  St.,  Flora  62839 
Members:  8 — District  No.  7 
Clinton  County 

President:  W.  R.  Ketterer 
289  Main  St.,  Breese  62230 
Secretary:  J.  Roger  Sosa 

Munster  St.,  German  Town  62245 
Members:  11 — District  No.  7 

COLES-CUMBERLAND  CoUNTY 

President:  Charles  E.  Ramsey 

Midwest  Prof.  Bldg.,  Charleston  61920 
Secretary:  G.  D.  Wright 

1517  University  Ave.,  Charleston  61920 
Members:  39 — District  No.  8 


41  [ 


loi  Odober,  1968 


Crawford  County 

President:  Charles  Salesman 
1201  N.  Allen,  Robinson  62454 
Secretary:  W.  B.  Schmidt 

306  S.  Cross,  Robinson  62454 
Members:  14 — District  No.  8 

De  Kalb  County 

President:  Thomas  deGraffenried 

DeVal  Shopping  Center,  De  Kalb  60115 
Secretary:  Frank  E,  Luedtke 
232  Second  St.,  De  Kalb  60115 
Members:  47 — District  No.  1 
De  Witt  County 

President:  John  W.  Veirs 
219  E.  Main,  Clinton  61727 
Secretary:  Charles  Ramey 
215  E.  Main,  Clinton  61727 
Members:  11 — District  No.  5 
Douglas  County 

President:  James  Taylor 

102  N.  Main,  Villa  Grove  61956 
Secretary:  Elmer  Allen 

120  S.  Locust,  Areola  61910 
Members:  13 — District  No.  8 
Du  Page  County 

President:  William  E.  Hill 

201  W.  Union  St.,  Wheaton  60187 
Secretary:  Charles  A.  Lang 

646  Roosevelt  Rd.,  Glen  Ellyn  60137 
Executive  Secretary:  Lillian  Widmer 
646  Roosevelt  Rd.,  Glen  Ellyn  60137 
Members:  339 — District  No,  11 
Edgar  County 

President:  C.  A.  McClelland 
502  Shaw  Ave.,  Paris  61944 
Secretary:  J.  M.  Ingalls 

502  Shaw  Ave.,  Paris  61944 
Members:  16 — District  No.  8 
Edwards  County 

President:  Paul  S.  Neirenberg 
7 W.  Main  St.,  Albion  62806 
Secretary:  Andrew  Krajec 
Box  336,  West  Salem  62476 
Members:  2 — District  No.  9 
Effingham  County 
President:  H.  F.  Webb 

300  N.  Maple,  Effingham  62401 
Secretary:  Nicholas  Beck 

300  Millsprings,  Greenup  62428 
Members:  24 — District  No.  7 
Fayette  County 

President:  J,  H.  Weiner 

5031/2  Gallatin,  Vandalia  62471 
Secretary:  E.  A.  Kuehn 

Greer  Bldg.,  Vandalia  62471 
Members:  9 — District  No.  7 
Ford  County 

President:  Clyde  Rulison,  Roberts  60962 
Secretary:  William  Garrett,  Sibley  61773 
Members:  12 — District  No.  11 


Franklin  County 

President:  C.  H.  William 

108  N.  Benton  Rd.,  W.  Frankfort  62896 
Secretary:  D.  L.  Griffin 

R.  D.  No.  1,  W.  Frankfort  62896 
Members:  22 — District  No.  9 

Fulton  County 

President:  Julius  Manber 

Graham  Hospital,  Canton  61520 
Secretary:  O.  M.  Wood,  Ipava  61441 
Members:  26 — District  No.  4 

Gallatin  County 

President:  Joe  Bryant,  Ridgway  62979 
Secretary:  John  Doyle,  Ridgway  62979 
Members:  3 — District  No.  9 

Greene  County 

President:  Jude  A.  Castelton 

419  N.  Main  St.,  Carrollton  62016 
Secretary:  A.  K.  Baldwin 

229  N.  Fifth  St.,  Carrollton  62016 
Members:  10 — District  No.  6 

Hancock  County 

President:  Irving  Burnell 

861  S.  State  St.,  Augusta  62311 
Secretary:  Use  Erika  Bruehsel,  Warsaw  62379 
Members:  10 — District  No.  4 

Henderson  County 

President:  Elmer  Swann,  Oquawka  61469 
Secretary:  Harold  L.  Bock,  Stronghurst  61480 
Members:  3 — District  No.  4 

Henry-Stark  County 

President:  Andrew  E.  Skladany 
1202  Fourth  St.,  Orion  61273 
Secretary:  Fred  V.  Colby 

213  W.  First  St.,  Geneseo  61254 
Members:  34— District  No.  4 

Iroquois  County 
President:  R.  K.  Swedlund 

112  N.  Fourth  St.,  Watseka  60970 
Secretary:  C.  L.  Clark,  Sheldon  60966 
Members:  19 — District  No.  11 

Jackson  County 
President:  O.  Ballesteros 

215  N.  14th  St.,  Murphysboro  62966 
Secretary:  Homer  H.  Hanson 
404  W.  Main,  Carbondale  62901 
Members:  52 — District  No.  10 

Jasper  County 

President:  Don  Hartrich 
Box  192,  Newton  62448 
Secretary:  C.  O.  Absher,  Newton  62448 
Members:  4 — District  No.  8 

Jefferson-Hamilton  County 
President:  Morris  Zelman 

117  N.  10th,  Mt.  Vernon  62864 
Secretary:  H.  Goff  Thompson,  Jr. 

320  N.  9th  St.,  Mt.  Vernon  62864 
Members:  23 — District  No.  9 


412 


Illinois  Medical  Journal 


Jersey-Calhoun  County 
President:  Clyde  L.  Wieland 

300  S.  Washington,  Jerseyville  62052 
Secretary:  Victor  Oberheu 

306  S.  Washington  St.,  Jerseyville  62052 
Members:  9 — District  No.  6 
Jo  Daviess  County 

President:  David  Hockman 
300  Summit  St.,  Galena  61036 
Secretary:  William  G.  Gillies 
300  Summit  St.,  Galena  61036 
Members:  8 — District  No.  1 
Kane  County 
President:  John  M.  Abell 

1870  W.  Galena  Blvd.,  Aurora  60506 
Secretary:  A.  G.  Baxter 

34  N.  Water  St.,  Batavia  60510 
Corresponding  Secretary:  Elsa  Carlson 
17  N.  Sixth  St.,  Geneva  60134 
Members:  264 — District  No.  1 
Kankakee  County 
President:  James  H.  Ryan 

1309  E.  Court  St.,  Kankakee  60901 
Secretary:  Herbert  P.  Swartz 

450  Kennedy  Dr.,  Kankakee  60901 
Members:  93 — District  No.  11 
Kendall  County 
President:  John  P.  Cullinan 
Main  St.,  Oswego  60543 
Secretary:  Joseph  L.  Daw 

985  Lindenwood  Dr.,  Montgomery  60538 
Members:  9 — District  No.  11 
Knox  County 
President:  E.  A.  Crowell 

311  E.  Main  St.,  Galesburg  61401 
Secretary:  Walter  J.  Zich 
St.  Mary’s  Hospital,  Galesburg  61401 
Members:  73 — ^District  No.  4 
Lake  County 

President:  Herman  B.  Lustigman 

303  Waukegan  Ave.,  Highwood  60040 
Secretary:  Ralph  Elson 

700  iSeerfield,  Deerfield  60015  - 
Executive  Secretary:  Mrs.  Julie  P.  Schulz 
P.O.  Box  148,  Gurnee  60031 
Members:  265 — District  No.  1 
La  Salle  County 
President:  William  E.  Ehling 

712  N.  Bloomington,  Streator  61364 
Secretary:  Allan  L.  Goslin 

1005  N.  Park  St.,  Streator  61364 
Members:  117 — District  No.  2 
Lawrence  County 
President:  Roger  T.  Kirkwood 

Kensler  Bldg.,  Lawrenceville  62439 
Secretary:  Gilbert  Miller 

Kensler  Bldg.,  Lawrenceville  62439 
Executive  Secretary:  Ruth  E.  Gariepy 

Lawrence  City  Mem.  Hospital,  Lawrenceville 
62439 

Members:  11 — District  No.  8 


Lee  County 

President:  Donald  Edwards 
821  S.  Peoria  St.,  Dixon  61021 
Secretary:  George  Silvest 

114  E.  Everett  Ave.,  Dixon  61021 
Members:  20 — District  No.  2 
Livingston  County 

President:  Andrew  McGee 

717  N.  Main  St.,  Pontiac  61764 
Secretary:  Dean  G.  Peterson 

204  N.  Locust  St.,  Pontiac  61764 
Members:  30 — District  No.  2 
Logan  County 
President:  Edward  A.  Ulrich 
Forrest  Hills,  Lincoln  62656 
Secretary:  Glen  E.  Tomlinson 

4 Lincoln  Prof.  Park,  Lincoln  62656 
Members:  29 — District  No.  5 
Macon  County 
President:  Hubert  C.  Magill 

1170  E.  Riverside,  Decatur  62521 
Secretary:  Paul  Reeder 

2113  N.  Edward,  Decatur  62526 
Executive  Secretary:  Mary  J.  Bretz 

1800  E.  Lake  Shore  Dr.,  Decatur  62521 
Members:  149 — District  No.  7 
Macoupin  County 
President:  W.  W.  Lusk 

224  E.  Main  St.,  Carlinville  62626 
Secretary:  J.  J.  Grandone 

109  W.  Pine,  Gillespie  62033 
Members:  27 — District  No.  6 
Madison  County 
President:  H.  A.  Mittleman 

304  St.  Louis  Ave.,  East  Alton  62832 
Secretary:  Leo  R.  Green 

1114  Milton  Rd.,  Alton  62002 
Members:  133 — District  No.  6 
Marion  County 
President:  Harold  E.  Snow 

418  S.  Popular  St.,  Centralia  62801 
Secretary:  Walter  Plassman 
Box  552,  Centralia  62801 
Members:  35 — District  No.  7 
Mason  County 
President:  Dario  Landazuri 

125  N.  Orange  St.,  Havana  62644 
Secretary:  Henry  W.  Maxfield,  Mason  City  62664 
Members:  14 — District  No.  5 
Massac  County 
President:  E.  Yap 

510  W.  10th  St.,  Metropolis  62960 
Secretary:  Virgil  O.  Decker 

105V^  E.  5th  St.,  Metropolis  62960 
Members:  9 — District  No.  9 
McDonough  County 
President:  V.  B.  Adams 

301  E.  Jefferson  St.,  Macomb  61455 
Secretary:  J.  L.  Symmonds 

301  E.  Jefferson  St.,  Macomb  61455 
Members:  20 — District  No.  4 


for  October,  1968 


413 


McHenry  County 

President:  Peter  Griesbach 

1110  N.  Green  St.,  McHenry  60050 
Secretary:  V.  B.  Petralia 

210  Northwest  Highway,  Fox  River  60021 
Executive  Secretary:  Evelyn  Rosulek 
308  Kimball  Ave.,  Woodstock  60098 
Members:  57 — District  No.  1 

McLean  County 

President:  George  W.  France 
429  N.  Main  St.,  Bloomington  61701 
Secretary:  Preston  Houk 
429  N.  Main  St.,  Bloomington  61701 
Executive  Secretary:  David  W.  Meister 
429  N.  Main  St.,  Bloomington  61701 
Members:  87 — District  No.  5 

Menard  County 

President:  Robert  Schafer 

116  N.  5th  St.,  Petersburg  62675 
Secretary:  H.  K.  Moulton 

119  N.  7th  St.,  Petersburg  62675 
Members:  4 — District  No.  5 

Mercer  County 

President:  Wilbur  A.  Miller 

109  N.  College  Ave.,  Aledo  61231 
Secretary:  James  W.  Hastings 
209  S.  College  Ave.,  Aledo  61231 
Members:  6 — District  No.  4 

Monroe  County 
President:  Otto  Kremer 
854  W.  Bottom,  Colmnbia  62236 
Secretary:  Edilberto  F.  Maglasang 
911  Briegel,  Columbia  62236 
Members:  9 — District  No.  10 

Montgomery  County 
President:  Rudolf  Sommer 

515  N.  Monroe  St.,  Litchfield  62056 
Secretary:  Vincent  J.  Parlente 
302  S.  Main  St.,  Hillsboro  62049 
Members:  16 — District  No.  5 

Morgan  County 
President:  Joseph  J.  Kozma 

1440  W.  Walnut,  Jacksonville  62650 
Secretary:  Robert  H.  Kooiker 

801  Lincoln  Ave.,  Jacksonville  62650 
Members:  44 — ^District  No.  6 

Moultrie  County 

President:  H.  E.  Kendall,  Sullivan  61951 
Secretary:  Dean  McLaughlin,  Sullivan  61951 
Members:  7 — District  No.  7 

Ogle  County 

President:  Warren  Duane  Dodd 
226  Blackhawk  Dr.,  Byron  61010 
Secretary:  Roger  Hofmeister 

102  Kable  Sq.,  Mt.  Morris  61054 
Members:  27 — District  No.  1 


Peoria  County 

President:  Charles  G.  Farnum 

427  First  Natl.  Bank  Bldg.,  Peoria  61602 
Secretary:  Paul  R.  Dirkse 

427  First  Nat’l.  Bank  Bldg.,  Peoria  61602 
Executive  Secretary:  David  W.  Meister 
427  First  Nat’l.  Bank  Bldg.,  Peoria  61602 
Members:  250 — District  No.  4 
Perry  County 

President:  George  D.  Mohr 

206  N.  Main,  Pickneyville  62274 
Secretary:  James  B.  Stotlar 

15  N.  Walnut  St.,  Pickneyville  62274 
Members:  22 — District  No.  10 
Piatt  County 

President:  George  Green 

340  N.  State  St.,  Monticello  61856 
Secretary:  Joseph  Allman 

121  N.  State  St.,  Monticello  61856 
Members:  8 — District  No.  7 
Pike  County 

President:  C.  B.  Lara 

326  W.  Washington,  Pittsfield  62363 
Secretary:  Thomas  C.  Bunting 

321  W.  Washington,  Pittsfield  62363 
Members:  9 — District  No.  6 
Pulaski  County 

President:  James  Conger,  Mounds  62964 
Secretary:  Alphonso  Robinson,  Mounds  62964 
Members:  2 — District  No.  10 
Randolph  County 
President:  V.  S.  Katty 

307  E.  Broadway,  Steeleville  62288 
Secretary:  C.  S.  Schlageter 
101  N.  Market,  Sparta  62286 
Members:  18 — District  No.  10 
Richland  County 
President:  James  Landis 
426  Whittle,  Olney  62450 
Secretary:  John  Spangler 

600  E.  Main  St.,  Olney  62450 
Members:  25 — District  No.  8 
Rock  Island  County 
President:  C.  P.  O’Neill 

1740  Ninth  Ave.,  Rock  Island  61201 
Secretary:  B.  H.  Shevick 
729  3rd  Ave.,  Moline  61265 
Members:  148 — District  No.  4 
St.  Clair  County 

President:  William  Knaus 

4825  Main  St.,  Belleville  62223 
Secretary:  Charles  Frazer 

4825  W.  Main  St.,  Belleville  62223 
Executive  Secretary:  Joe  Gasparich 
4825  W.  Main  St.,  Belleville  62223 
Members:  173 — District  No.  10 
Saline-Pope-Hardin  County 

President:  John  R.  Duffey,  Roseclare  62982 
Secretary:  William  R.  Durham 
203  N.  Vine  St.,  Harrisburg  62946 
Members:  21 — District  No.  9 


414 


Illinois  Medical  Journal 


Sangamon  County 

President:  Patrick  Me  Vary 

1218  S.  7th  St.,  Springfield  62703 
Secretary:  David  B.  Lewis 

Memorial  Hospital,  Springfield  62701 
Members:  215 — District  No.  5 

Schuyler  County 

President:  Rosemary  Utter 

513  W.  Clinton,  Rushville  62681 
Secretary:  Henry  C.  Zingher 

Rushville  Clinic,  Rushville  62681 
Members:  5 — District  No.  4 

Shelby  County 

President:  Otto  G.  Kauder,  Findlay  62534 
Secretary:  Smith  D.  Taylor 

520  Penns.  Ave.,  Windsor  61957 
Members:  9 — District  No.  7 

Stephenson  County 

President : Thomas  A.  Haymond 
222  W.  Exchange,  Freeport  61032 
Secretary:  F.  C.  Tucker 

420  S.  Harlem  Ave.,  Freeport  61032 
Members:  20 — District  No.  1 

Tazewell  County 

President:  Robert  G.  Rhoades 

427  First  Nat’l.  Bank  Bldg.,  Peoria  61602 
Secretary  : Erik  Maran 

427  First  Nat’l  Bank  Bldg.,  Peoria  61602 
Executive  Secretary : David  W.  Meister 
427  First  Nat’l.  Bank  Bldg.,  Peoria  61602 
Members:  44 — District  No.  5 

Union  County 

President:  William  H.  Whiting 
Box  410,  Anna  62906 
Secretary:  William  H.  Whiting 
Box  410,  Anna  62906 
Members:  8 — District  No.  10 

Vermilion  County 
President:  E.  M.  Laury 

605  N.  Logan,  Danville  61832 
Secretary:  L.  W.  Tanner 

7 N.  Virginia,  Danville  61832 
Members:  85 — District  No.  8 

Wabash  County 

President:  R.  A.  Richey,  Grayville  62844 
Secretary:  C.  L.  Johns 

114  W.  Fifth,  Mt.  Carmel  62863 
Members:  8 — District  No.  9 

Warren  County 

President:  Joseph  Simmons,  Kirkwood  61447 
Secretary:  Glen  Chamberlin 
219  E.  Euclid,  Monmouth  61462 
Members:  12 — District  No.  4 

Washington  County 
President:  Charles  W.  Longwell 
121  E.  Elm  St.,  Nashville  62263 
Secretary:  W.  P.  Lesko 

111  N.  Mill,  Nashville  62263 
Members:  4 — District  No.  10 


Wayne  County 
President:  D.  A.  Gershenson 
308  E.  Main,  Fairfield  62837 
Secretary:  C.  J.  Jannings 

101  E.  Center  St.,  Fairfield  62837 
Members:  6 — ^District  No.  9 

White  County 

President:  P.  D.  Boren 

507  W.  Main  St.,  Carmi  62821 
Secretary:  J.  G.  Harrell,  Carmi  62821 
Members:  7 — District  No.  9 

Whiteside  County 

President:  Edgar  Picken 

101  E.  Miller  Rd.,  Sterling  61081 
Secretary:  Saul  Parks 

1601  First  Ave.,  Sterling  61080 
Members:  43 — District  No.  2 

Will-  Grundy  County 
President:  John  H.  Kendall 
333  N.  Madison,  Joliet  60435 
Secretary:  Richard  A.  Tarizzo 

2112  W.  Jefferson  #246,  Joilet  60435 
Executive  Director:  vacant 
Members:  183 — District  No.  11 

Williamson  County 
President:  James  Felts 

517  Bainbridge  Rd.,  Marion  62959 
Secretary:  Herbert  V.  Fine 

110  N.  Division,  Carterville  62918 
Members:  26 — District  No.  9 

Winnebago  County 

President : Harold  E.  Zenisek 
6670  E.  State,  Rockford  61108 
Secretary : Robert  A.  Behmer 

2500  N.  Rockton  Ave.,  Rockford  61103 
Executive  Administrator:  Donald  A.  Westbrook 
310  N.  Wyman  St.,  Rockford  61101 
Members:  268 — District  No.  1 

Woodford  County 
President:  K.  Vaicius 

511  Oak  St.,  Minonk  61760 
Secretary:  Victor  Jay 

601  N.  Jefferson,  Washburn  61570 
Members:  10 — District  No.  2 

No  Organized  County  Socie  fy 
Brown 
Johnson 
Marshall 
Putnam 
Scott 

Joint  County  Societies 
Coles-Cumberland 
Henry-Stark 
J ef  f erson-Hamilton 
Jersey-Calhoun 
Saline-Pope-Hard  i n 
Will-Grundy 


for  October,  1968 


415 


Wisconsin 


MARIOff 


lERMILLION 

Indiana 


Missouri 


STE.  GENEVIEVE 


TRUSTEE 

DISTRICTS 


CRinCNDCN 

scoTtm  ^ Kentucky 


416 


Illinois  Medical  Journal 


TRUSTEE  DISTRICT  COMMITTEES 


First  District 

Joseph  L.  Bordenave,  Geneva,  Trustee 
Counties  of  Boone,  Carroll,  DeKalb,  Jo  Daviess, 
Kane,  Lake,  McHenry,  Ogle,  Stephenson,  Winne- 
bago 

Ethical  Relations  Committee  Term  Expires 


John  H.  Steinkamp,  Belvidere,  Chairman  1969 

Benjamin  F.  Shirer,  Batavia  1970 

John  W.  Ovitz  Jr.,  Sycamore 1971 

E.  J.  McKinney,  Rockford  1969 

Grievance  Committee 

Russell  Zack,  Rochelle,  Chairman  1970 

M.  Mijanovich,  Marengo 1971 

A.  K.  Matthews,  Rockford  1969 

Walter  J.  Reedy,  Waukegan 1969 

Prepayment  Plans  & Organizations 
Kenneth  L.  Morris,  Waukegan,  Chairman  ....  1969 

Delbert  O.  Williams,  Jr.,  Stockton  1971 

Jerald  A.  Bowman,  Rockford  1971 

Rodney  Nelson,  Geneva  1969 

Erwin  A.  Schilling,  Rockford  1969 

R.  E.  Whitsitt,  Rockford  1969 

John  E.  Madden,  Freeport  1970 


Second  District 

William  A.  McNichols,  Jr.,  Dixon,  Trustee 
Counties  of  Bureau,  LaSalle,  Lee,  Livingston, 
Marshall,  Putnam,  Whiteside,  Woodford 


Ethical  Relations  Committee 

K.  Dexter  Nelson,  Princeton,  Chairman 1971 

Ralph  Bailey,  Ottawa  1969 

Tim  Sullivan,  Sterling  1970 

Grievance  Committee 

K.  M.  Nelson,  Princeton,  Chairman  1969 

Francis  J.  Brennan,  Utica 1970 

Edward  Murphy,  Dixon  1971 

Philip  Terry,  Kewanee 1970 

Prepayment  Plans  & Organizations 

M.  D.  Burnstine,  Sterling,  Chairman  1970 

Wm.  Ehling,  Streator  1971 

Joseph  Phifer,  Eureka  1969 


Third  District 

William  E.  Adams,  Chicago,  Trustee 
J.  Ernest  Breed,  Chicago,  Trustee 
James  B.  Hartney,  Oak  Park,  Trustee 
Frank  J.  Jirka,  Jr.,  River  Forest,  Trustee 
William  M.  Lees,  Lincolnwood,  Trustee 
Warren  W.  Young,  Chicago,  Trustee 
No  district  committees  are  appointed. 

Fourth  District 

Paul  P.  Youngberg,  Moline,  Trustee 
Counties  of  Fulton,  Hancock,  Henderson,  Henry, 
Knox,  McDonough,  Mercer,  Peoria,  Rock  Is- 
land, Schuyler,  Stark,  Warren 


Term 

Ethical  Relations  Committee  Expires 

John  Bowman,  Abingdon,  Chairman  1970 

Richard  Icenogle,  Roseville  1971 

William  D.  Larsen,  Annawan  1969 

Grievance  Committee 

F.  A.  Christensen,  Peoria,  Chairman  1969 

Elliott  Parker,  Moline  1971 

Russell  Jensen,  Monmouth  1970 

Prepayment  Plans  & Organizations 

James  C.  Parsons,  Geneseo,  Chairman  1970 

Donald  Dexter,  Macomb  1971 

William  O.  McQuiston,  Peoria 1969 


Fifth  District 

Darrell  H.  Trumpe,  Springfield,  Trustee 
Counties  of  DeWitt,  Logan,  McLean,  Mason, 
Menard,  Montgomery,  Sangamon,  Tazewell 


Ethical  Relations  Committee 

Arthur  Conklin,  Bloomington,  Chairman  ....  1970 

William  W.  Curtis,  Springfield 1971 

Rudolph  A.  Helden,  Pekin  1969 

Grievance  Committee 

Clifford  Draper,  Hillsboro,  Chairman 1969 

A.  J.  Morris,  Springfield  1970 

James  Borgerson,  Mt.  Pulaski 1971 

Prepayment  Plans  & Organizations 

J.  G.  Meyer,  Jr.,  Springfield,  Chairman 1969 

Robert  B.  Perry,  Lincoln 1970 

Robert  Price,  Bloomington  1971 


for  October,  1968 


417 


Sixth  District 

Mather  Pfeiffenberger,  Alton,  Trustee 
Counties  of  Adams,  Brown,  Calhoun,  Cass, 
Greene,  Jersey,  Macoupin,  Madison,  Morgan, 
Pike,  Scott 


Term 

Ethical  Relations  Committee  Expires 

Leo  R.  Greene,  Alton,  Chairman  1969 

W.  W.  Bowers,  Granite  City  1970 

Joseph  J.  Grandone,  Gillespie  1971 

Edward  K.  DuVivier,  Alton 1971 

Grievance  Committee 
Robert  R.  Hartman, 

Jacksonville,  Chairman  1969 

Bruno  DeSulis,  Beardstown  1971 

Robert  C.  Murphy,  Quincy 1970 

Richard  Cooper,  Quincy  1971 

Prepayment  Plans  & Organizations 

Paul  A.  Dailey,  Carrollton,  Chairman  1971 

E.  C.  Bone,  Jacksonville  1970 

Jude  A.  Caselton,  Carrollton  1969 

Frank  B,  Norbury,  Jacksonville  1969 

Meyer  Shulman,  Pittsfield  1971 


Eighth  District 

William  H.  Schowengerdt,  Champaign,  Trustee 
Counties  of  Champaign,  Clark,  Coles,  Crawford, 
Cumberland,  Douglas,  Edgar,  Jasper,  Lawrence, 
Richland,  Vermilion 


Ethical  Relations  Committee 

Mack  W.  Hollowell,  Charleston,  Chairman  ..  1971 

James  H.  Pass,  Olney  1969 

Alan  M.  Taylor,  Danville  1970 

Grievance  Committee 

A.  R.  Brandenberger,  Danville,  Chairman  ....  1971 

Eugene  Johnson,  Casey  1969 

Gordon  Sprague,  Paris 1970 

Prepayment  Plans  & Organizations 

James  W.  Landis,  Olney,  Chairman  1971 

E.  A.  Kendall,  Mattoon  1970 

George  T.  Mitchell,  Marshall  1969 


Seventh  District 

Arthur  F.  Goodyear,  Decatur,  Trustee 
Counties  of  Bond,  Christian,  Clay,  Clinton,  Ef- 
fingham, Fayette,  Macon,  Marion,  Moultrie, 
Piatt  and  Shelby 


Term 

Ethical  Relations  Committee  Expires 

Max  Hirschfelder,  Centralia,  Chairman  1971 

E.  H.  Rames,  Vandalia 1969 

Carl  L.  Sandburg,  Decatur  1970 

Grievance  Committee 

Karl  D.  Venters,  Centralia,  Chairman  1970 

Boyd  McCracken,  Greenville  1971 

William  Sargent,  Effingham  1969 

Prepayment  Plans  & Organizations 

Clarence  Glenn,  Decatur,  Chairman  1969 

Richard  Larson,  Shelbyville 1971 

Stanley  W.  Moore,  Vandalia  1970 


Ninth  District 

Charles  K.  Wells,  Mt.  Vernon,  Trustee 
Counties  of  Edwards,  Franklin,  Gallatin,  Hamil- 
ton, Hardin,  Jefferson,  Johnson,  Massac,  Pope, 
Saline,  Wabash,  Wayne,  White,  Williamson 

Ethical  Relations  Committee 

Donald  Mitchell,  McLeansboro,  Chairman  ..  1970 


Philip  Boren,  Carmi 1971 

John  P.  Pope,  Benton  1969 

Grievance  Committee 

C.  J.  Jannings,  III,  Fairfield,  Chairman 1970 

Herbert  Fine,  Carterville  1969 

John  Duffey,  Rosiclare 1971 

Prepayment  Plans  & Organizations 

Denton  Farrell,  Eldorado,  Chairman  1971 

H,  L.  Lewis,  Benton  1970 

A.  Watson  Miller,  Herrin  1969 


Tenth  District 

Willard  C.  Scrivner,  East  St.  Louis,  Trustee 
Counties  of  Alexander,  Jackson,  Monroe,  Perry, 
Pulaski,  Randolph,  St.  Clair,  Union,  Washing- 
ton 


Ethical  Relations  Committee 
William  Borgsmiller,  Murphysboro, 


Chairman  1969 

Harold  McCann,  East  St.  Louis  1971 

A.  L.  Robinson,  Mounds  1970 


Grievance  Committee 

William  H.  Walton,  Belleville,  Chairman  ....  1969 

William  H.  Whiting,  Anna  1971 

George  Cutridge,  DuQuoin  1970 

Prepayment  Plans  & Organizations 

R.  W.  Jost,  Waterloo,  Chairman  1969 

R.  E.  Schettler,  Red  Bud 1971 

Joseph  A.  Petrazio,  Murphysboro  1970 


418 


Illinois  Medical  Journal 


Eleventh  District 

Joseph  R.  O’Donnell,  Glen  Ellyn,  Trustee 
Counties  of  DuPage,  Ford,  Grundy,  Iroquois, 
Kankakee,  Kendall,  Will 


Ethical  Relations  Committee 

Donald  A.  Meier,  Kankakee,  Chairman 1969 

Lawrence  D.  Lee,  Manhattan  1970 

John  Bowden,  Joilet  1971 


DELEGATES  TO  THE 
AMERICAN  MEDICAL 
ASSOCIATION 

Elected  May  18,  1966 

(To  serve  from  Jan.  1,  1967  to  Dec.  31,  1968) 
MAURICE  M.  HOELTGEN 
1836  W.  87th  St.,  Chicago 
LEO  P.  A.  SWEENEY 
2658  W.  95th  St.,  Chicago 
H.  CLOSE  HESSELTINE 

5708  S.  Dorchester  Ave.,  Chicago 
WILLIAM  K.  FORD 

303  N.  Main  St.,  Rockford 
JACOB  E.  REISCH 

1129  S.  2nd.  St.,  Springfield 

Elected  May  24,  1967 

(To  serve  from  Jan.  1,  1968  to  Dec.  31,  1969) 
H.  KENNETH  SCATLIFF 
1415  Greenleaf  Ave.,  Chicago 
WALTER  C.  BORNEMEIER 
4665  Peterson  Ave.,  Chicago 
FRANK  H.  FOWLER 

6356  Diversey  Ave.,  Chicago 
ARTHUR  F.  GOODYEAR 
142  E.  Prairie  Ave.,  Decatur 
HARLAN  ENGLISH 

909  N.  Logan  Ave.,  Danville 
EDWARD  W.  CANNADY 
4601  State  St.,  East  St.  Louis 

Elected  May  21,  1968 

(To  serve  from  Jan.  1,  1969  to  Dec.  31,  1970) 
Maurice  M.  Hoeltgen 
Leo  P.  A.  Sweeney 
H.  Close  Hesseltine 
William  K.  Ford 
Jacob  E.  Reisch 
Honorary  Delegates 
Edwin  S.  Hamilton, 

151  N.  Schuyler  St.,  Kankakee 
Burtis  E.  Montgomery, 

37  S.  Main  St.,  Harrisburg 
George  F.  LuU, 

2440  Lakeview,  Chicago 


Grievance  Committee 

William  C.  Perkins,  West  Chicago, 

Chairman  1970 

Samuel  J.  Goldhaber,  Joilet  1969 

Victor  Smith,  Newark  1971 

Prepayment  Plans  & Organizations 

Chas.  Allison,  Kankakee,  Chairman  1969 

James  E.  Dailey,  Watseka  1969 

James  Lambert,  Joilet  1970 

Julius  Schweitzer,  Hinsdale  1971 


ALTERNATE  DELEGATES 
TO  THE  AMERICAN 
MEDICAL  ASSOCIATION 

Elected  May  18,  1966 

(To  serve  from  Jan.  1,  1967  to  Dec.  31,  1968) 
Theodore  R.  Van  Dellen,  435  N.  Michigan  Ave., 
Chicago 

Allison  L.  Burdick,  Sr.,  5906  W.  North  Ave., 
Chicago 

Arkell  M.  Vaughn,  9012  S.  Leavitt  St.,  Chicago 
Paul  A.  Dailey,  620  N.  Main  St.,  Carrollton 
Fred  C.  Endres,  229  E.  Glen  Ave.,  Peoria 
Elected  May  24,  1967 

(To  serve  from  Jan.  1,  1968  to  Dec.  31,  1969) 
Harold  A.  Sofield,  715  Lake  St.,  Oak  Park 
George  C.  Turner,  6627  Ponchartrain  Ave., 
Chicago 

Edward  A.  Piszczek,  6410  N.  Leona  Ave., 
Chicago 

Newton  DuPuy,  1842  Grove  Ave.,  Quincy 
Joseph  R.  Mallory,  Link  Clinic,  Mattoon 
Carl  E.  Clark,  Sycamore 

Elected  May  21,  1968 

(To  serve  from  Jan.  1,  1969  to  Dec.  31,  1970) 
Theodore  R.  Van  Dellen 
Allison  L.  Burdick,  Sr. 

Arkell  M.  Vaughn 
Paul  A.  Dailey 

Jack  Gibbs,  Coleman  Clinic,  Canton 


/or  October,  1968 


419 


CO 


Illinois  Medical  Journal 


Councils  of  the  Illinois  State  Medical  Society 

Committees  of  the  Illinois  State  Medical  Society  are  appointed  by  the  Board  of  Trustees  and  are 
assigned  to  one  of  six  councils  which  report  directly  to  the  Board.  Councils  are  composed,  for  the  most 
part,  of  committee  chairmen. 


COUNCIL  ON  LEGISLATION 
AND  PUBLIC  AFFAIRS 


V.  P.  Siegel,  Chairman,  4601  State  St.,  East  St. 
Louis  62205 

Richard  Allyn,  709  Myers  Building,  Springfield 
62701 

Alfred  J.  Faber,  2110  Swainwood  Dr.,  Glenview 
60025 

Theodore  Grevas,  (Public  Affairs)  1800  Third 
Ave.,  Rock  Island  61201 

Frank  J.  Kresca,  (Eye)  208  W.  Green,  Cham- 
paign 61822 

Eugene  J.  Scherba,  13826  Lincoln  Ave.,  Dolton 
60419 

Thomas  P.  deGraffenried,  1208  Sunnymeade,  De- 
Kalb  60115 
Consultants: 

H.  Close  Hesseltine,  5807  S.  Dorchester  Ave- 
nue, Chicago  60637 

Harold  A.  Sofield,  715  Lake  St.,  Oak  Park 
60301 

J.  Ernest  Breed,  55  E.  Washington,  Chicago 
60602 

William  A.  Lees,  6518  N.  Nokomis,  Lincoln- 
wood  60646 
Auxiliary: 

Mrs.  Alan  Taylor,  1607  N.  Vermilion,  Dan- 
ville 61832 
Staff:  Dan  Morgan 


Responsibilities  and  Purposes 

The  Council  on  Legislation  and  Public  Affairs 

shall: 

1.  Keep  the  Society  and  its  members  aware  of 
all  state  and  federal  legislation  and  laws  affect- 
ing the  health  of  citizens  of  Illinois  and  the 
practice  of  medicine  in  Illinois, 

2.  Promulgate  legislation  to  improve  the  health 
care  of  citizens  of  Illinois  and  the  practice  of 
medicine  in  Illinois, 

3.  Cooperate  with  the  AM  A in  similar  programs 
and, 

4.  Shall  develop  programs  to  educate  the  public 
and  the  Illinois  State  Medical  Society  mem- 
bership in  the  privileges  and  responsibilities 
of  citizenship. 


MEDICAL-LEGAL  COUNCIL 


Noel  G.  Shaw,  Chairman,  2901  Central  St.,  Evans- 
ton 60201 

Clinton  L.  Compere,  (Impartial  Medical  Testi- 
mony) 737  N.  Michigan  Ave.,  Chicago  60611 
William  G.  McCarthy,  (Medical  Practice  and 
Quackery)  13826  Lincoln,  Dolton  60419 
George  Alvary,  1110  N.  Green,  McHenry  60050 
Andrew  John  Toman,  6738  W.  Cermak  Rd., 
Berwyn  60609 

Grover  L.  Seitzinger,  (Laboratory  Evaluation) 
812  N.  Logan  Ave.,  Danville  61832 
Staff:  Mel  Sloan 
Responsibilities  and  Purposes 

Special  attention  shall  be  given  to  liaison  with 
the  Bar  Association.  The  responsibilities  formerly 
assigned  to  the  Medical  Legal  Committee  shall 
be  provided  by  this  council  as  follows:  to  edu- 
cate the  members  of  the  profession  in  medico- 
legal affairs  and  cooperate  with  the  AMA  in  its 
program. 


The  same  shall  pertain  to  the  work  of  the 
former  Committee  on  Medical  Testimony,  and 
this  council  shall  have  the  authority  to  examine 
any  member  of  the  ISMS  who  is  either  suspected 
of,  or  has  been  accused  of  giving  improper  testi- 
mony in  any  court  proceedings.  It  shall  (if  deemed 
necessary)  procure  and  examine  transcripts  of 
court  testimony  to  determine  whether  or  not  fraud- 
ulent testimony  has  been  given  and  report  its 
findings  to  the  Board  of  Trustees.  When  irregu- 
larities are  found,  the  Board  may  submit  the 
findings  to  the  Ethical  Relations  Committee  of 
the  county  medical  society. 

A committee  may  be  appointed  to  act  with 
members  of  a similar  committee  of  the  Illinois 
Bar  Association  in  matters  involving  both  pro- 
fessions. 


/or  October,  196S 


421 


i 


COUNCIL  ON  MEDICAL  EDUCATION 

Jack  Gibbs,  Chairman  (Rural  Health  & Student 
Loan),  24  Main  St.,  Canton  61520 
Herschel  L.  Browns,  (Continuing  Education), 
4600  N.  Ravenswood  Avenue,  Chicago  60640 
Robert  T.  Fox,  (Scientific  Assembly),  2136  Robin 
Crest  Lane,  Glenview  60025 
Morgan  M.  Meyer,  (Medical  Education),  573 
South  Lombard,  Lombard  60148 
J.  Robert  Thompson,  (Director  of  Exhibits),  1129 
North  Elmwood  Avenue,  Oak  Park  60302 
Consultant: 

Paul  W.  Sunderland,  214  North  Sangamon 
Street,  Gibson  City  60936 
Staff:  Perry  L.  Smithers 
Responsibilities  and  Purposes 

The  Council  on  Medical  Education  shall  (1) 
study  and  evaluate  all  phases  of  medical  educa- 
tion including  the  development  of  programs  ap- 
proved by  the  House  of  Delegates  for  the  provi- 
sion of  a continuing  supply  of  well-qualified  phy- 
sicians; (2)  study  and  evaluate  education  relat- 
ing to  the  health  professions  and  services  im- 
portant to  medicine,  including  the  development 
of  programs  approved  by  the  House  of  Delegates, 
for  the  provision  of  a continuing  supply  of  well- 
qualified  personnel  in  these  fields;  (3)  carry  to 
the  deans  of  the  medical  schools  recommenda- 
tions from  the  viewpoint  of  the  practicing  physi- 
cian; (4)  study,  evaluate  and  criticize  the  post- 
graduate programs  of  ISMS  and  other  organiza- 
tions; (5)  be  available  to  advise  and  cooperate 
with  the  Department  of  Registration  and  Educa- 
tion of  the  State  of  Illinois;  and  (6)  organize, 
coordinate  and  administer  the  scientific  sessions 
of  the  ISMS  subject  to  the  regulations  outlined 
in  the  Bylaws,  especially  those  in  Chapter  II,  An- 
nual Convention,  Section  3,  Scientific  Meetings. 


COUNCIL  ON  MEDICAL  SERVICE 

Fred  Z.  White,  Chairman,  (Medical  Economics  & 
Insurance)  723  N.  2nd  St.,  Chillicothe  61523 

Preston  S.  Houk  (Prepayment  Plans),  207  Park- 
view  Dr.,  Bloomington  61701 

T.  T.  Tourlentes  (Aging),  Galesburg  Research 
Hosp.,  Galesburg  61401 

Fred  A.  Tworoger  (Adv.  to  IDPA),  4753  Broad- 
way, Chicago  60640 
Staff:  James  Slawny 

Responsibilities  and  Purposes 

1)  Coordinate  committee  activities,  avoid  dupli- 
cation in  over-lapping  of  projects,  close  gaps 
in  medical  service  programming  and  serve  as 
a catalyst  in  activating  new  committee  pro- 
grams, 

2)  Initiate,  explore  and  bring  to  the  attention  of 
the  Board  of  Trustees  suggested  new  policies 
and  philosophies  relating  to  medical  service 
in  Illinois, 

3)  Serve  as  an  advisory  body  to  allow  for  the 
interchange  of  ideas  between  various  commit- 
tees of  the  Council, 

4)  Consult  with  Council  members  as  chairmen 
of  committees  with  similar  aims  and  objectives, 

5)  Advise  the  staff  in  socio-economic  issues  and 
further  the  health  and  welfare  of  the  public 
by  seeking  continuous  improvement  of  medical 
services  in  Illinois, 

6)  Establish  liaison  with  other  Councils  of  or- 
ganized medicine,  including  those  of  the  AMA, 
and 

7)  Provide  a channel  of  communication  between 
the  Illinois  State  Medical  Society  and  the  fed- 
eral health  agencies,  the  health  insurance  in- 
dustry, the  Blue  Cross-Blue  Shield  Plans,  and 
similar  organizations  in  matters  of  mutual 
concern. 


COUNCIL  ON  PUBLIC  RELATIONS 


Thomas  R.  Harwood,  Chairman,  (Adv.  to  Para- 
medical Groups),  4902  Tollview  Rd.,  Rolling 
Meadows  60008 

Max  Klinghoffer  (Disaster  Medical  Care),  127 
E.  Vallette  St.,  Elmhurst  60126 
Julian  W.  Buser  (Hospital  Relations),  4601  State 
St.,  East  St.  Louis  62205 
Matthew  B.  Eisele  (Public  Relations),  4601  State 
St.,  East  St.  Louis  62205 
Robert  S.  Mendelsohn  (Religion  and  Medicine), 
1100  Hull  Terrace,  Evanston  60202 
Henry  A.  Holle  (Membership),  160  N.  LaSalle 
St.,  Chicago  60601 


James  D.  Mrjerakis  (Adv.  to  Interprofessional 
Groups),  30  N.  Michigan  Ave.,  Chicago  60602 
W.  I.  Taylor  (Nursing),  28  N.  Main  St.,  Canton 
61520 

Edwin  A.  Lee  (Public  Safety),  501  S.  13th  St., 
Springfield  62703 
Staff:  James  R.  Slawny 
Responsibilities  and  Purposes 

The  Council  on  Public  Relations  shall  plan 
and  execute  programs  designed  to  enhance  the 
relationship  between  the  public  and  the  medical 
profession. 


422 


Illinois  Medical  Journal 


COUNCIL  ON  SCIENTIFIC  SERVICES 


Joseph  H.  Skom,  Chairman,  (Narcotics)  707  N. 

Fairbanks  Ct.,  Chicago  60611 
John  R.  Adams,  (Mental  Health)  707  N.  Fair- 
banks Ct.,  Chicago  60611 
Henry  B.  Betts,  (Rehabilitation  Services),  401  E. 
Ohio,  Chicago  60611 

Howard  D.  Burkhead,  (Radiation),  130  Dempster 
St.,  Evanston  60201 

Paul  A.  Dailey  (Nutrition),  620  N.  Main  Street, 
Carrollton  62016 

Abraham  Gelperin,  (Alcoholism),  DMP-Room 
554,  1853  W.  Polk,  Chicago  60612 
Robert  R.  Hartman,  (Maternal  Welfare),  1515 
Walnut,  Jacksonville  62650 
Ralph  H.  Kunstadter,  (Child  Health),  664  N. 

Michigan  Avenue,  Chicago  60611 
Edward  A.  Piszczek,  (Public  Health),  6410  N. 
Leona,  Chicago  60646 

John  V.  Standard,  (Cancer  Control),  701  N.  Wal- 
nut, Springfield  62702 
Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  Council  on  Scientific  Services  shall  (1) 
encourage  and  assist  in  the  development  of  com- 
munity programs  designed  to  maintain,  protect 
and  improve  the  health  of  residents  of  the  State 
of  Illinois;  (2)  cooperate  with  the  Illinois  De- 
partment of  Health  in  the  control  and  prevention 
of  contagious  diseases;  (3)  formulate  and  partici- 
pate in  programs  designed  to  decrease  occupa- 
tional, environmental,  and  physical  hazards;  (4) 
recommend  and  promulgate  standards  for  ancil- 
lary medical  services;  (5)  participate  and  advise 
in  programs  designed  to  reduce  morbidity  and 
mortality  in  diseases  peculiar  to  any  segment  of 
the  people  of  Illinois;  (6)  work  for  the  estab- 
lishment of  measures  for  the  control  of  hazard- 
ous drugs  and  agents;  and  (7)  develop  and  sup- 
port legislative  measures  to  accomplish  these  aims. 


COMMITTEES 

The  following  committees  have  been  appointed  for  the  year,  1968-69.  Each  committee  is  assigned  to  a 
council  for  reporting  purposes,  except  those  that  are  composed  entirely  of  trustees,  or  for  reasons  of 
efficiency  and  control,  report  directly  to  the  Board  of  Trustees. 


COMMITTEE  ON  AGING 
(Council  on  Medical  Service) 


Thomas  T.  Tourlentes,  Chairman 

Galesburg  Research  Hospital,  Galesburg  61401 

Bertram  B.  Moss 

5360  N.  Lincoln  Ave.,  Chicago  60625 
Marshall  Falk 

226  Kilpatrick,  Wilmette  60091 
M.  H.  Powell 

306  W.  Main  St.,  Carbondale  62901 

Ralph  A.  Rittenhouse 
P.O.  Box  248,  Winfield  60190 

Clyde  Rulison 
Roberts  60962 

Auxiliary  Representation: 

Mrs.  Herbert  P.  Swartz 

575  S.  Wall  St.,  Kankakee  60901 
Staff:  Gary  Kennon 


Responsibilities  and  Purposes 

The  functions  of  the  Committee  on  Aging  en- 
compass the  broad  field  of  aging  with  special  con- 
sideration for  the  types  of  medical  services  and 
patterns  of  care  available  to  the  aging  and  the 
economics  involved,  promotion  of  positive  health 
and  meaningful  living  through  sound  living  habits, 
periodic  health  supervision,  and  full  use  of  hu- 
man potentials,  regardless  of  age.  The  committee 
cooperates  with  the  American  Medical  Associa- 
tion’s Committee  on  Aging  and  other  appropriate 
agencies. 

Included  among  the  committee’s  activities  are 
the  study  and  support  of  expansion  of  additional 
home  care  programs  in  Illinois;  relationships  with 
nursing  homes,  home  nursing,  homemaker  pro- 
grams, and  other  programs  involving  services 
oriented  toward  the  aging;  emphasizing  preretire- 
ment planning;  discouraging  the  mandatory  re- 
tirement age  and  arbitrary  age  limits  for  employ- 
ment whether  the  individual  wants  to  continue 
working  or  not;  and  liaison  with  other  agencies 
having  a similar  interest. 


for  October,  1968 


423 


COMMITTEE  ON  ALCOHOLISM 
(Council  on  Scientific  Services) 


Abraham  Gelperin,  Chairman,  Room  554,  D.M.P. 

1853  W.  Polk  St.,  Chicago,  60612 
Charles  L.  Anderson 

120  N.  Oak  St.,  Hinsdale,  60521 
Richard  S.  Cook 

230  N.  Michigan  Ave.,  Chicago  60601 
David  J.  Stinson 

2026  Jonquil  Place,  Rockford,  61107 
John  C.  Troxel 

425  N.  Michigan  Ave.,  Chicago,  60611 
Frank  J.  Walsh 

6445  W.  North  Ave.,  Oak  Park,  60302 
William  H.  Wehrmacher 

670  N.  Michigan  Ave.,  Chicago,  60611 

Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  Committee  on  Alcoholism  serves  as  a re- 
source on  alcoholism  for  ISMS  and  evaluates  in- 
formation and  makes  recommendations  to  the 
Board  of  Trustees  for  the  position  ISMS  should 
take  on  issues  in  this  area.  It  cooperates  with 
institutions,  industry,  government  and  health  agen- 
cies in  disseminating  information  on  the  causes, 
prevention,  diagnosis,  and  treatment  of  alcohohsm 
to  the  medical  profession  and  the  public. 


ARCHIVES  COMMITTEE 
(Board  of  Trustees) 


Leo  Zimmerman,  Chairman 

55  E.  Washington  St.,  Chicago  60602 

Everett  P.  Coleman 

24  N.  Main,  Canton  61520 

Emmet  F.  Pearson 

701  N.  Walnut  St.,  Springfield  62702 

H.  Kenneth  Scatliff 

1415  Greenleaf  Ave.,  Chicago  60625 
Staff:  Frances  C.  Zimmer 


Responsibilities  and  Purposes 

Assist  in  the  collection  and  evaluation  of  medi- 
cal items  and  records  of  historical  interest  to 
the  society  and  the  public;  cooperate  with  other 
associations  and  agencies  to  preserve  and  display 
such  material;  supervise  the  preparation  of  any 
written  records  of  the  society  or  any  of  its  activ- 
ities; and  inform  the  Board  of  Trustees  of  those 
special  anniversaries  which  should  be  commem- 
orated and  shall  supervise  the  observance  of  these 
occasions. 


SUB-COMMITTEE  ON  BENEVOLENCE 
(See  Finance  Committee) 


COMMITTEE  ON  CANCER  CONTROL 
(Council  on  Scientific  Services) 


John  V.  Standard,  Chairman 

701  N.  Walnut,  Springfield,  611  Oil 
Robert  E.  Field 

13000  S.  Maple,  Blue  Island,  60406 
Russell  M.  Jensen 

319  N.  Main  St.,  Monmouth,  61462 
Roland  A.  Kowal 

505  S.  Oak  Park  Ave.,  Oak  Park,  60302 
Rudolph  G.  Mrazek 

3237  S.  Oak  Park  Ave.,  Berwyn,  60403 
Thomas  Sellett 

101  E.  Miller  Rd.,  Sterling,  61081 
Caesar  Sweitzer 

251  E.  Chicago  Ave.,  Chicago,  60611 

Auxiliary  Representation: 

Mrs.  Richard  E.  Icenogle 
Box  188,  Roseville,  61473 


Consultants: 

J.  Ernest  Breed 

55  E.  Washington  St.,  Chicago  60602 
Caesar  Portes 

25  E.  Washington,  Chicago,  60602 
Staff:  Perry  L.  Smithers 
Responsibilities  and  Purposes 

This  committee  shall  serve  as  a source  of  in- 
formation on  cancer  matters  for  the  ISMS.  It 
shall  evaluate  available  information  and  make 
recommendations  to  the  Board  of  Trustees  on 
the  position  the  ISMS  should  take  in  this  area 
of  scientific  endeavor.  It  shall  cooperate  with  in- 
stitutions and  voluntary  health  agencies  in  dis- 
seminating information  on  cancer  subjects  to  the 
profession  and  to  the  public.  It  shall  be  on  the 
alert  for  misleading  or  fallacious  programs  and 
information  which  need  correction  for  the  protec- 
tion of  the  public. 


424 


Illinois  Medical  Journal 


ON  CHILD  HEALTH 
Scientific  Services) 

Kenneth  S.  Nolan 

172  Schiller,  Elmhurst  60126 
T.  A.  Palus 

101  Orchard  Terrace,  Lombard  60148 
Ira  M.  Rosenthal 

700  S.  Wood  St.,  Chicago  60612 
Norman  T.  Welford 

656-58th  St.,  Hinsdale  60521 
Staff:  Perry  L.  Smithers 


COMMITTEE 
(Council  on 

Ralph  H.  Kunstadter,  Chairman 

664  N.  Michigan  Ave.,  Chicago  60611 
Irving  Abrams 

228  N.  LaSalle  St.,  Chicago  60601 
William  J.  Ball 

143  S.  Lincoln,  Aurora  60505 
Marvin  E.  Cooper 

6450  N.  California  Ave.,  Chicago  60645 
Eugene  F.  Diamond 

11055  S.  St.  Louis,  Chicago  60655 
Richard  E.  Dukes 

602  W.  University,  Urbana  61801 
W.  W.  Fullerton 

101  N.  Market  St.,  Sparta  62286 
Edmond  R.  Hess 

1737  W.  Howard  St.,  Chicago  60626 
Howard  R.  Hone 

151  Herrick  Road,  Riverside  60546 
Edward  Jung 

13826  Lincoln  Ave.,  Dolton  60419 
Harvey  Kravitz 

6223  Dempster  St.,  Morton  Grove  60053 
Edward  F.  Lis 

840  S.  Wood  St.,  Chicago  60612 
Fred  Long 

2116  N.  Sheridan  Rd.,  Peoria  61604 
J.  Keller  Mack 

922  S.  4th  St.,  Springfield  62702 
Franklin  A.  Munsey 

1429  Myott  Ave.,  Rockford  61101 


Responsibilities  and  Purposes 

The  committee  shall  serve  as  a source  of  in- 
formation on  matters  pertaining  to  child  health. 
It  shall  evaluate  available  information  and  make 
recommendations  to  the  Board  of  Trustees  for 
the  position  the  ISMS  should  take  on  issues  in 
this  area  and  cooperate  with  institutions  and  volun- 
tary health  agencies  in  disseminating  informa- 
tion pertinent  to  general  child  health.  It  shall 
be  on  the  alert  for  misleading  or  fallacious  pro- 
grams and  information  which  need  correction  for 
the  protection  of  the  public.  It  shall  conduct  edu- 
cational programs  for  public  enlightenment  for 
the  encouragement  and  the  establishment  of  school 
health  councils;  it  shall  strive  for  increased  serv- 
ices for  exceptional  children.  It  shall  conduct  in 
cooperation  with  the  Maternal  Welfare  Commit- 
tee research  on  neonatal  mortahty  through  the 
state;  and  shall  seek  the  formulation  and  adop- 
tion of  uniform  school  health  records. 


COMMITTEE  ON  COMMITTEES 
(Board  of  Trustees) 


Darrell  H.  Trumpe,  Chairman 

St.  John’s  Sanatorimn,  Springfield  62707 

James  B.  Hartney 

410  Lake  St.,  Oak  Park  60302 

Charles  K.  Wells 

117  N.  10th  St.,  Mt.  Vernon  62824 

Warren  W.  Young 

10816  PameU  Ave.,  Chicago  60628 
Staff:  Frances  C.  Zimmer 


Responsibilities  and  Purposes 

The  Committee  on  Committees  shall  review 
annually  the  purpose,  activity  and  structure  of 
aU  committees,  and  shall  recommend  such  changes 
in  existing  committees  as  appear  to  be  required 
for  the  eflScient  conduct  of  the  business  of  the 
Society. 

The  activities  of  the  Committee  on  Committees 
shall  be  reviewed  by  the  Executive  Committee 
and  approved  by  the  Board  of  Trustees. 


COMMITTEE  ON  CONSTITUTION  AND  BYLAWS 
(Board  of  Trustees) 


Andrew  J.  Brislen,  Chairman 

6060  S.  Drexel  Blvd.,  Chicago  60637 
David  S.  Fox 

826  E.  61st  St.,  Chicago  60637 
Wayne  N.  Leimbach 

370  L.R.A.  Dr.,  Aurora  60506 
Edward  A.  Razim 

3340  S.  Oak  Park  Ave.,  Bervyn  60402 
Carl  Weissmann 

1508-7th  St.,  Mohne  61265 
Staff:  Frances  C.  Zimmer 


Responsibilities  and  Purposes 

The  Committee  on  Constitution  and  Bylaws  shall 

a)  Receive  from  Individual  members,  county  so- 
cieties, committees,  the  Board  of  Trustees,  and 
the  House  of  Delegates,  all  suggestions  and 
proposals  for  modification  of  the  Constitu- 
tion & Bylaws. 

b)  Prepare  for  the  consideration  of  the  House 
of  Delegates,  all  changes  in  the  Constitution 
and  Bylaws,  and 

c)  Maintain  constant  surveillance  of  both  docu- 
ments to  keep  them  current,  effective  and  con- 
sistent with  the  policies  of  the  House  of  Dele- 
gates. 


for  October,  1968 


425 


COMMITTEE  ON  CONTINUING  EDUCATION 
(Council  on  Medical  Education) 


Herschel  L.  Browns,  Chairman 

4600  N.  Ravenswood,  Chicago  60640 
W.  W.  Bowers 

1820  Delmar,  Granite  City  62040 
T.  Howard  Clarke 

251  E.  Chicago  Ave.,  Chicago  60611 
Robert  Craig 

2111  N.  Edward  St.,  Decatur  62526 
Lawrence  C.  Day 

121  W.  Church  St.,  Libertyville  60048 
Robert  J.  Freeark 

1825  W.  Harrison  St.,  Chicago  60612 
Richard  F.  Herndon 

326  N.  7th  St.,  Springfield  62701 
Louis  N.  Katz 

2900  S.  Ellis  Ave.,  Chicago  60616 
Louis  R.  Limarzi 

910  N.  East  Ave.,  Oak  Park  60302 
Janies  M.  Schless 

3249  S.  Oak  Park  Ave.,  Berwyn  60402 


Gordon  S.  Sprague 

502  Shaw  Ave.,  Paris  61944 
Consultant: 

William  E.  Adams 

55  E.  Erie  St.,  Chicago  60611 
Staff:  Perry  L.  Smithers 
Responsibilities  and  Purposes 

The  committee  shall  provide  a program  of  con- 
tinuing education  for  the  practicing  physicians 
of  Illinois.  This  shall  include  courses  in  specific 
medical  subjects  as  requested  by  component  so- 
cieties as  well  as  speakers  on  scientific  subjects. 
The  committee  shall  solicit  individuals  or  teams 
from  the  medical  schools  of  Illinois,  the  hospitals 
and  research  centers  and  the  body  of  practitioners 
to  present  this  program  of  continuing  education. 
It  shall  study  more  effective  means  of  presenting 
educational  material  throughout  the  state.  It  shall 
provide  additional  services  to  component  societies 
as  are  deemed  necessary  to  the  conduct  of  an 
effective  program. 


COMMITTEE  ON  DISASTER  MEDICAL  CARE 
(Council  on  Public  Relations) 


Max  Klinghoffer,  Chairman 

127  E.  Vallette  St.,  Elmhurst  60126 
Jack  R.  Baldwin 

1315  S.  6th  St.,  Springfield  62703 
William  A.  Hark 

30  N.  Michigan,  Chicago  60602 
Harold  C.  Lueth 

636  Church  St.,  Evanston  60201 
Carl  Steinhoff 

8909  Kilpatrick  Ave.,  Skokie  60076 
Charles  F.  Sutton 

505  State  Office  Bldg.,  Springfield  62706 
Staff:  Gary  Kennon 


Responsibilities  and  Purposes 

The  committee  shall  be  responsible  for  assisting 
in  the  education  of  the  profession  and  the  public 
on  the  development  and  implementation  of  pro- 
grams to  provide  medical  care  in  the  event  of 
disaster;  be  responsible  for  directing  the  society’s 
efforts  toward  preparedness  in  the  event  of  natural 
or  man-made  catastrophes;  cooperate  with  civil 
defense  agencies,  public  health  departments,  hos- 
pitals, management  and  labor  organizations,  para- 
medical groups  and  other  agencies  to  establish 
unity  and  coordination,  and  serve  in  an  advisory 
capacity  to  county  medical  societies  in  medical 
self-help  training  programs  and  hospital  disaster 
planning. 


SUB-COMMITTEE  ON  DRUGS  AND  THERAPEUTICS 
(See  Medical  Advisory  Committee  to  The  Illinois  Department  of  Public  Aid) 


EDITORIAL  BOARD 
(See  Journal  Committee) 


EDUCATIONAL  & SCIENTIFIC  FOUNDATION 
(Board  of  Trustees) 


Newton  DuPuy,  Chairman 

1842  N.  Grove,  Quincy  62301 

Frank  J.  Jirka,  Jr. 

1507  N,  Keystone  Ave.,  River  Forest  60305 


Philip  G.  Thomsen 

13826  Lincoln  Ave.,  Dolton  60419 
Jacob  E.  Reisch 

1129  S.  2nd  St.,  Springfield  62704 
Staff:  Perry  Smithers 


426 


Illinois  Medical  Journal 


Responsibilities  and  Purposes 

The  foundation  was  founded  to  provide  an  ad- 
ministrative agency  to  foster  the  advancement  of 
medical  science  through  ( 1 ) the  initiation  of  scien- 
tific and  medical  research  activities,  (2)  the 
collection,  evaluation  and  dissemination  of  the 
results  of  research  activities  to  the  public  and  (3) 
the  implementation  and  management  of  projects 


related  to  medicine  for  individuals  or  organizations 
seeking  to  inform  or  educate  others,  or  to  improve 
their  own  knowledge.  The  charter  of  the  founda- 
tion calls  for  a board  of  directors  consisting  of  the 
following  officers  of  the  Illinois  State  Medical 
Society:  Immediate  Past  President  (as  chairman). 
Chairman  of  the  Board  of  Trustees,  President,  and 
Secretary-Treasurer. 


SUB-COMMITTEE  ON  ENVIRONMENTAL  HEALTH 
(See  Committee  on  Public  Health) 


ETHICAL  RELATIONS  COMMITTEE 
(Board  of  Trustees) 


Willard  C.  Scrivner,  Chairman 

4601  State  St.,  East  St.  Louis  62205 
William  A.  McNichols,  Jr. 

101  W.  First  St.,  Dixon  61021 
J.  Ernest  Breed 

55  E.  Washington,  Chicago  60602 
Newton  DuPuy 

1842  Grove  Ave.,  Quincy  62301 

Staff:  Roger  N.  White 
Responsibilities  and  Purposes 

The  duties  of  this  committee  are  outlined  in 
details  in  the  Bylaws  under  the  chapter  on  “Dis- 
cipline.” 

Illinois  State  Medical  Society  Ethical  Relations 
Committee.  The  Board  of  Trustees  shall  appoint 
from  its  members,  an  Ethical  Relations  Committee 
to  review  matters  involving  the  interpretation  of 
the  Principles  of  Medical  Ethics,  violations  of  the 
Constitution  and  Bylaws  of  the  Illinois  State 
Medical  Society  or  its  component  societies,  and 
charges  of  misconduct  of  members  of  the  Society. 

It  shall  serve  as  an  appellate  body  to  review 
cases  involving  these  matters  referred  by  com- 
ponent medical  societies,  and  shall  consider  mat- 
ters of  law  (ethics)  and  procedure. 

Appeals  from  Component  Society  Verdicts. 
Appeals  received  by  the  Illinois  State  Medi- 
cal Society  Board  of  Trustees  shall  be  referred  to 
the  Ethical  Relations  Committee  of  the  Board  for 
review.  Appeals  must  be  accompanied  by  perti- 
nent data  and  transcripts  indicating  the  basis  for 
the  appeal.  Failure  to  provide  such  data  shall  be 
grounds  for  a verdict  of  default  against  the  plain- 
tiff. The  committee  shall  notify  the  accused  and 
the  secretary  of  the  component  society  by  cer- 
tified mail  at  least  thirty  days  prior  to  the  date 
set  for  the  hearing  of  the  appeal.  The  chairman 
of  the  committee  shall  preside  over  the  hearing 
in  accordance  with  the  rules  established  by  the 
Board  of  Trustees. 

Verdict.  On  conclusion  of  the  hearing,  the 
Ethical  Relations  Committee  of  the  Board  of 
Trustees  shall  meet  in  executive  session  to  consider 
its  decision,  and  shall  report  in  writing  to  the 


Board  at  its  next  meeting  for  approval  or  rejection. 

Notification  of  Parties.  The  secretary  of  the 
Society  shall  notify  the  defendant  and  the  secretary 
of  the  component  society  wherein  the  defendant 
holds  membership,  of  the  action  of  the  Board. 

A.  Right  of  Appeal  to  the  American  Medical 
Association.  In  case  of  findings  against  the 
accused,  and  in  support  of  the  action  taken 
by  the  component  society,  the  secretary  of 
the  state  society  shall  notify  the  accused 
within  ten  days  by  certified  mail  of  his  right 
to  appeal  to  the  Judicial  Council  of  the 
American  Medical  Association. 

B.  Error.  In  the  event  of  a decision  by  the 
Board  of  Trustees  of  improper  law  (ethics) 
and/or  procedure  by  the  trial  body  of  the 
component  society,  the  case  shall  be  re- 
manded with  recommendations  to  the  com- 
ponent society  for  reconsideration. 

The  Committee  shall  be  authorized  by  the 
Board  of  Trustees  to: 

1)  Investigate 

(a)  Controversies  arising  under  this 
Constitution  and  Bylaws  and  un- 
der the  principles  of  medical  ethics, 
to  which  the  Society  is  a party,  and 

(b)  Controversies  between  two  or  more 
county  societies  and  their  members. 

2)  Investigate  all  questions  of  medical 
ethics  and  the  interpretation  of  the 
Constitution,  Bylaws  and  Policies  of  the 
Society. 

3)  Investigate  general  professional  condi- 
tions and  all  matters  pertaining  to  the 
relations  of  physicians  to  one  another 
or  to  the  public. 

4)  To  receive  appeals  filed  by  applicants 
who  alleged  that  they  have  been  denied 
membership  in  a component  society  be- 
cause of  race,  creed,  color,  or  ethnic 
origin,  to  determine  the  facts  of  the 
case  and  to  report  the  findings  to  the 
Board  of  Trustees. 


for  October,  1968 


427 


EXECUTIVE  COMMITTEE 


(Board  of 

Frank  J.  Jirka,  Chairman 

1507  Keystone  Ave.,  River  Forest  60305 
Philip  G.  Thomsen,  President 

13826  Lincoln  Ave.,  Dolton  60419 
Edward  W.  Cannady,  Pres. -elect 
4601  State  St.,  E.  St.  Louis  62205 
William  E.  Lees,  Finance 

6518  N.  Nokomis,  Ave.,  Lincolnwood  60646 
Newton  DuPuy,  Past  Pres. 

1842  Grove  Ave.,  Quincy  62301 
Jacob  E.  Reisch,  Secy.-Treas. 

1129  S.  2nd  St.,  Springfield  62704 
William  E.  Adams,  Policy 
55  E.  Erie  St.,  Chicago  60611 
Legal  Counsel: 

John  W.  Neal 
Frank  M.  Pfeifer 
Staff:  Roger  N.  White 

Frances  C.  Zimmer 


Trustees) 


Responsibilities  and  Purposes 

The  Executive  Committee  shall  consist  of  the 
president,  the  president-elect,  the  chairman  of 
the  Board,  the  chairman  of  the  Finance  Commit- 
tee, the  chairman  of  the  Policy  Committee,  the 
secretary-treasurer  and  the  trustee-at-large. 

It  may  be  given  authority  to  act  by  the  Board 
of  Trustees. 

In  matters  of  routine  administration,  special 
plans,  policy,  endorsement  or  expenditure  it  shall 
report  to  and  request  approval  of  the  Board.  It 
shall  receive  the  reports  of  the  Finance  and  Policy 
Committees  and  make  recommendations  concern- 
ing them  to  the  Board.  It  shall  furnish  a report 
of  its  actions  to  the  Board  at  each  meeting. 


EYE  COMMITTEE 

(Council  on  Legislation  & Public  Affairs) 


Frank  J.  Kresca,  Chairman 

208  W.  Green,  Champaign  61820 
James  R.  Fitzgerald 

6429  North  Ave.,  Oak  Park  60302 
Edward  C.  Albers 

Christie  Clinic,  104  W.  Clark  St.,  Champaign 
61820 

Charles  L.  Pannabecker 
331  Fulton,  Peoria  61602 
Lawrence  J.  Lawson 

636  Church  St.,  Evanston  60201 
Wilbur  W.  Baumgartner 

118  N.  Chestnut  St.,  Kewanee  61443 
David  V.  Brown 

122  S.  Michigan  Ave.,  Chicago  60604 
Max  Hirschf elder 

408-2nd  St.,  Centralia  62801 
David  Shock 

700  N.  Michigan  Ave.,  Chicago  60611 
Manuel  L.  Stillerman 

111  N.  Wabash  Ave.,  Chicago  60602 


M.  Byron  Weisbaum 

520  E.  Allen,  Springfield  62703 
Consultant: 

Maurice  M.  Hoeltgen 

1836  W.  87th  St.,  Chicago  60620 
Staff:  Mel  Sloan 

Responsibilities  and  Purposes 

The  function  of  the  Eye  Committee  is 
to  concern  itself  with  state  legislation  regard- 
ing ophthalmic  matters,  to  secure  and  dissemi- 
nate information  and  make  recommendations  re- 
garding specific  legislative  proposals.  The  Eye 
Committee  also  meets  with  the  Illinois  State 
Joint  Council  of  Ophthalmology  to  study  prob- 
lems and  formulate  policy  on  the  medical  and 
social  economic  aspects  of  ophthalmology. 


FINANCE  COMMITTEE 
(Board  of  Trustees) 


William  M.  Lees,  Chairman 

6518  N.  Nokomis  Ave.,  Lincolnwood  60646 
Mather  Pfeiffenberger 

State  & Wall  Sts.,  Alton  62002 
William  H.  Schowengerdt 

301  E.  University  Ave.,  Champaign  61820 
Jacob  E.  Reisch 

1129  S.  2nd  St.,  Springfield  62704 
Legal  Counsel: 

John  W.  Neal 
Frank  M.  Pfeifer 
Consultant: 

Carl  E.  Clark 

225  Edward  St.,  Sycamore  60178 


Staff:  Roger  N.  White 
Roland  I.  King 

Responsibilities  and  Purposes 

The  Finance  Committee  shall  consist  of  the 
secretary-treasurer  of  the  Society  and  three  mem- 
bers of  the  Board  appointed  by  the  chairman.  It 
shall  develop  for  approval  of  the  Board  through 
the  Executive  Committee,  a budget  for  the  fiscal 
year.  It  shall  supervise  the  financial  transactions 
of  the  Society.  It  shall  make  recommendations  to 
the  Board  for  the  control  and  investment  of  the 
funds  of  the  Illinois  State  Medical  Society. 


428 


Illinois  Medical  Journal 


COMMITTEE  ON  BENEVOLENCE 
(Subcommittee  of  the  Finance 
Committee) 

Keith  H.  Frankhauser,  Chairman 
Avon  61415 
Allison  L.  Burdick,  Sr. 

5906  W.  North  Ave.,  Chicago  60639 
Leo  P.  A.  Sweeney 

2658  W.  95th  St.,  Evergreen  Park  60642 
Auxiliary  Representation: 

Mrs.  Michael  G.  Maitino 
601  N.  Taylor  Ave.,  Oak  Park  60302 
Staff:  Frances  C.  Zimmer 


Responsibilities  and  Purposes 

The  committee  shall  examine  applications  to  the 
society  for  assistance  to  determine  eligibility  for 
benefits;  keep  the  names  of  the  beneficiaries  con- 
fidential and  known  only  to  the  committee,  and 
recommend  to  the  Finance  Committee  of  the 
Board  of  Trustees  the  allotment  of  each  recipient. 
It  shall  operate  as  a sub-committee  of  the  Finance 
Committee. 

If  funds  available  become  inadequate  to  meet 
disbursements,  the  Finance  Committee  of  the 
Board  of  Trustees  shall  be  requested  to  appro- 
priate sufficient  funds  to  support  the  program 
until  the  next  budget  appropriation. 


SUB-COMMITTEE  ON  HEALTH  CAREERS  COUNCIL  OF  ILLINOIS 
(See  Advisory  Committee  to 
Paramedical  Groups) 


COMMITTEE  ON  HOSPITAL  RELATIONS 
(Council  on  Public  Relations) 


J.  W.  Buser,  Chairman 

4601  State  St.,  East  St.  Louis  62205 
John  A.  Bowman 

300  N.  Main  St.,  Abingdon  61410 
Caesar  Portes 

25  E.  Washington  St.,  Chicago  60602 
Kenneth  John  Smith 

2320  High  St.,  Blue  Island  60406 
Consultant: 

Harlan  English 

909  N.  Logan  Ave.,  Danville  61832 
Staff:  James  Slawny 

Responsibilities  and  Purposes 

Among  the  functions  of  the  committee  are  the 
consideration  of  all  problems  bearing  on  the  rela- 
tionship between  physicians  and  hospitals  except 


those  pertaining  to  medical  training.  A prime  ob- 
jective of  the  committee  is  to  encourage  hospital 
staffs  to  become  actively  interested  in  the  eco- 
nomics of  hospital  operation  and  hospital  services. 
In  areas  of  health  insurance,  nursing  and  items 
requiring  legislative  action,  the  committee  should 
coordinate  its  activities  with  the  respective  com- 
mittees of  the  society  to  avoid  duplication  of 
effort. 

The  committee  will  continue  to  work  toward 
solving  mutual  problems  pertaining  to  hospital 
utilization;  medical,  nursing  and  administrative 
care  of  patients;  hospital  costs;  accreditation  of 
nonaccredited  hospitals;  and  to  improve  physi- 
cian-hospital relationships  in  the  interest  of  pa- 
tient care. 


COMMITTEE  ON  IMPARTIAL  MEDICAL  TESTIMONY 
(Medical-Legal  Council) 

Clinton  L.  Compere,  Chairman 
111  N.  Michigan,  Chicago  60611 
R.  Gregory  Green 

1355  Charles  St.,  Rockford  61108 
Jerome  J.  McCullough 

110  N.  High  St.,  Belleville  62202 
Maurice  D.  Murfin 
250  N.  Water  St.,  Decatur  62523 
Consultants: 

Samuel  A.  Levinson 

3730  Lake  Shore  Dr.,  Chicago  60613 
Vincent  C.  Sarley 

811  Wellington  Ave.,  Chicago  60657 
Staff  : Mel  Sloan 
Responsibilities  and  Purposes 

The  Committee  shall  cooperate  with  the  judi- 
ciary in  both  federal  and  state  courts  within  the 
state  of  Illinois.  It  shall,  when  requested  by  the 
court,  implement  the  Impartial  Medical  Testimony 
panel. 


/or  October,  1968 


429 


ADVISORY  COMMITTEE  TO  INTERPROFESSIONAL  GROUPS 
(Council  on  Public  Relations) 


James  D.  Majarakis,  Chairman 

30  N.  Michigan  Ave.,  Chicago  60602 
Lawrence  J.  Bowness 

9135  S.  Exchange  Ave.,  Chicago  60617 
Walter  J.  Reedy 

814  Washington  St.,  Waukegan  60085 
George  Callahan 

4 S.  Genesee  St.,  Waukegan  60085 
Eugene  L.  Vickery 

202  S.  Schuyler  St.,  Lena  61048 
David  Whitsell 

2441  W.  79th  St.,  Chicago  60652 


Consultants: 

Caesar  Fortes 

25  E.  Washington,  Chicago  60602 
E.  A.  Piszczek 

6410  N.  Leona  St.,  Chicago  60646 
Staff:  Gary  Kennon 

Responsibilities  and  Purposes 

This  committee  shall  maintain  general  liaison 
with  the  officers  and  members  of  other  professions, 
conduct  programs  and  activities  which  will  en- 
hance the  relationship  between  the  professions.  It 
shall  serve  especially  to  provide  liaison  with  the 
Interprofessional  Council. 


JOURNAL  (PUBLICATIONS)  COMMITTEE 
(Board  of  Trustees) 


Jacob  E.  Reisch,  Chairman 

1129  S.  2nd  St.,  Springfield  62704 
J.  Ernest  Breed 

55  E.  Washington  St.,  Chicago  60602 
Darrell  H.  Trumpe 

St.  John’s  Sanatorium,  Springfield  62707 
Warren  W.  Young 

10816  Parnell  Ave.,  Chicago  60628 

Staff:  Richard  A.  Ott 

Staff  Advisor:  Roland  I.  King 

Responsibilities  and  Purposes 

The  Journal  (Publications)  Committee  shall  be 
composed  of  members  of  the  Board  of  Trustees, 
and  shall  be  responsible  for  the  production  of  the 
Illinois  Medical  Journal  and  other  Society  publi- 
cations. 

It  shall  recommend  to  the  Board  of  Trustees 
all  policies  governing  the  editorial,  business  and 
production  aspects  of  the  Journal.  It  shall  super- 
vise the  editor  in  the  selection  and  preparation 
of  all  copy,  and  it  shall  establish  standards  for 
the  editorial  content. 

It  shall  establish  advertising  policies,  rates,  and 
standards,  and  shall  review  all  new  accounts  prior 
to  acceptance,  and  shall  approve  reprint  and  cir- 
culation policies. 

It  shall  conduct  a periodic  review  of  the  print- 
er’s contract  and  solicit  bids  as  indicated.  It  shall 
establish  the  format,  cover,  type  faces  and  gen- 
eral layout  of  the  Journal. 


EDITORIAL  BOARD 

Sub-Committee  of  Journal  Committee 

Edwin  F.  Hirsch,  Chairman 

5830  Stony  Island  Ave.,  Chicago  60637 
James  H.  Hutton 

67  E.  Madison  St.,  Chicago  60603 
Samuel  A.  Levinson 

3730  Lake  Shore  Dr.,  Chicago  60613 
Charles  Mrazek 

1210  Robin  Hood  Lane,  LaGrange  Park  60525 
C.  J.  Mueller 

108  W.  4th  St.,  Sterling  61081 
Frederick  Steigman 

1825  W.  Harrison  St.,  Chicago  60612 
Frederick  Stenn 

6400  S.  Kedzie  Ave.,  Chicago  60629 
Arkell  M.  Vaughn 

9012  S.  Leavitt  Ave.,  Chicago  60643 

Staff:  Richard  A.  Ott 

Responsibilities  and  Purposes 

The  responsibilities  of  this  committee  lie  in 
the  area  of  the  editorial  content  of  the  Illinois 
Medical  Journal,  and  it  will  function  as  a sub- 
committee of  the  Journal  Committee.  It  shall 
make  recommendations  to  the  editor  concerning 
the  scientific  content,  regular  features  and  sub- 
jects of  special  interest  to  the  members.  It  shall 
serve  as  a review  board  for  manuscripts  which  the 
editor  believes  require  special  medical  evalua- 
tion. It  shall  assist  the  editor  in  any  way  possible 
to  obtain  and  present  medical  manuscripts  of  the 
highest  quality  and  maximum  interest  to  the  phy- 
sicians of  Illinois. 


430 


Illinois  Medical  Journal 


COMMITTEE  ON  LABORATORY  EVALUATION 
(Medical-Legal  Council) 


Grover  L.  Seitzinger,  Chairman 
812  N.  Logan,  Danville  61832 
Ronald  lessen 

5145  California,  Chicago  60625 
Jack  Williams 

130  E.  Randolph,  Chicago  60601 
Hans  Willuhn 

1335  Charles  St.,  Rockford  61108 


Consultant: 

James  B.  Hartney 

410  Lake  St.,  Oak  Park  60302 
Staff:  Mel  Sloan 
Responsibilities  and  Purposes 

The  committee  shall  effect  methods  of  elevat- 
ing and  maintaining  the  standards  of  medical 
laboratories  in  Illinois,  encourage  the  use  of  medi- 
cal diagnostic  laboratories  supervised  by  duly 
qualified  physicians,  and  encourage  each  county 
and  district  to  establish  evaluation  committees. 


COMMITTEE  ON  LEGISLATION 
(See  Council  on  Legislation 
and  Public  Affairs) 


SUB-COMMITTEE,  ADVISORY 
TO  ILLINOIS  MEDICAL  ASSISTANTS 
ASSOCIATION 

(See  Advisory  Committee  to 
Paramedical  Groups) 


COMMITTEE  ON  MATERNAL  WELFARE 
(Council  on  Scientific  Services) 


Robert  R.  Hartman,  Chairman 

1515  Walnut  St.,  Jacksonville  62650 
Frederick  H.  Falls,  Chairman  Emeritus  & 
Special  Consultant 
Box  47,  River  Forest  60305 
District  Member  and  Alternate 

(alternates  in  italics) 

1.  William  R.  Larsen 

13707  W.  Jackson,  Woodstock  60098 
Hugh  C.  Falls 

711  N.  McKinley  Rd.,  Lake  Forest  60045 

2.  William  J.  Farley 

710  Peoria  St.,  Peru  61354 
Donald  M.  Gallagher 
Box  538,  Granville  61326 

3.  Melvin  Goodman 

13826  Lincoln  Ave.,  Dolton  60419 
Charles  F.  Kramer 

12647  Justine  St.,  Calumet  Park  60643 

4.  V.  B.  Adams 

301  E.  Jefferson,  Macomb  61455 
Ralph  Gibson 

416  St.  Marks  Ct.,  #410,  Peoria  61603 

5.  William  W.  Curtis 

100  W.  Miller  Rd.,  Springfield  62702 
Donald  M.  Barringer 
118  Walnut,  Lincoln  62656 

6.  Robert  R.  Hartman 

1515  Walnut  St.,  Jacksonville  62650 
Hubert  L.  Allen 
1312  Delmar,  Godfrey  62035 


District  Member  and  Alternate 

7.  Paul  A.  Raber 

149  W.  King  St.,  Decatur  62521 
Hubert  Magill 

1170  E.  Riverside,  Decatur  62521 

8.  George  E.  Fagan 

301  E.  Springfield  Ave.,  Champaign  61820 
John  C.  Mason  Jr. 

715  N.  Logan  Ave.,  Danville  61832 

9.  Harry  L.  Lewis 

104  S.  Maple,  Benton  62812 
Donald  R.  Risley 
319  Market  St.,  Mt.  Carmel  62863 

10.  James  B.  Stotlar 

15  N.  Walnut,  Pickneyville  62274 
Berry  V.  Rife 
102  Lafayette,  Anna  62906 

11.  John  J.  McLaughlin 

1000  Jefferson  St.,  Joliet  60435 
Charles  P.  Westfall 
172  Schiller  St.,  Elmhurst  60126 
Consultants  : 

John  Louis 

Hematology  Section 
Stritch  School  of  Medicine 
1400  S.  First  Ave.,  Hines,  60141 


for  October,  1968 


431 


Donaldson  F.  Rawlings,  Chief 
Division  of  Preventive  Medicine 
500  State  Office  Building,  Springfield  62706 
William  R.  Roach 

700  North  Michigan,  Chicago  60611 
(Section  Chairman  OB-GYN) 

Willard  C.  Scrivner 

4601  State  St.,  East  St.  Louis  62205 
Augusta  Webster 

Northwestern  University 
707  N.  Fairbanks  Ct,,  Chicago  60611 
Franklin  D.  Yoder 

503  State  Office  Building,  Springfield  62706 
Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  committee  shall  cooperate  with  the  State 
Department  of  Public  Health  in  reducing  the  ma- 
ternal mortality  rate  in  Illinois.  As  a means  of 
achieving  this  goal,  it  shall  review  all  maternal 
deaths  reported  and  send  its  evaluation  of  the 
management  of  the  case  to  the  attending  physi- 
cian. Appropriate  measures  should  be  taken  to 
share  the  results  of  this  research  with  those  prac- 
titioners in  a position  to  apply  it  for  the  benefit 
of  their  patients. 


MEDICAL  ADVISORY  COMMITTEE  TO 
THE  ILLINOIS  DEPARTMENT 
OF  PUBLIC  AID 
(Council  on  Medical  Service) 


Fred  A.  Tworoger,  Chairman 
4753  Broadway,  Chicago  60640 
Rex  O.  McMorris,  Vice-Chairman 

619  N,  East  Glen  Oak  Ave.,  Peoria  61603 
Louis  Arp,  Jr. 

1409  6th  Ave.,  Moline  61265 
Charles  E.  Baldree,  Jr. 

26  E.  Washington  St.,  Belleville  62220 
James  R.  Cooper 

1416  Maine  St.,  Quincy  62301 
Herbert  Fine 

110  N.  Division,  Carterville  62918 
George  F.  Lull 

2440  N.  Lakeview,  Chicago 
George  T.  Mitchell 

116  S.  5th  St.,  Marshall  62441 
Robert  C.  Muehrcke 

518  N.  Austin  Blvd.,  Oak  Park  60302 
Frank  B.  Norbury 

1515  W.  Walnut  St.,  Jacksonville  62650 
Alphonse  L.  Robinson 

104a  N.  Front,  Mounds  62964 
William  Scanlon 

654-lst  St.,  LaSalle  61301 
John  H.  Steinkamp 

824  Van  Buren  St.,  Belvidere  61008 
R.  Kent  Swedlund 

112  N.  Fourth  St.,  Watseka  60970 
Consultant: 

Jacob  E.  Reisch 

1129  S,  2nd  St.,  Springfield  62704 
Staff:  Don  B.  Freeman 
Responsibilities  and  Purposes 

The  Medical  Advisory  Committee  meets  at  regu- 
lar intervals  with  the  staff  of  the  Illinois  Depart- 
ment of  Public  Aid  to  perform  functions  necessary 
to  the  operation  of  the  medical  program  under 
public  aid.  The  committee  renders  advisory  decis- 
ions on  matters  of  medical  policy  in  the  adminis- 
tration of  the  quality,  quantity,  and  cost  standards 
of  the  various  public  aid  programs.  The  committee 


operates  in  conjunction  with  an  established  system 
of  county  medical  advisory  committees  and  serves 
as  a final  reviewing  body.  It  provides  a channel  of 
communication  between  physicians  and  the  De- 
partment of  Public  Aid  and  strives  to  foster  mutual 
understanding  and  good  relationships. 

The  committee’s  functions  also  include  a con- 
tinuing program  of  education  of  physicians  to 
familiarize  them  with  the  administrative  details 
of  public  aid  programs. 

SUB-COMMITTEE  ON 
DRUGS  & THERAPEUTICS 

Robert  C.  Muehrcke,  Chairman 

518  N.  Austin  Blvd.,  Oak  Park  60302 
Joseph  Cece 

120  Oakbrook  Center,  Oak  Brook  60521 
Charles  R.  Frazer,  Jr. 

1401  Gaty  Ave.,  East  St.  Louis  62201 
Richard  L.  Landau 

950  E.  59th  St.,  Chicago 
Kenneth  Kessel 

9042  W.  31st  St.,  Brookfield 
Consultant: 

Louis  Gdalman,  R.Ph. 

1753  W.  Congress  St.,  Chicago  60612 
Staff:  Mrs.  Pat  Uznanski 
Responsibilities  and  Purposes 

The  committee  will  operate  as  a sub-committee 
of  the  Advisory  Committee  to  the  Illinois  Depart- 
ment of  Public  Aid  and  will  continue  to  work  with 
the  department  in  an  effort  to  keep  the  Drug 
Manual  current  and  effective.  When  suggestions 
and  comments  from  the  members  are  submitted 
to  the  committee,  it  will  review  them  and  present 
them  to  the  Department  of  Public  Aid  when 
necessary.  The  committee  will  also  consider  other 
drug  matters  affecting  the  policy  of  the  medical 
society. 


432 


Illinois  Medical  Journal 


MEDICAL  ECONOMICS  & INSURANCE 
(Council  on  Medical  Service) 


Frederick  Z.  White,  Chairman 
723  N.  2nd  St.,  ChiUicothe  61523 
Don  Mitchell 

140  E.  Market  St.,  McLeansboro  62859 
H.  P.  Swartz 

450  Kennedy  Dr.,  Kankakee  60901 
A.  Everett  Joslyn,  Jr. 

557  Keystone  Ave.,  River  Forest  60305 
Lawrence  J.  Knox 

600  E.  Main  St.,  Olney  62450 
James  B.  Flanagan 

10400  S.  Western,  Chicago 
John  M.  Coleman 

2015  E.  79th  St.,  Chicago 
Paul  Van  Pernis 

1316  Charles  St.,  Rockford  61107 
Staff:  Don  B.  Freeman 


Responsibilities  and  Purposes 

The  functions  of  the  committee  shall  include  its 
continuing  review  of  the  Tax  Qualified  Investment 
Program  (Keogh);  the  Retirement  Investment  Pro- 
gram; the  Group  Disability  Program;  the  Group 
Major  Medical  Program;  and  the  Professional  Li- 
abihty  Insurance  Program.  The  committee  shall 
continue  to  investigate  various  insurance  programs 
that  may  serve  to  benefit  members  of  the  society. 

The  committee  shall  continue  to  assist  in  the 
administration  of  the  presently  sponsored  disability 
program  by  performing  the  adjudication  services 
provided  for  in  the  master  contract. 

Matters  having  an  economic  bearing  on  the  prac- 
tice of  medicine,  including  fact-finding  and  re- 
search studies  in  the  general  field  of  medical  eco- 
nomics, shall  be  brought  before  this  committee 
for  consideration. 

This  committee  shall  study  insurance  plans  pro- 
vided the  membership  of  the  Society,  and  shall 
make  suggestions  for  changes,  additions,  and  can- 
cellation of  pohcies. 


COMMITTEE  ON  MEDICAL  EDUCATION 
(Council  on  Medical  Education) 


Morgan  M.  Meyer,  Chairman 

573  S.  Lombard  St.,  Lombard  60148 
William  F.  Hubble 

866  Citizens  Bldg.,  Decatur  62523 
Jerry  Ingalls 

502  Shaw  Ave.,  Paris  61944 
Mays  C.  Maxwell 

4202  Bond  St.,  East  St.  Louis  62207 
R.  Charles  Oldfield,  Jr. 

40  S.  Clay  St.,  Hinsdale  60521 
F.  H.  Riordan,  III 

6670  State  St.,  Rockford  61108 
Robert  J.  Schafer 

404  W.  Washington  Ave.,  Petersburg  62675 
Representatives  of  Medical  Schools 
Richard  Landau,  University  of  Chicago 
950  E.  59th  St.,  Chicago  60637 
LeRoy  Levitt,  Chicago  Medical  School 
2020  W.  Ogden  Ave.,  Chicago  60612 
Edward  S.  Petersen,  Northwestern  University 
303  E.  Chicago  Ave.,  Chicago  60611 
Wm.  B.  Rich,  Stritch  School  of  Medicine 
Loyola  University  1400  S.  1st  Ave., 

Hines  60141 


Nicholas  J.  Cotsonas,  Jr.,  University  of 
Illinois  at  the  Medical  Center 
Box  6998,  Chicago  60680 
Consultants: 

William  E.  Adams 

55  E.  Erie  St.,  Chicago  60610 
Paul  W.  Sunderland 

214  N.  Sangamon  St.,  Gibson  City  60936 
Philip  G.  Thomsen 

13826  Lincoln  Ave.,  Dolton  60419 
Staff:  Perry  L.  Smithers 

Responsibilities  and  Purposes 

This  committee  shall  (A)  maintain  a continu- 
ing interest  in  the  recruitment  of  students,  in  the 
curricula  of  the  medical  schools  and  in  postgradu- 
ate in-hospital  training  programs;  (B)  carry  to 
the  deans  of  the  medical  schools  recommenda- 
tions from  the  viewpoint  of  the  practicing  physi- 
cian; (C)  encourage  and  implement  the  AMA- 
ERF  program  in  Illinois;  (D)  study,  evaluate  and 
criticize  the  postgraduate  programs  of  ISMS  and 
other  organizations;  and  (E)  be  available  to  advise 
and  cooperate  with  the  Department  of  Registra- 
tion and  Education  of  the  State  of  Illinois. 


/or  October,  1968 


433 


COMMITTEE  ON  MEDICAL  PRACTICE  AND  QUACKERY 
(Medical  Legal  Council) 


William  G.  McCarthy,  Chairman 
13826  Lincoln  Ave.,  Dolton  60419 
Elliott  Parker, 

1630  Fifth  Ave.,  Moline,  61265 
Wilson  West, 

7300  State,  East  St.  Louis  62205 
Ross  Hutchinson, 

126  E.  Ninth,  Gibson  City  60936 
Raymond  B.  Murphy, 

R.R.  3 Box  19,  Robinson  62454 
Staff:  Mel  Sloan 


Responsibilities  and  Purposes 

The  committee  shall  concern  itself  with  the 
illegal  practice  of  medicine  and  other  healing 
arts  groups  associated  with  unfounded  claims  for 
cure  of  disease.  It  shall  cooperate  with  the  legal 
authorities  of  the  state  (such  as  the  office  of  the 
Attorney  General  and  the  Department  of  Regis- 
tration and  Education)  in  providing  information 
and  witnesses  for  the  prosecution  of  violators 
of  the  law.  It  shall  cooperate  with  the  AMA’s 
Department  of  Investigation  and  other  agencies 
interested  in  this  field. 


MEMBERSHIP  COMMITTEE 
(Council  on  Public  Relations) 


Henry  A.  Holle,  Chairman 
160  N.  LaSalle  St.,  Chicago 
Joseph  N.  Bourque 

1465-41st  St.,  Moline  61265 
Burton  J.  Soboroff 

307  N.  Michigan  Ave.,  Chicago  60601 
Andrew  J.  Sullivan 

4258  W.  55th  St.,  Chicago  60632 
Consultant: 

H.  Close  Hesseltine 

5807  S.  Dorchester  Ave.,  Chicago  60637 


Auxiliary  Representation: 

Mrs.  Sherman  C.  Arnold 

2416  Brookwood  Dr.,  Flossmoor  60422 
Staff:  James  Slawny 

Responsibilities  and  Purposes 

The  responsibilities  of  this  committee  shall  in- 
clude the  development  of  orientation  courses  for 
new  members  and  such  other  projects  as  will  en- 
courage participation  in  both  county  and  state 
medical  society  activities. 


60601 


COMMITTEE  ON  MENTAL  HEALTH 
(Council  on  Scientific  Services) 


John  R.  Adams,  Chairman 

707  N.  Fairbanks  Ct.,  Chicago  60611 
Milton  C.  Baumann 

725-2nd  St.,  Springfield  62704 
E.  Eliot  Benezra 

103  Haven  St.,  Ehnhurst  60126 
Robert  S.  Daniels 

950  E.  59th  St.,  Chicago  60637 
Irving  Frank 

135  S.  Sacramento,  Sycamore  60178 
Richard  J.  Graff 

204  Julie  Dr.,  Kankakee  60901 
John  H.  McMahan 

8601  W.  Main  St.,  Belleville  62223 
Walter  P.  Plassman 

Box  552,  Centralia  62801 
Billie  Harold  Shevick 

729-3rd  Ave.,  Moline  61265 


Auxiliary  Representation: 

Mrs.  Thomas  Tourlentes 

Research  Hospital,  Galesburg  61401 
Staff:  Perry  L.  Smithers 

Responsibilities  and  Purposes 

The  responsibilities  of  this  committee  are  as 
follows:  It  shall  serve  as  a source  of  information 
on  mental  health  matters  for  the  ISMS.  It  shall 
evaluate  available  information  and  make  recom- 
mendations to  the  Board  of  Trustees  for  the  posi- 
tion the  ISMS  should  take  on  issues  in  this  area. 
It  shall  also  cooperate  with  institutions  and 
voluntary  health  agencies  in  disseminating  in- 
formation on  mental  health  subjects  to  the  pro- 
fession and  the  public.  It  shall  be  on  the  alert 
for  misleading  or  fallacious  programs  and  infor- 
mation which  need  correcting  for  the  protection 
of  the  public. 


4M 


Illinois  Medical  Journal 


COMMITTEE  ON  NARCOTICS  & HAZARDOUS  SUBSTANCES 
(Council  on  Scientific  Services) 


Joseph  H.  Skom,  Chairman,  707  N.  Fairbanks  Ct., 
Chicago,  60611 

Richard  B.  Eisenstein,  6730  South  Shore  Dr., 
Chicago  60649 

H.  Frank  Holman,  1509  Illinois  Ave.,  East  St. 
Louis  62201 

Jerome  H.  Jaffee,  Dept,  of  Psychiatry, 

950  E.  59th  St.,  Chicago  60649 

Thaddeus  L.  Kostrubala,  Room  526,  506  S.  Wa- 
bash Ave.,  Chicago  60605 

Kermit  T.  Mehlinger.,  4901  S.  Drexel  Ave.,  Chi- 
cago 60615 

David  Slight,  25  E.  Washington  St.,  Chicago  60602 
Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  functions  of  the  Committee  on  Narcotics 
and  Hazardous  Substances  are:  (1)  study,  research 
and  dissemination  of  educational  information  on 
narcotics  and  hazardous  substances  to  members  of 
the  medical  profession;  (2)  to  recommend  accep- 
table measures  for  the  control  of  distribution,  the 
use  and  disposal  of  narcotics  and  hazardous  sub- 
stances, exclusive  of  radiation  products  but  in- 
cluding poison  control,  and  (3)  to  cooperate  with 
official  and  non-official  agencies  in  all  matters 
pertaining  to  this  subject. 


COMMITTEE  ON  NURSING 
(Council  on  Public  Relations) 


W.  I.  Taylor,  Chairman 

28  N.  Main  St.,  Canton  61520 
Raymond  Firfer, 

6846  W.  Cermak  Rd.,  Berwyn  60402 
Roger  Sondag 

518  State  Office  Bldg.,  Springfield  62706 
H.  J.  Kolb 

303  Sherman,  St.  Joseph  61837 
Luke  R.  Pascale 

18668  Dixie  Highway,  Homewood  60430 
Consultant: 

Willard  C.  Scrivner 

4601  State  St.,  East  St.  Louis  62205 
Auxiliary  Representation: 

Mrs.  Mitchell  Spellberg 

7408  S.  Clyde  Ave.,  Chicago  60649 
Staff:  James  Slawny 


Responsibilities  and  Purposes 

The  major  objective  of  this  committee  is  to 
estabUsh  a close  professional  relationship  between 
the  medical  and  nursing  professions  for  the  im- 
provement of  the  health  care  of  the  patient.  It 
should  work  with  representatives  of  the  nursing 
organizations  to  obtain  sound  educational  pro- 
grams for  nurses,  to  improve  the  working  relation- 
ships of  the  doctor  and  nurse  in  the  hospital,  and 
to  help  establish  work  patterns  for  nurses  in  the 
hospital  which  utiUze  the  full  skill  of  the  nurse 
for  the  care  of  the  patient.  The  committee  should 
also  assist  in  programs  to  recruit  more  graduate 
nurses,  registered  nurses,  practical  nurses,  nurses 
aids  and  other  ancillary  nursing  personnel.  It  shall 
function  as  a sub-committee  of  the  Advisory  Com- 
mittee to  Paramedical  Groups. 


COMMITTEE  ON  NUTRITION 
(Council  on  Scientific  Services) 


Paul  A.  Dailey,  Chairman,  620  N.  Main  St.,  Car- 
rollton 62016 

Allan  A.  Filek,  Box  870,  Evanston  60204 
Richard  Icenogle,  Box  188,  Roseville  61473 
Eugene  P.  Johnson,  22  W.  Main  St.,  Casey  62420 
James  Litsey,  1312  W.  Delmar,  Godfrey  62035 
Harvey  D.  Scott,  800  W.  State  St.,  Jacksonville 
62650 

Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  committee  shall  serve  as  a source  of  in- 
formation on  nutrition  matters  for  the  ISMS  and 
evaluate  available  information  and  make  recom- 
mendations to  the  Board  of  Trustees  for  the  posi- 
tion the  ISMS  should  take  on  issues  in  this  area. 
It  shall  cooperate  with  institutions  and  voluntary 
health  agencies  in  disseminating  information  on 
nutrition  subjects  to  the  profession  and  to  the 
public.  It  shall  be  on  the  alert  for  misleading  or 
fallacious  programs  and  information  which  need 
correction  for  the  protection  of  the  public. 


joT  October,  1968 


435 


SUB-COMMITTEE  ON  OCCUPATIONAL  HEALTH 
(See  Committee  on  Public  Health) 

COMMITTEE  TO  STUDY  OSTEOPATHIC  PROBLEMS 
(Board  of  Trustees) 


William  E.  Adams,  Chairman,  55  E.  Erie, 
Chicago  60611 

Charles  K.  Wells,  117  N.  10th  St., 

Mt.  Vernon  62864 

Arthur  F.  Goodyear,  142  E.  Prairie  Ave., 
Decatur  62523 

Paul  P.  Youngberg,  1520  Seventh  St., 
Moline  61265 
Staff  : Roger  N.  White 


Respionsibilities  and  Purposes 

The  responsibilities  of  this  committee  are  to 
assist  in  developing  rapport,  cooperation  with  and 
an  understanding  of  the  osteopathic  profession. 
Its  findings  in  any  specific  instance  shall  be  re- 
ported to  either  the  Board  of  Trustees  or  the 
House  of  Delegates  for  consideration  and  action. 
The  committee  shall  study  and  report  on  the  pre- 
sent situation  in  Illinois  in  view  of  recent  action 
by  the  AMA  House,  and  keep  the  Board  informed 
of  any  changes  in  relationship  between  the  two 
professions. 


ADVISORY  COMMITTEE  TO  PARAMEDICAL  GROUPS 
(Council  on  Public  Relations) 


Thomas  R.  Harwood,  Chairman 

4902  Tollview  Rd.,  Rolling  Meadows  60008 
Maynard  I.  Shapiro 

7531  Stony  Island  Ave.,  Chicago  60649 
Robert  E.  Lynn 

209  Henry  St.,  Alton  62002 
William  Mohlenbroch 

108  N.  14th  St.,  Murphysboro  62966 
Edward  J.  Krol 

4255  W.  63rd  St.,  Chicago  60629 
Burton  M.  Krimmer 

5736  W.  North  Ave.,  Chicago  60639 
Paul  G.  Theobold 

1210  Towanda,  Bloomington  61701 
Allison  Burdick,  Jr. 

5906  W.  North  Ave.,  Chicago  60639 
Consultants: 

E.  A.  Piszczek 

6410  N.  Leona,  Chicago  60646 
Carl  Clark 

225  Edwards  St.,  Sycamore  60178 


Casper  Epsteen 

25  E.  Washington  St.,  Chicago  60602 
James  B.  Hartney 

410  Lake  St.,  Oak  Park  60301 
Auxiliary  Representative: 

Mrs.  John  W.  Koenig 
2518  Oakwood  Dr.,  Olympia  Fields  60461 
Staff:  Gary  Kennon 

Responsibilities  and  Purposes 

The  Advisory  Committee  to  Paramedical 
Groups  serves  as  liaison  between  the  Illinois  State 
Medical  Society  and  the  Health  Careers  Council 
of  Illinois,  the  Illinois  Medical  Assistants  Associa- 
tion and  the  five  Illinois  chapters  of  the  Student 
American  Medical  Association,  and  with  any 
other  such  organizations  developed  in  the  future. 
It  shall  also  advise  and  assist  these  organizations 
in  the  development  of  new  financial  resources 
needed  to  maintain  their  operations. 


POLICY  COMMITTEE 
(Board  of  Trustees) 

William  E.  Adams,  Chairman,  55  E.  Erie  St., 
Chicago  60611 

Arthur  F.  Goodyear,  142  E.  Prairie  Ave.,  De- 
catur 62523 

Paul  P.  Youngberg,  1520  Seventh  St.,  Moline 
61265 

Staff:  Frances  C.  Zimmer 
Responsibilities  and  Purposes 

The  Policy  Committee  shall  consist  of  three 
members  of  the  Board  appointed  by  the  chairman. 
It  shall  continually  review  past  and  current  pro- 
ceedings of  the  House  of  Delegates  to  determine 
the  established  policies  of  the  Illinois  State  Medi- 
cal Society. 


LS(j 


Illinois  Medical  Journal 


COMMITTEE  ON 

PREPAYMENT  PLANS  AND  ORGANIZATIONS 
(Council  on  Medical  Service) 


Preston  S.  Houk,  Chairman 

207  Parkview  Dr.,  Bloomington  61701 
C.  P.  Cunningham 

2526  18th  Ave.,  Rock  Island 
B.  A.  Kinsman 

20714  E.  Main  St.,  DuQuoin  62832 
Philip  Lynch 

1314  N.  Main  St.,  Decatur  62526 
Theodore  J.  Wachowski 

310  Ellis  Ave.,  Wheaton  60187 
James  P.  FitzGibbons 

4753  N.  Broadway,  Chicago  60640 


Consultant: 

Jacob  E.  Reisch 

1129  S.  2nd  St.,  Springfield  62704 
Staff:  Don  B.  Freeman 
Responsibilities  and  Purposes 

The  function  of  the  committee  is  to  provide  a 
channel  of  communication  between  the  health  in- 
surance industry.  Blue  Cross-Blue  Shield  Plans, 
and  the  Illinois  State  Medical  Society  on  matters 
of  mutual  concern.  Specific  problems  which  may 
arise  as  a result  of  this  liaison  will  be  referred  to 
appropriate  committees  for  detailed  study. 


COMMITTEE  ON  PUBLIC  AFFAIRS 
(Council  on  Legislation  & Public  Affairs) 


Theodore  Grevas,  Chairman  1800  Third  Ave., 
Rock  Island  61201 

Edward  C.  Albers,  Christie  Clinic,  104  W.  Clark 
St.,  Champaign  61820 

William  F.  Ashley,  6545  W.  33rd  St.,  Berwyn 
60402 

William  W.  Boswell,  2500  N.  Rockton  Ave., 
Rockford  61103 

Herschel  L.  Browns,  4600  N.  Ravenswood  Ave., 
Chicago  60640 

James  E.  Coeur,  630  Locust  St.,  Carthage  62321 

Edwin  L.  Fallon,  9543  S.  Central  Park,  Evergreen 
Park  60642 

Justin  Fleischmann,  320  South  Ela  Rd.,  Palatine 
60067 

George  L.  Gertz,  2376  E.  71st  St.,  Chicago  60649 

A.  Z.  Goldstein,  Rosiclare  62982 

P.  H.  Heller,  1173  Algonquin  Rd.,  Des  Plaines 
60018 

William  J.  Hillstrom,  280  Virginia  Ave.,  Crystal 
Lake  60014 

W.  Robert  Malony,  Carbondale  Clinic,  Carbondale 
62901 

John  W.  Ovitz,  Jr.,  204  W.  Elm  St.,  Sycamore 
60178 

Paul  A.  Raber,  149  W.  King  St.,  Decatur  62521 

James  D.  Rogers,  120  Scott  St.,  Joliet  60531 

Peter  C.  Rumore,  401  N.  Mulberry  St.,  Effingham 
62401 

Stanley  E.  Ruzich,  9944  Damen  Ave.,  Chicago 
60643 

James  H.  Ryan,  1309  E.  Court  St.,  Kankakee 
60901 

John  L.  Savage,  723  Elm  St.,  Winnetka  60093 


Julius  P.  Schweitzer,  120  Oakbrook  Mall,  Oak 
Brook  60521 

D.  William  Sherrick,  2325  Sylvan  Rd.,  Springfield 
62704 

Eugene  H.  Siegel,  103  Haven  Rd.,  Elmhurst  60126 
Lorin  D.  Whittaker,  840  Jefferson  Building,  Peoria 
61602 

Herbert  Sohn,  4640  N.  Marine  Dr.,  Chicago  60640 
Frederick  Weiss,  15318  Center,  Harvey  60426 
Consultants: 

J.  Ernest  Breed,  55  E.  Washington,  Chicago  60602 
Frank  J.  Jirka,  Jr.,  1507  Keystone,  River  Forest 
60305 

Philip  G.  Thomsen,  13826  Lincoln  Ave.,  Dolton 
60419 

Auxiliary  Representation: 

Mrs.  David  Kweder,  1432  N.  Sheridan  Rd., 
Waukegan  60085 
Staff:  Dan  Morgan 
Responsibilities  and  Purposes 

The  Public  Affairs  Committee  is  concerned  with 
the  political  process  as  it  pertains  to  medicine  and 
public  health.  Within  this  broad  context,  appropri- 
ate education  of  the  public  is  basic  to  continue 
health  improvement  in  a free  society.  The  elector- 
ate must  make  its  wishes  known  to  public  offici- 
als. 

The  Public  Affairs  Committee  shall  strive  to 
generate  interest  in  the  overall  field  of  politics  to 
enable  the  physician  to  participate  effectively.  Pro- 
grams of  public  affairs  orientation,  political  edu- 
cation and  campaign  characteristics  will  be  under- 
taken to  increase  the  effectiveness  of  the  physician 
in  public  affairs. 


for  October,  1968 


437 


COMMITTEE  ON  PUBLIC  HEALTH 
(Council  on  Scientific  Services) 


Edward  A.  Piszczek,  Chairman,  6410  N.  Leona, 
Chicago  60646 

Kenneth  G.  Bulley,  1329  N.  Lake  St.,  Aurora 
60506 

Clifton  Hall,  504  State  Office  Bldg.,  Springfield 
62706 

Edward  C.  Holmblad,  1350  Lake  Shore  Dr.,  Chi- 
cago 60610 

John  S.  Hyde,  715  Lake  St.,  Oak  Park  60301 
George  H.  Irwin,  1791  Howard,  Chicago  60626 
David  F.  Lowen,  400  W.  Hay  St.,  Decatur  62526 
Robert  J.  Maganini,  727  W.  Hickory  St.,  Hins- 
dale 60521 

Karl  H.  Pfuetze,  55  & County  Line  Rd.,  Hinsdale 
60521 

Arthur  E.  Sulek,  2710  Bradley  Rd.,  Rockford 
61107 

Consultant; 

Warren  W.  Young,  10816  Parnell  Ave.,  Chi- 
cago 60628 

Staff  : Perry  L.  Smithers 
Responsibilities  and  Purposes 

The  Committee  on  Public  Health  shall  cooper- 
ate with  the  Illinois  Department  of  Public  Health 
in  certain  specific  areas.  Its  responsibilities  shall 
include  the  maintenance,  protection  and  improve- 


ment of  the  health  of  the  people  of  Illinois  through 
organized  community  efforts. 

It  shall  serve  as  a source  of  information  on  tu- 
berculosis and  cooperate  with  institutions  and  vol- 
untary health  agencies  in  disseminating  such  infor- 
mation. 

The  committee  should  encourage  the  establish- 
ment of  county  or  multi-county  health  units,  work 
with  the  state  department  in  immunization  pro- 
grams or  specific  programs  designed  to  diagnose 
and  refer  certain  communicable  diseases. 

It  is  responsible  for  medicine’s  interest  in  the 
relationship  of  man  to  his  surroundings,  particular- 
ly air,  water  and  soil  pollution;  health  problems 
related  to  population  growth;  urbanization  and 
technological  developments  bearing  on  the  ecology 
of  man. 

The  committee  also  shall  be  concerned  with  dis- 
eases and  problems  associated  with  occupational 
and  industrial  health;  cooperate  with  the  Council 
on  Occupational  Health  of  AMA,  Industrial 
Medical  Association  and  similar  state  agencies 
and  to  recommend  to  the  State  of  Illinois  Work- 
man’s Compensation  Board  medical  procedures  de- 
signed to  assist  the  Board  in  the  evaluation  of 
claims. 


COMMITTEE  ON  PUBLIC  RELATIONS 
(Council  on  Public  Relations) 


Matthew  B.  Eisele,  Chairman 

4601  State  St.,  East  St.  Louis  62205 
William  H.  Harridge 

636  Church,  Evanston  60201 
Charles  S.  Vil 

9450  S.  Francisco  St.,  Evergreen  Park  60642 
Charles  I.  Weigel 

7579  Lake  St.,  River  Forest  60305 
Lee  F.  Winkler 

850  S.  Fourth  St.,  Springfield  62703 
Consultants: 

Jacob  E.  Reisch 

1129  S.  Second  St.,  Springfield  62704 


Paul  W.  Sunderland 

214  N.  Sangamon  St.,  Gibson  City  60936 
Leo  P.  A.  Sweeney 

2658  W.  95th  St.,  Evergreen  Park  60642 
Staff:  James  Slawny 
Responsibilities  and  Purposes 

The  Committee  on  Public  Relations  shall  consist 
of  five  members  appointed  by  the  Board  of  Trus- 
tees. 

It  shall  plan  and  execute  programs  designed  to 
enhance  the  relationship  between  the  public  and 
the  medical  profession.  It  shall  request  the  Board 
of  Trustees  to  appoint  sub-committees  to  accom- 
plish specific  purposes. 


COMMITTEE  ON  PUBLIC  SAFETY 
(Council  on  Public  Relations) 


Edwin  A.  Lee,  Chairman 

501  S.  13th  St.,  Springfield  62703 
fames  P.  Campbell 

322  N.  Blanchard  St.,  Wheaton  60187 
fulius  M.  Kowalski 
436  Park  Ave.,  East,  Princeton  61356 
Norman  J.  Rose 

400  S.  Spring  St.,  Springfield  62706 
Clifford  P.  Sullivan 

2800  W.  87th  St.,  Chicago  60652 
Donald  S.  Miller 
6 N.  Michigan,  Chicago  60602 


Auxiliary  Representation: 

Mrs.  Arthur  A.  Smith 

206  Country  Club  Lane,  Belleville  62223 
Staff  : Gary  Kennon 
Responsibilities  and  Purposes 

The  Committee  shall  study  the  medical  aspects 
of  accident  prevention;  alert  the  public  to  season- 
al health  hazards;  and  co-operate  with  the  Illinois 
Department  of  Public  Health,  the  National  Safety 
Council  and  similar  organizations.  It  shall  func- 
tion as  a sub-committee  of  the  Committee  on  Dis- 
aster Medical  Care. 


L38 


Illinois  Medical  Journal 


COMMITTEE  ON  RADIATION 
(Council  on  Scientific  Services) 


Howard  C.  Burkliead,  Chairman 
130  Dempster  St.,  Evanston  60201 
Abram  H.  Cannon, 

194  Michael  John  Dr.,  Park  Ridge  60068 
Stephen  L.  Casper, 

1101  Maine  St.,  Quincy  62301 
J.  Homer  Goodlad, 

221  N.  E.  Glen  Oak  Ave.,  Peoria  61603 
Stuart  P.  Lippert, 

7 Pitner  PL,  Jacksonville  62650 
Howard  C.  Neucks, 

602  W.  University,  Urbana  61801 
James  J.  Nickson, 

2900  S.  Ellis  Ave.,  Chicago  60616 
Hyman  R.  Osheroff, 

420  S.  Harlem,  Freeport  61032 
Norman  R.  Shippey, 

4601  State  St.,  East  St.  Louis  62205 
Raymond  B.  White, 


9333  S.  Damen  Ave.,  Chicago  60620 
Consultant: 

J.  Ernest  Breed 

55  E.  Washington  St.,  Chicago  60602 
Carl  E.  Clark 

225  Edwards  St.,  Sycamore  60178 
Staff:  Perry  L.  Smithers 
Responsibilities  and  Purposes 

The  committee  shall  serve  as  a source  of  in- 
formation on  radiation  matters  for  ISMS  and 
evaluate  available  information  and  make  recom- 
mendations to  the  Board  for  the  position  ISMS 
should  take  on  issues  in  this  area.  It  shall  coop- 
erate with  institutions  and  voluntary  health  agen- 
cies in  disseminating  information  on  radiation 
subjects  to  the  profession  and  to  the  public.  It 
shall  be  on  the  alert  for  misleading  or  fallacious 
programs  and  information  which  need  correcting 
for  the  protection  of  the  pubhc. 


COMMITTEE  ON  REHABILITATION  SERVICES 
(Council  on  Scientific  Services) 


Henry  B.  Betts,  Chairman, 

401  E.  Ohio  St.,  Chicago  60611 
Eli  L.  Borkon, 

Box  1030,  Carbondale  62901 
Bruce  C.  Ehmke, 

Suite  1112,  411  Hamilton  Blvd.,  Peoria  61602 
John  E.  Finch, 

135  S.  Kenilworth,  Elmhurst  60126 
Frank  B.  Kelly,  Jr., 

122  S.  Michigan  Ave.,  Chicago  60603 
Joseph  L.  Koczur, 

9143  S.  Ashland  Ave.,  Chicago  60620 
John  G.  Meyer, 

413  W.  Monroe,  Springfield  62704 
Arthur  A.  Rodriquez, 

9145  S.  Ashland  Ave.,  Chicago  60620 
Consultant: 

Frank  J.  Jirka,  Jr. 

1507  Keystone  Ave.,  River  Forest  60305 
Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  committee  shall  render  assistance  to  public 
and  private  agencies  in  the  establishment  of  policies 
regarding  rehabilitation  facilities  to  be  used  and 
selection  of  patients  for  these  services;  encourage 
the  training  of  rehabilitation  personnel,  thereby 
promulgating  high  quality  care;  and  assist  when 
possible  to  see  that  adequate  medically  supervised 
rehabilitation  services  be  made  available  in  all 
hospitals,  according  to  the  need  of  the  hospitals. 

The  committee  shall  also  provide  liaison  be- 
tween the  ISMS  and  the  Division  of  Vocational 
Rehabilitation,  the  Department  of  Public  Aid,  and 
other  official  or  non-official  agencies  which  pur- 
chase rehabilitation  care  for  patients.  The  com- 
mittee also  works  closely  with  the  Governor’s 
Committee  on  Employment  of  the  Handicapped 
when  called  upon  for  its  advice  and  counsel. 


SUB-COMMITTEE  ON  RELATIVE  VALUE 
(See  Committee  on  Medical  Economics  & Insurance) 


COMMITTEE  ON  RELIGION  & MEDICINE 
(Council  on 


Robert  S.  Mendelsohn,  Chairman 

1100  Hull  Terrace,  Evanston  60202 
Anna  A.  Marcus 

5852  W.  North  Ave.,  Chicago  60639 
Charles  W.  Pfister 

5511  N.  Harlem  Ave.,  Chicago  60656 
Paul  S.  Rhoads 

814  Roslyn  Terrace,  Evanston  60621 
The  Very  Rev.  Msgr.  Armand  J.  Rotondi  (M.D.) 

504  Lockport,  Plainfield  60544 
William  H.  Whiting 

Box  410,  525  N.  Main  St.,  Anna  62906 

/or  October,  1968 


Public  Relations) 

Rabbi  E.  H.  Prombaum 

5030  N.  Hamlin,  Chicago  60625 
Rev.  John  Marren 

916  S.  Wolcott,  Chicago  60612 
Rev.  Christian  Hovde 

116  S.  Michigan  Ave.,  Chicago  60603 
Consultants: 

J.  Ernest  Breed 

55  E.  Washington  St.,  Chicago  60602 
Caesar  Portes 

25  E.  Washington  St.,  Chicago  60602 


439 


Auxiliary  Representation: 

Mrs.  Sherman  C.  Arnold 

2416  Brookwood  Dr.,  Flossmoor  60422 
Mrs.  John  W.  Koenig 

2518  Oakwood  Drive,  Olympia  Fields 
60461 

Staff:  James  Slawny 


Responsibilities  and  Purposes 

The  committee  is  responsible  for  the  develop- 
ment of  effective  lines  of  communication  between 
the  physicians  and  the  clergymen  leading  to  the 
most  effective  care  and  treatment  of  the  patient 
and  his  family. 


COMMITTEE  ON  RURAL  HEALTH  & STUDENT  LOAN  FUND 
(Council  on  Medical  Education) 


Jack  Gibbs,  Chairman 

24  Main  St.,  Canton  61520 
Charles  N.  Salesman 

1201  N.  Allen  St.,  Robinson  62454 
Donald  L.  Stehr 

102  E.  Market  St.,  Havana  62644 
Consultant: 

Jacob  E.  Reisch 

1129  S.  2nd  St.,  Springfield  62704 
Staff:  Roland  I.  King 


Responsibilities  and  Purposes 

The  committee  shall  be  responsible  to  the  Board 
of  Trustees  in  matters  related  to  improving  the 
standards  of  health  in  rural  areas  and  with  ad- 
ministration of  the  Student  Loan  Program  oper- 
ated jointly  with  the  Illinois  Agricultural  Associa- 
tion to  induce  physicians  to  practice  in  rural 
areas.  Members  of  the  committee  shall  be  ap- 
pointed by  the  Board  for  terms  of  one  year.  The 
committee  shall  work  closely  with  the  Illinois 
Agricultural  Association  in  efforts  to  improve 
the  standard  of  health  in  farm  areas. 


COMMITTEE  ON 
SCIENTIFIC  ASSEMBLY 
(Council  on  Medical  Education) 


Robert  T.  Fox,  Chairman 

2136  Robin  Crest  Lane,  Glenview  60025 
J.  Robert  Thompson,  Director  of  Exhibits 
1129  N.  Elmwood  Ave.,  Oak  Park  60302 
Coye  C.  Mason,  Assistant  Director  of  Exhibits 
2056  N.  Clark  St.,  Chicago  60614 
George  E.  Block 

950  E.  59th  St.,  Chicago  60637 
John  J.  Brosnan 

9156  S.  Francisco,  Evergreen  Park  60642 
Robert  R.  Fahringer 

1230  S.  6th  St.,  Springfield  62706 
Charles  P.  McCartney 

5841  S.  Maryland,  Chicago  60637 
Harold  P.  McGinnes 

2304  E.  Oakland  Ave.,  Bloomington  61701 
Donald  L.  Unger 

185  N.  Wabash  Ave.,  Chicago  60601 
Auxiliary  Representation  : 

Mrs.  John  Van  Prohaska 

5830  S.  Stony  Island  Ave.,  Chicago  60637 
Mrs.  Maurice  Goldstein 

6853  N.  Hiawatha  Ave.,  Chicago  60646 
Staff:  Perry  L.  Smithers 
Responsibilities  and  Purposes 

The  Committee  on  Scientific  Assembly  shall 
consist  of  nine  members  appointed  by  the  Board 
of  Trustees.  It  shall  coordinate  the  programs  for 
the  general  assemblies;  the  section  meetings  and 
the  scientific  exhibits  at  the  annual  convention; 
shall  appoint,  with  the  approval  of  the  Board, 
a secret  committee  to  make  awards  to  the  scien- 
tific exhibitors;  may  incorporate  in  the  annual 
scientific  meeting  those  meetings  of  medical 
specialty  groups  which  wish  to  affiliate  with  the 
ISMS  annual  convention,  and  shall  arrange  for 


the  annual  banquet  and  other  functions  held  dur- 
ing the  annual  convention. 

SCIENTIFIC  MEETINGS 

(A)  with  the  consent  of  the  House  of  Delegates 
or  the  Board  of  Trustees  any  special  group  may 
conduct  its  meeting  in  connection  with  the  an- 
nual convention  of  the  ISMS  (B)  for  the  trans- 
action of  scientific  business,  there  shall  be  one 
or  more  sections  as  may  be  determined  from 
year  to  year  by  the  Board  of  Trustees  (C)  sec- 
tion officers  shall  be  appointed  by  the  president 
of  the  Society  from  nominees  recommended  by 
the  section,  or  if  there  are  no  nominees,  from 
a list  submitted  by  the  Chairman  of  the  Com- 
mittee on  Scientific  Assembly  (D)  the  officers  of 
the  sections  shall  arrange  the  scientific  program 
for  the  section  in  cooperation  with  the  commit- 
tee (E)  all  registered  members  may  attend  and 
participate  in  the  proceedings  and  discussions  of 
the  general  scientific  meetings  and  of  the  section 
meetings  (F)  the  general  scientific  meetings  may 
recommend  to  the  House  of  Delegates  the  ap- 
pointment of  committees  or  commissions  for 
scientific  investigation  of  special  interest  and  im- 
portance to  the  profession  and  to  the  public  (G) 
all  papers  read  before  the  Society  or  any  section 
thereof,  shall  become  the  property  of  the  Society. 
Each  paper  shall  be  deposited  with  the  secre- 
tary when  read,  and  presentation  of  the  paper 
in  the  ILLINOIS  MEDICAL  JOURNAL  shall  be 
considered  tantamount  to  the  assurance  on  the 
part  of  the  writer  that  such  paper  has  not  already 
been  published  (H)  The  Board  of  Trustees  shall 
be  entirely  responsible  for  the  annual  convention. 


440 


Illinois  Medical  Journal 


SCIENTIFIC  SECTION  CHAIRMEN 

ALLERGY 

Donald  B,  Frankel 
111  N.  Wabash  Ave.,  Chicago  60601 
DERMATOLOGY 

Malcolm  C.  Spencer 
605  N.  Logan  Ave.,  Danville  61832 
EYE,  EAR,  NOSE  and  THROAT 
E.  M.  Skolnick 

64  Old  Orchard,  Skokie  60076 
INTERNAL  MEDICINE 
Angelo  P.  Creticos 

67  E.  Madison  St.,  Room  1505  Chicago 
60603 

NEUROLOGY  & PSYCHIATRY 
David  Swanson 

Dept,  of  Neurology  & Psychiatry 
Stritch  School  of  Medicine 
1400  S.  1st  Ave.,  Hines  60141 


OBSTETRICS  and  GYNECOLOGY 
William  R.  Roach 

700  N.  Michigan  Ave.,  Chicago  60611 
PATHOLOGY 

Elizabeth  A.  McGrew 
1853  W.  Polk  St.,  Chicago  60612 
PEDIATRICS 

Ira  M.  Rosenthal 
700  S.  Wood  St.,  Chicago  60612 
PHYSICAL  MEDICINE  and  REHABILITATION 
W.  T.  Liberson 

VA  Hospital,  P.O.  Box  28,  Hines  60141 
PREVENTIVE  MEDICINE  & PUBLIC  HEALTH 
Roger  F.  Sondag 

518  State  Office  Bldg.,  Springfield  62706 
RADIOLOGY 

Richard  E.  Buenger 

1753  W.  Congress  Parkway,  Chicago  60612 
SURGERY 

Roderick  H.  Maguire 

106  Martin  Ave.,  Canton  61520 


SUB-COMMITTEE,  ADVISORY  TO 
STUDENT  AMERICAN  MEDICAL  ASSOCIATION 
(See  Advisory  Committee  to 
Paramedical  Groups) 


SUB-COMMITTEE  ON  TUBERCULOSIS 
(See  Committee  on  Public  Health) 


COMMITTEE  ON 
USUAL  AND  CUSTOMARY  FEES 
(Board  of  Trustees) 


Joseph  R.  O’Donnell,  Chairman 
444  Park  Blvd.,  Glen  EUyn  60137 
W.  C.  Scrivner 

4601  State  St.,  East  St.  Louis  62205 
James  B.  Hartney 

410  Lake  St.,  Oak  Park  60302 
J.  Mather  Pfeiffenberger 

State  & WaU  Sts.,  Alton  62004 
Joseph  L.  Bordenave 

1665  South  St.,  Geneva  60134 
Staff:  James  Slawny 
Responsibilities  and  Purposes 

The  Committee  on  Usual  & Customary  Fees  was 
appointed  by  the  Board  of  Trustees  to  define  the 


concepts  of  usual,  customary,  and  reasonable  fees, 
and  to  develop  guidelines  for  the  implementation 
of  these  concepts  at  the  county,  district,  and  state 
society  level.  In  carrying  out  the  directive  that 
physicians  be  reimbursed  on  the  basis  of  their  usual 
and  customary  fees  without  reference  to  existing 
fee  schedules,  the  committee  meets  with  repre- 
sentatives of  health  insurance  carriers,  government 
intermediaries,  and  government  agencies  who  pay 
for  medical  services,  and  reviews  the  adequacy  and 
appropriateness  of  physician  reimbursement  in 
accordance  with  the  position  of  the  Board  of  Trus- 
tees and  the  House  of  Delegates. 


ADVISORY  COMMITTEE 
TO  THE  WOMAN'S  AUXILIARY 
(Board  of  Trustees) 


Edward  W.  Cannady,  Chairman 

4601  State  St.,  East  St.  Louis  62205 

Philip  G.  Thomsen 

13826  Lincoln  Ave.,  Dolton  60419 

Frank  J.  Jirka,  Jr. 

1507  Keystone  Ave.,  River  Forest  60305 
Staff:  Roger  N.  White 


Responsibilities  and  Purposes 

The  committee  shall  consist  of  the  president- 
elect as  chairman,  the  president,  the  chairman 
of  the  board.  The  committee  shall  provide  advice 
and  assistance  to  the  president  of  the  Woman’s 
Auxiliary  in  her  program  for  the  year,  and  shall 
assist  her  in  interpreting  the  activities  of  the  state 
medical  society  to  the  auxiliary  members. 


/or  October,  1968 


441 


COMMITTEE  INDEX 


Committee 

Aging 

Alcoholism 

Archives 

Benevolence  see  Finance 
Cancer  Control 
Child  Health 

Committees,  Committee  on 

Constitution  & Bylaws 

Continuing  Education 

Disaster  Medical  Care 

Drugs  & Therapeutics,  Sub-Committee 

Editorial  Board,  Sub-Committee 

Educational  & Scientific  Foundation 

Ethical  Relations 

Executive 

Eye 

Finance 

Health  Careers  Council, 
see  Paramedical  Groups 
Hospital  Relations 
Impartial  Medical  Testimony 
Interprofessional  Groups,  Adv.  to 
Journal  (Publications) 

Laboratory  Evaluation 
Maternal  Welfare 

Medical  Assistants  Assn.,  see  Paramedical  Groups 

Medical  Economics  & Insurance 

Medical  Education 

Medical  Practice  and  Quackery 

Membership 

Mental  Health 

Narcotics  & Hazardous  Substances 

Nursing 

Nutrition 

Osteopathic  Problems,  to  study 
Paramedical  Groups,  Adv.  to 
Policy 

Prepayment  Plans 
Public  Affairs 

Public  Aid,  Medical  Adv.  to  111.  Dept,  of 

Public  Health 

Public  Relations 

Public  Safety 

Radiation 

Rehabilitation  Services 

Religion  & Medicine 

Rural  Health  & Student  Loan  Fund 

Scientific  Assembly 

Scientific  Section  Chairmen 

Usual  & Customary  Fees 

Woman’s  Auxiliary,  Adv.  to 


Council 

Page 

Medical  Service 

423 

Scientific  Services 

424 

Board  of  Trustees 

424 

429 

Scientific  Services 

424 

Scientific  Services 

425 

Board  of  Trustees 

425 

Board  of  Trustees 

425 

Medical  Education 

426 

Public  Relations 

426 

Medical  Service 

426 

Board  of  Trustees 

430 

Board  of  Trustees 

426 

Judicial 

All 

Board  of  Trustees 

428 

Legislation  & Public  Affairs 

428 

Board  of  Trustees 

428 

436 

Public  Relations 

429 

Judicial 

429 

Public  Relations 

430 

Board  of  Trustees 

430 

Medical  Legal 

431 

Scientific  Services 

431 

436 

Medical  Service 

433 

Medical  Education 

433 

Medical  Legal 

434 

Public  Relations 

434 

Scientific  Services 

434 

Scientific  Services 

435 

Public  Relations 

435 

Scientific  Services 

435 

Board  of  Trustees 

436 

Public  Relations 

436 

Board  of  Trustees 

436 

Medical  Service 

437 

Legislation  & Public  Affairs 

437 

Medical  Service 

432 

Scientific  Services 

438 

Public  Relations 

438 

Public  Relations 

438 

Scientific  Services 

439 

Scientific  Services 

439 

Public  Relations 

439 

Medical  Education 

440 

Medical  Education 

440 

Medical  Education 

441 

Board  of  Trustees 

441 

Board  of  Trustees 

441 

442 


Illinois  Medical  journal 


ISMS  SERVICES 


Pursuit  of  Obligations 

Purposes  of  the  Illinois  State  Medical  So- 
ciety are: 

• to  promote  the  science  and  art  of  medicine 

• to  protect  the  public  health 

• to  evaluate  the  standards  of  medical  education 

• to  unite  the  medical  profession  behind  these 
purposes,  and 

• to  unite  with  similar  organizations  in  other 
states  and  territories  of  the  United  States  to 
form  the  American  Medical  Association. 

The  Society  shall  inform  the  public  and  the  pro- 
fession concerning  the  advancements  in  medical 
science  and  the  advantages  of  proper  medical  care. 

To  fulfill  these  purposes,  the  Society  maintains 
a headquarters  office  at  360  N.  Michigan  Ave., 
Chicago,  and  an  office  in  Springfield  at  520  S. 


for  October,  1968 


Sixth  St.  Services  of  the  Society,  under  the  gen- 
eral supervision  of  Roger  N.  White,  Executive 
Administrator,  are  conducted  by  the  following 
divisions: 

Administration;  Business  Services;  Public  Rela- 
tions and  Economics;  Legislation  and  Public  Af- 
fairs, Publications,  and  Educational  and  Scientific 
Services. 

Many  and  varied  are  the  activities  of  the 
Society  in  pursuit  of  its  obligations.  Some  of 
these  activities  are  major  programs  of  statewide 
(and  sometimes  national)  interest  for  all  citizens; 
others  are  of  special  interest  to  doctors,  and  still 
others  are  sponsored  for  specific  groups  or  in- 
dividuals. 

Following  are  descriptions  of  the  Society’s 
divisions  and  the  programs,  services  and  publi- 
cations available  directly  to  Society  members  or 
sponsored  for  their  benefit. 


44.3 


DIVISION  OF  ADMINISTRATION 


The  Executive  Administrator  has  the  responsi- 
bility and  the  authority  to  provide  for  the  smooth 
and  efficient  functioning  of  the  Illinois  State 
Medical  Society. 

The  implementation  of  established  policy,  fiscal 
and  budgetary  matters,  the  employment  of  quali- 
fied personnel  and  the  development  and  main- 
tenance of  personnel  policies  are  all  part  of  the 
Administrator’s  activities. 

In  order  to  provide  the  membership  of  the  So- 
ciety with  the  best  professional  staff  services 
available,  headquarters  has  been  set  up  by  di- 
visions. The  Division  of  Administration  provides 
many  important  functions. 

This  Division  maintains  liaison  with  the  Board 
of  Trustees  and  assists  the  chairman  in  carrying 
out  his  duties.  Close  cooperation  with  the  speaker 


of  the  House  of  Delegates  and  the  officers  of  the 
Society  provides  a smooth  and  efficient  atmosphere 
in  which  the  Society  may  function. 

The  controlling  factor  in  all  these  areas  is  the 
Constitution  and  Bylaws.  Cooperation  is  main- 
tained with  the  Committee  on  Constitution  and 
Bylaws  to  present  to  the  House  all  suggested 
changes  for  official  action. 

The  Division,  through  the  Administrator,  chan- 
nels all  legal  inquiries  and  works  with  the  General 
Legal  Counsel  and  the  Special  Legal  Counsel  to 
provide  guidance  to  the  officers,  trustees,  com- 
mittee chairmen  and  county  medical  society  of- 
ficers. 

The  duties  and  responsibilities  of  the  Executive 
Administrator  are  of  utmost  importance,  and  are 
outlined  in  the  Bylaws  of  the  Society. 


DIVISION  OF  BUSINESS  SERVICES 


Just  as  the  entire  staff  of  the  Illinois  State 
Medical  Society  exists  to  serve  the  needs  of  more 
than  10,000  members,  the  Division  of  Business 
Services  exists  to  serve  the  needs  of  the  other 
staff  divisions.  Specifically,  all  mail  room  and 
central-supply  services  are  provided  by  the  divi- 
sion. 

Membership  records  are  maintained  so  that 
quick  access  may  be  had  to  correct  information 
concerning  the  basic  membership  history  of  each 
of  our  members.  In  addition,  forms  to  obtain  dues, 
address  changes  and  other  necessary  information 
are  designed  and  supplied  to  each  county  society 
secretary  for  his  use. 

Electronic  Data  Processing 

The  Business  Services  Division  has  primary 
responsibility  for  development  of  computer  proc- 
essing service  for  ISMS  administrative  require- 
ments. Membership  dues  billing,  colleetion  and 
reporting  service  is  already  available  to  county 
societies  that  desire  the  service,  and  mailing 
of  the  Society’s  membership  publications  will  be 
handled  by  computer  in  the  near  future.  The 
1967  Reference  Committee  on  the  Opinion  Re- 


search Survey  recommended  incorporation  of  mod- 
ern data  processing  in  support  of  administrative 
and  membership  programs.  Special  research 
and  study  is  being  devoted  by  the  Business 
Services  Division  to  provide  the  information 
and  data  resources  necessary  to  retain  Illinois 
leadership  in  the  world  of  organizational  medicine. 

Committees 

The  Committees  on  the  Annual  Leadership 
Conference  and  Rural  Health  and  Medical  Stu- 
dent Loan  Fund  are  assigned  to  this  division  for 
the  staff  services  which  might  be  required.  The 
Advisory  Committee  to  the  Annual  Leadership 
Conference  has  responsibility  for  developing  an 
enlightening  program  which  will  help  county 
society  leaders  find  better  ways  to  serve  both 
the  public  and  their  county  society  membership 
more  effectively.  The  Rural  Health  and  Medical 
Student  Loan  Fund  Committee  co-administers  the 
joint  Illinois  State  Medical  Society/Illinois  Agri- 
cultural Association  Medical  Student  Loan  Fund 
Program.  Since  its  inception  in  1948  the  program 
has  helped  over  125  qualified  applicants  to  hurdle 
financial  or  borderline  academic  barriers  to  a 
medical  education.  The  objective  of  the  program 


444 


Illinois  Medical  Journal 


is  to  proWde  an  incentive  to  the  prospective  medi- 
cal students  to  enter  family  practice  in  the  areas 
in  Illinois  that  are  in  need  of  new  physicians  to 
sene  their  rural  communities. 

Accounting  and  Budget 

Responsibilitv  for  pro^*iding  safekeeping  and 
proper  accounting  for  all  money  and  securities  of 
the  Socien  rests  with  this  di^■ision,  upon  the 
direction  and  guidance  of  the  Board  of  Trustees 
Finance  Committee,  the  Secretaiy-Treasurer,  and 
the  Executive  Administrator.  Assistance  is  offered 
to  all  interested  staff  and  oflBcers  in  the  interpre- 
tation of  the  di\ision's  regular  and  special  ac- 
counting and  budgetar}'  reports. 

Liaison  with  outside  agencies  in  regard  to  mat- 
ters affecting  the  finances  of  the  SocieU’  is  a 
prime  responsibilits'  of  this  disision:  the  Internal 
Revenue  Sersice,  the  Societs’s  banking  and  in- 
vestment agencies,  oflace  building  rental  agent, 
and  the  American  Medical  Association  are  major 
examples. 

Advertising 

'VSlthin  the  Illinois  Medical  Journal,  and  for 
the  publications  Pulse  and  What  Goes  On,  com- 


mercial advertising  is  carried.  The  maintenance 
of  the  records  of  advertisers,  insenions,  contracts, 
and  direct  communication  with  advertising  agen- 
cies fall  within  the  purview  of  the  division. 
Through  the  division  and  its  representatives  the 
opportunitv’  of  presenting  a product  to  members 
of  ISMS  through  advertising  in  our  publications 
is  offered. 

Insurance  Coverage 

Provision  for  and  maiutenance  of  the  Societv’s 
propertv',  Uability,  and  employee  insurance  cov- 
erages are  handled  within  this  division,  so  that 
legal  and  financial  requirements  are  satisfied  at 
the  most  economical  premium  cost  In  this  area  of 
responsibilitv',  the  assistance  and  cooperation  of 
the  Division  of  Economics  and  Insurance  are 
utilized  in  order  that  best  results  for  the  Societv- 
may  be  obtained. 

Standardization  of  office  procedures  and  systems 
in  order  to  reduce  the  cost  and  raise  the  efficiency 
of  the  office  operation  is  a continuing  assignment 
for  the  division.  Assistance  in  personnel  recruit- 
ment, job  analysis,  and  salarv'  range  administration 
is  provided  to  the  Executive  Administrator  and 
other  division  directors. 


DIVISION  OF  LEGISLATION  AND  PUBLIC  AFFAIRS 


As  professional  medicine  striv'es  to  maintain 
the  vigorous  condition  of  the  public  health,  the 
profession  is  vitally  and  intimatelv  concerned 
with  legislative  actions  of  the  Illinois  General 
Assembly  and  the  L*.  S.  Congress  which  affect 
physicians,  other  members  of  the  healing  arts, 
and  the  lay  public.  To  insure  that  the  best  health 
interests  of  the  public  and  professional  interests 
of  the  physician  are  served,  the  Division  monitors 
aU  state  and  national  legislation  which  affect  the 
health  of  the  individual  and  his  communitv. 

The  monitoring  process  is  designed  to  present 
the  thoughtful  views  of  professional  medicine  in 
Illinois  on  specific  medically  related  pieces  of  leg- 
islation. 

The  ISMS  Council  on  Legislation  acts  as  the 
clearing  house  for  legislative  proposals  recom- 
mended by  specialized  ISMS  committees;  gener- 
ated by  allied  groups;  produced  by  special  in- 
terests and  introduced  by  representatives  and  sen- 
ators. Such  legislation  is  thoroughly  analvzed  by 
physician-members  of  the  specialized  ISMS  com- 
mittee covering  the  subject  matter  of  the  in- 
troduced legislation. 

Support  or  Oppose  Legislation 

Upon  appropriate  consideration  and  recom- 
mendation. legislation  of  medical  significance  in 
the  Illinois  Legislature  is  either  supported  or 
opposed  to  protect  and  promote  the  interests  of 
the  public  and  the  profession.  Peninent  subject 
matter  testimony  is  presented  before  the  House 
and  Senate  committees  as  the  bill  proceeds 
through  the  legislative  process. 

On-the-scene  surveillance  of  monitored  legis- 


lation is  maintained  by  ISMS  legislative  rep- 
resentatives. 

Through  these  essential  actions.  ISMS  plays  a 
meaningful  role  in  shaping  legislation  for  the 
betterment  of  the  people  of  Illinois. 

Action  similar  to  the  above  is  taken  with  re- 
spect to  bills  in  Congress  when  they  have  special 
significance  to  Illinois  physicians.  This  activitv'  is 
conducted  in  concen  with  the  American  Medical 
Association. 

Integrated  with  and  designed  to  augment  the 
legislative  activitv"  is  the  Public  Affairs  Program. 
This  program,  executed  by  the  Division  of  Leg- 
islation and  Public  Affairs,  as  directed  by  the 
ISMS  Public  Affairs  Committee,  strives  to  alert 
the  physician  to  his  role  in  public  affairs  and  to 
involve  him  in  effective  participation  in  public 
affairs  in  his  communitv",  state,  and  nation. 

Other  Activities 

Divisional  activ"ities  also  includes  other  services. 
One  of  these,  involving  medicine,  law,  and  the 
judiciary,  is  the  administration  of  the  Impartial 
Medical  Testimonv  program.  Operating  in  con- 
junction with  the  Supreme  Court  of  Illinois  and 
the  Federal  District  Court,  the  services  of  im- 
panial  medical  e.xaminers  are  provided  in  per- 
sonal injury  cases. 

Other  facets  of  medical-legal  interaction  are 
e.xplored  through  the  Medical-Legal  Council  and 
problems  resolved  through  liaison  with  commit- 
tees of  the  judicial  and  the  bar  associations. 

In  addition  to  the  foregoing,  the  division  staffs 
the  Committees  on  Laboratorv  Evaluation.  Medical 
Practice  and  Quackeiy  and  the  Eye  Committee. 


/or  October,  196S 


445 


DIVISION  OF  PUBLICATIONS 


All  publications  of  the  Society,  including  the 
Illinois  Medical  Journal,  are  produced  through 
this  division.  The  Journal,  the  official  publication 
of  the  Society,  is  mailed  monthly  to  all  members, 
who  are  urged  to  read  it  to  keep  abreast  of 
the  scientific,  economic,  political,  legal  and  social 
developments  within  the  state.  The  editor  wel- 
comes suggestions  for  articles  which  may  be  of 
special  interest  to  members. 


Other  publications  are  Pulse,  a monthly  news- 
letter, and  What  Goes  On  In  Illinois,  a calendar 
of  events  of  medical  interest. 

This  division  provides  staff  services  for  the 
Publications  Committee  and  the  Editorial  Board. 

Within  the  division,  responsibility  is  taken  for 
all  printing  and  duplicating  services  for  the  so- 
ciety; a small  print  shop  is  maintained  along  with 
modern  reproduction  and  collating  equipment. 


DIVISION  OF  EDUCATIONAL 

Committee  Responsibilities 

This  division  provides  staff  services  for  the 
Council  on  Scientific  Services,  the  Council  on 
Medical  Education  and  the  15  committees  as- 
signed to  these  councils. 

Annual  Convention 

Similarly,  the  staff  serves  as  an  arm  of  the 
Committee  on  Scientific  Assembly  to  arrange  and 
produce  the  annual  convention  of  ISMS.  Held  in 


AND  SCIENTIFIC  SERVICES 

May  in  Chicago  each  year,  the  convention  offers 
scientific  meetings  and  exhibits  as  well  as  ses- 
sions of  the  House  of  Delegates. 

An  additional  function  of  the  division  is  to  ad- 
minister the  affairs  of  the  Educational  and  Scien- 
tific Foundation,  a non-profit  organization  estab- 
lished to  conduct  educational  and  scientific  projects 
related  to  medicine.  Physicians  are  invited  to 
become  Fellows  of  the  Foundation  for  a charter 
membership  of  $100. 


DIVISION  OF  PUBLIC  RELATIONS  AND  ECONOMICS 


The  Public  Relations  and  Economics  Division 
serves  both  as  a news  outlet  to  the  lay  press, 
and  as  a source  of  supply  for  information  on 
socio-economic  and  insurance  matters  to  the 
membership. 

With  increasing  frequency,  the  division  is  con- 
tacted by  news  writers  seeking  information  on 
socio-economic,  as  well  as  scientific  subjects.  Its 
counseling  services  on  public  relations  and 
publicity  are  available  to  any  county  medical 
society. 

The  division  is  also  frequently  called  upon  to 
prepare  speeches,  write  and  publish  pamphlets 
and  other  materials  and  make  them  available 
for  distribution  on  such  subjects  as  public  aid 
in  Illinois,  medical  care  financing  through  Social 
Security,  and  physician  retirement  programs. 

So  far  as  it  is  possible  to  do  so,  the  division 
designs  and  directs  research  in  the  area  of  eco- 
nomics. Such  projects  have  included  the  Relative 
Value  and  the  Membership  Fee  Surveys. 

News  Releases 

A mailing  list  of  all  Illinois  newspapers,  radio 
and  television  stations  is  maintained  by  the  di- 
vision. The  list  is  so  arranged  that  news  releases 
may  be  addressed  to  individual  counties,  and 
county  society  secretaries  may  avail  themselves 
of  this  service. 

News  releases  for  county  societies  are  auto- 
matically prepared  by  the  division  staff  and  dis- 
tributed to  all  news  outlets  in  the  particular 
county  whenever  a county  society  makes  use  of 
the  ISMS  post-graduate  education  program.  Other 
than  this,  the  state  society’s  staff  does  not  pre- 
pare news  releases  of  county  society  activities 
unless  this  service  is  specifically  requested. 


Health  Columns  for  Newspapers 

Currently,  ISMS  presents  weekly  and  daily  pub- 
lic service  health  columns  entitled  “Dr.  SIMS 
Says.”  These  columns,  offered  to  the  700  news- 
papers in  Illinois,  carry  the  logotype  of  Dr. 
“SIMS”  which  readily  identifies  the  column  with 
the  Illinois  State  Medical  Society. 

Another  public  service  column,  being  carried 
by  some  300  high  school  newspapers  throughout 
Illinois,  is  entitled  “Dr.  SIMS  Talks  to  Teens.” 
It  is  distributed  on  a monthly  basis. 

Public  Aid  Liaison 

Familiarity  with  the  medical  care  programs 
of  the  Illinois  Department  of  Public  Aid  and 
liaison  with  the  staff  of  the  department  are  other 
responsibilities  of  the  Division  of  Public  Rela- 
tions and  Economics.  Liaison  is  also  maintained 
with  public  and  private  agencies  interested  in  the 
fields  of  aging,  insurance,  hospitals,  and  re- 
habilitation. 

Periodically,  information  is  prepared  for  phy- 
sicians and  the  public  pertaining  to  such  medical 
care  programs  as  Old  Age  Assistance,  Aid  of  the 
Medically  Indigent,  and  the  Military  Dependents’ 
Medical  Care. 

The  division  provides  staff  services  to  the 
Councils  on  Medical  Services  and  Public  Rela- 
tions, as  well  as  the  committees  on:  Religion  and 
Medicine,  Membership,  Disaster  Medical  Care, 
Public  Safety,  Hospital  Relations,  Prepayment 
Plans,  Medical  Economics  and  Insurance,  Drugs 
and  Therapeutics,  Aging,  and  Public  Relations. 

Also  provided  with  staff  services  are  advisory 
committees  to:  Paramedical  Groups,  Inter-Pro- 
fessional Groups,  and  the  Illinois  Department 
of  Public  Aid. 


446 


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THE  EDUCATIONAL  & SCIENTIFIC  FOUNDATION 


The  Educational  & Scientific  Foundation  was 
founded  to  provide  an  administrative  agency  to 
foster  the  advancement  of  clinical  science  through: 

1)  The  initiation  of  scientific  and  medical  re- 
search activities. 

2)  The  collection,  evaluation  and  dissemination 
of  the  results  of  research  activities  to  the  public. 


3)  The  implementation  and  management  of 
projects  related  to  medicine  for  individuals  or 
organizations  seeking  to  inform  or  educate  others, 
or  to  improve  their  own  knowledge. 

The  Foundation  is  a distinct  corporate  entity 
which  has  an  interlocking  Board  with  the  Illinois 
State  Medical  Society.  It  is  staffed  through  ISMS 
headquarters. 


FILMS 


Stroke — Early  Restorative  Measures 
in  Your  Hospital 

A film  entitled  “Stroke — Early  Restorative 
Measures  in  Your  Hospital,”  produced  by  the 
ISMS  Committee  on  Aging,  is  available  from  the 
Society. 

Directed  toward  physicians  in  all  general  hos- 
pitals, regardless  of  size,  the  film  illustrates  simple 
and  effective  methods  and  devices  used  in  the  re- 
habihtation  of  stroke  patients.  It  emphasizes  the 
procedures  to  be  instituted  immediately  upon 
the  patient’s  admission  to  the  hospital. 

Primary  purpose  of  the  film  is  to  inform  physi- 
cians and  nurses  of  the  need  for  immediate 
action  in  stroke  cases  and  to  interest  them  in 
acquiring  additional  details  for  treatment  through 
available  publications  or  study  courses.  The  20- 
minute  sound,  color  film  illustrates  a program 
of  constructive  rehabihtation  which  may  be  con- 
ducted in  any  hospital,  however  small,  by  an  in- 
terested nurse  using  a minimum  of  equipment. 

The  film  may  be  obtained  from  the  Society 
on  a loan  basis  for  viewing  without  charge  or  may 
be  purchased  for  $125. 


Modern  Management  of  Multiple  Births 

“Modem  Management  of  Multiple  Births”  is  a 
16  mm.  sound-color  motion  picture  produced  by 
the  Educational  and  Scientific  Foundation  of  the 
Illinois  State  Medical  Society  in  cooperation  with 
Lederle  Laboratories  Division  of  American  Cyana- 
mid  Co. 

Teaching  “heart”  of  the  film  is  step-by-step 
reconstmction  of  an  elaborate  protocol  which 
serves  as  a standard  of  prenatal  planning  for 
any  physician  faced  with  the  management  of 
multiple  pregnancy. 

For  added  teaching  interest,  the  film  reviews 
birth  of  identical  quadmplets,  showing  how 
identicality  was  estabhshed  with  major  and  minor 
blood  typings,  examination  of  placenta  and  fetal 
membranes  and  other  procedures.  There  are  also 
scenes  of  actual  delivery  of  quadmplets. 

Showings  of  the  film  are  restricted  to  profes- 
sional audiences.  Organizations  may  borrow  the 
film  from  Lederle  Laboratories  Film  Library,  Pearl 
River,  N.  Y.,  or  from  the  Illinois  State  Medical 
Society,  360  N.  Michigan  Ave.,  Chicago  60601. 


SPECIAL  PUBLICATIONS 


What  Goes  On  in  Illinois 

What  Goes  On  in  Illinois  is  a calendar  of  medi- 
cal and  scientific  meetings  conducted  in  Illinois 
and  adjacent  states.  It  contains  information  about 
conventions,  medical  meetings,  seminars  and  short 
courses  conducted  by  educational  Institutions,  hos- 
pitals, specialty  societies,  and  voluntary  health  or- 
ganizations. Published  by  the  lUinois  State  Medi- 
cal Society  under  a grant  from  Lederle  Labora- 
tories, What  Goes  On  in  Illinois  is  mailed  to  all 
doctors  in  Illinois  and  other  interested  persons 
nine  times  a year.  Combined  issues  are  published 
m May-June,  July-August,  and  November-Decem- 
ber. 

Program  chairmen  of  organizations  or  institu- 
tions sponsoring  scientific  meetings  open  to  medi- 
cal and  paramedical  personnel  outside  of  their 
own  membership  are  invited  to  submit  pertinent 
information  to  What  Goes  On  In  Illinois,  c/o  the 
Illinois  State  Medical  Society,  360  N.  Michigan 
Ave.,  Chicago  60601.  Deadline  for  copy  is  35 
days  in  advance  of  pubhcation. 

Pulse 

Pulse  is  a monthly  newsletter  published  by  the 


Illinois  State  Medical  Society  under  a grant  from 
Roche  Laboratories,  Division  of  Hoffmann  La- 
Roche,  Inc.  It  is  distributed  to  all  doctors  in  the 
state,  to  members  of  the  Woman’s  Auxihary  and 
Illinois  Medical  Assistants  Association,  and  is 
supplied  in  quantity  to  hospitals  for  interns,  resi- 
dents and  other  personnel. 

Pulse  carries  non-scientific  news,  photographs 
and  feature  materials  of  interest  to  the  medical 
profession  in  Illinois.  A special  section  is  devoted 
to  the  activities  of  the  Woman’s  Auxiliary. 

Comb-1  Insurance  Form 

Because  of  the  variety  of  data  required  for 
health  insurance  claims,  the  Comb-1  Form  was 
developed  jointly  by  the  American  Medical  As- 
sociation and  the  Health  Insurance  Council  to 
simplify  and  reduce  the  number  of  attending 
physicians  forms  equally  acceptable  to  the  health 
insurance  industry  and  the  medical  profession. 

Information  requested  by  many  diverse  forms 
from  a large  number  of  insurance  companies  was 
first  classified  and  minimum  needs  for  claim 


/or  October,  196S 


447 


purposes  were  determined.  Then  appropriate  and 
clearly  worded  questions  were  developed  and 
arranged  in  a standard  sequence,  to  facilitate  com- 
pletion. Out  of  this  came  two  basic  forms,  one 
for  group  health  insurance  and  one  for  individual 
health  insurance,  and  four  abbreviated  forms.  A 
further  simplification  involved  devising  an  all- 
purpose form  which  is  a combination  of  the 
group  and  individual  forms — the  Comb-1  Simpli- 
fied Health  Insurance  Claim  Form. 

These  forms  are  available  to  physicians  from 
the  Illinois  State  Medical  Society  and  should  be 
substituted  for  any  non-standardized  forms  re- 
ceived, Each  physician  has  been  asked  to  vol- 
untarily adopt  the  following  procedure: 

1)  When  a physician  receives  a form  from  an 
insurance  company  bearing  the  HIC  symbol 
it  should  be  completed  and  returned  to  the 
company. 

2)  When  a physician  receives  a form  not  iden- 
tified by  the  HIC  symbol,  the  standardized 
form  should  be  filled  out  and  clipped  to  the 
unacceptable  form  with  both  forms  returned 
to  the  insurance  company. 

3 ) If  the  insurance  company  insists  upon  having 
its  own  form  completed,  the  doctor  should 
feel  justified  in  making  a reasonable  charge 
for  the  added  work  involved  in  handling 
the  non-standardized  form. 

The  attempt  to  standardize  these  forms  is  an 
aid  in  cutting  back  on  the  ever-increasing  load  of 
paper  work  involved  in  medical  practice.  Forms 
are  available  without  charge  from  the  ISMS  Di- 


vision of  Public  Relations  and  Economics  while 
the  supply  lasts. 

Disaster  Hospital  Manual 

The  responsibility  of  providing  immediate  medi- 
cal and  hospital  care  in  disasters  of  any  magni- 
tude falls  directly  on  physicians,  nurses  and  hos- 
pitals. To  aid  Illinois  communities  in  developing 
disaster  plans,  the  ISMS  Committee  on  Disaster 
Medical  Care  has  adopted  a model  emergency 
plan  for  hospitals. 

Originally  developed  by  the  Memorial  Hospital 
of  DuPage  County,  Elmhurst,  the  plan  is  recog- 
nized as  a model  by  the  Office  of  Defense 
Mobilization  in  Washington,  D.  C,  Copies  are 
available  from  the  Society. 

Medical  Career  Recruitment  Programs 

As  man  has  advanced  his  life  expectancy,  it  fol- 
lows that  many  additional  young  men  and  women 
are  and  will  be  needed  as  members  of  the  health 
team.  Youth  must  be  counseled  early  in  their 
academic  years  in  order  to  receive  the  proper 
educational  background  for  a doctorate  of  medi- 
cine or  allied  health  field  degree. 

The  Woman’s  Auxiliary  of  the  ISMS  has  been 
the  spearhead  force  in  Illinois  to  interest  and 
recruit  the  youth  of  the  state  in  medical  careers. 
Members  are  asked  to  aid  this  effort  by  investi- 
gating the  possibility  of  conducting  or  participat- 
ing in  career  days  in  their  home  communities, 

A paper  back  book  entitled  “Horizons  Un- 
limited” is  available  from  the  Society. 


SCIENTIFIC  SPEAKERS  BUREAU 


The  Illinois  State  Medical  Society,  through  its 
Scientific  Speakers  Bureau,  aids  county  societies 
in  their  efforts  to  keep  members  abreast  of  medi- 
cal advances.  Sponsored  by  the  ISMS  Committee 
on  Continuing  Education,  the  bureau  helps  local 
groups  arrange  and  conduct  postgraduate  medical 
education  programs  in  their  own  areas.  This  as- 
sistance includes  obtaining  speakers,  helping  them 
with  travel  arrangements,  preparing  and  mail- 
ing notices  of  meetings,  and  paying  an  honorarium 
and  travel  expenses.  ISMS  can  also  provide  pub- 
licity services  upon  request. 

It  also  pays  a $50  honorarium  and  expenses  for 
individual  speakers  obtained  by  county  medical 
societies  for  their  regular  meetings. 

The  Bureau  operates  under  a grant  from  Merck, 
Sharp  & Dohme,  which  provides  funds  to  the 
ISMS  Educational  and  Scientific  Foundation  for 
the  specific  purpose  of  obtaining  speakers  for 
county  medical  society  meetings. 

The  following  procedures  govern  use  of  the 


Bureau : 

1 ) County  societies  select  speakers  from  a 
roster  containing  the  names  of  more  than  400 
speakers  and  over  1,000  topics. 

2)  Eight  weeks  advance  notice  is  required  for 
postgraduate  meetings.  Requests  for  such  meet- 
ings, which  usually  are  scheduled  for  an  entire 
afternoon,  should  be  sent  to  the  chairman  of  the 
Committee  on  Continuing  Education,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave.,  Chicago. 

3)  Publicity  to  media  in  the  area  of  the 
meeting  will  be  handled  by  ISMS  upon  request 
of  the  county  society. 

4)  Postcard  notices  will  be  mailed  to  physicians 
in  the  county  if  requested.  ISMS  will  prepare  and 
mail  notices  if  the  information  is  received  no  less 
than  three  weeks  prior  to  the  meeting. 

5)  The  county  medical  society  program  chair- 
man and  the  speaker  are  both  expected  to  sub- 
mit to  ISMS  a report  on  the  meeting  and  the 
arrangements. 


PHYSICIANS  PLACEMENT  & STUDENT  LOAN  FUND  PROGRAM 


The  Illinois  State  Medical  Society  not  only 
offers  help  to  students  who  wish  to  become  physi- 
cians, but  also  is  able  to  assist  the  careers  of  those 
already  licensed  to  practice  medicine. 

The  society  provides  this  aid  through  two  spe- 


cial activities.  First  is  its  own  Physicians  Place- 
ment Service.  Second  is  the  Illinois  Medical  Stu- 
dent Loan  Fund  Program  that  the  society  sponsors 
in  conjunction  with  the  Illinois  Agricultural  As- 
sociation. 


448 


Illinois  Medical  Journal 


Physicians  PI 

The  Physicians  Placement  Service  is  designed  to 
help  physicians  find  a desirable  area  in  which  to 
establish  practice  or  to  relocate.  The  program’s 
purpose  is  twofold,  since  it  is  interested  also  in 
helping  those  communities  which  demonstrate 
need  of  a resident  physician. 

More  than  400  medical  doctors  have  been 
placed  through  this  program  since  its  inception 
shortly  after  World  War  II. 

The  Physicians  Placement  Service  maintains  an 
up-to-date  listing  of  some  150  “open”  areas  need- 
ing general  practitioners.  It  maintains  a similar 
listing  of  areas  in  need  of  specialists  in  a given 
field. 

This  service  accepts  requests  from  both  physi- 
cians and  communities  for  satisfactory  placement. 

In  addition,  physicians  are  referred  to  the  service 
by  a number  of  organizations,  among  them  the 
American  Medical  Association,  the  Illinois  State 
Health  Department  and  the  Illinois  Agricultural 
Association.  Frequently,  responsible  citizens  or 

Illinois  Medical  Student 

The  Illinois  Medical  Student  Loan  Fund  Pro- 
gram is  designed  to  help  those  who  have  what 
it  takes  to  become  a physician  but  lack  sufficient 
financial  resources  or  a recommendation  for  medi- 
cal school.  Since  its  inception  in  1948,  the  pro- 
gram has  helped  over  125  qualified  applicants  to 
hurdle  financial  or  borderline  academic  barriers 
to  a medical  education. 

Loans  to  students  in  need  are  provided  by  joint 
contributions  from  the  Illinois  State  Medical  So- 
ciety and  the  Illinois  Agricultural  Association.  The 
program  offers  loans  of  $625  per  semester — up  to 
a total  of  $6,250  over  a five-year  period.  A two 
per  cent  interest  rate  is  charged  semi-annuaUy 
from  the  time  the  loan  is  received.  The  borrower 
must  also  insure  himself  for  the  entire  amount  of 
the  loan  and  pay  premimns  on  the  policy.  How- 
ever, he  has  four  years  after  receipt  of  his  M.D. 
degree  before  the  first  principal  payment  is  due. 

The  program  also  offers  assistance  to  those  who 
may  not  have  financial  difficulties  but  can’t  get 
into  a “Class  A”  medical  school  because  their 
college  grades  are  marginal.  The  board  represent- 
ing the  sponsoring  organizations  of  the  program 
can  recommend  10  candidates  annually  to  the 
University  of  Illinois  College  of  Medicine  in  Chi- 
cago. After  careful  screening  to  determine  whether 
the  applicant  has  the  potential  to  make  a good 
medical  student,  the  board  can  recommend  him 
for  admittance  on  the  basis  of  its  investigation. 


ement  Service 

overburdened  physicians  in  a community  will  con- 
tact the  service. 

Another  important  function  of  the  Physicians 
Placement  Service  is  to  assist  small  communities 
in  developing  programs  to  attract  physicians. 

The  Physicians  Placement  Service  sends  a ques- 
tionnaire to  the  applicant  physician  to  obtain  in- 
formation on  his  educational  background,  his  in- 
terests and  preferences  of  type  of  practice.  Upon 
return  of  the  questionnaire,  the  physician  is  sent 
a complete  list  of  openings.  Each  opening  is  de- 
tailed on  its  facilities  for  home  life,  office  space, 
proxunity  to  hospital  facilities  and  other  specifics. 
The  physician  is  also  sent  bulletins  with  infor- 
mation on  new  locations  as  they  develop. 

The  Physicians  Placement  Service  offers  its  as- 
sistance to  all  qualified  physicians  who  request  it. 
An  applicant  need  not  be  a member  of  the  state 
medical  society.  There  is  no  charge  either  to  the 
physician  or  to  the  community  seeking  the  services 
of  this  program. 

Loan  Fund  Program 

In  return  for  this  assistance  from  the  Medical 
Student  Loan  Fund  Program,  the  applicant  must 
agree  to  practice  medicine  in  an  Illinois  town — 
serving  a rural  population  for  five  years.  The 
applicant  may  select  a town  from  an  up-to-date 
list  of  communities  which  have  demonstrated  need 
and  ability  to  support  a physician,  but  choice  is 
subject  to  approval  by  the  program’s  board.  The 
purpose  of  this  agreement  is  to  provide  family 
doctors  for  the  rural  communities  in  Illinois. 

To  be  considered  for  assistance  from  the  Med- 
ical Student  Loan  Fund  Program,  an  applicant 
must  be  recommended  by  the  presidents  of  his 
home  county  medical  society  and  farm  bureau. 
Rules  of  eligibility  require  that  an  applicant  be  a 
male  premedical  student  of  at  least  three  years  col- 
lege standing  ...  an  Illinois  resident  outside  of 
Cook  County  . . . and  that  he  take  a medical  col- 
lege admissions . test  for  review  by  the  program’s 
board. 

The  board  of  the  Medical  Student  Loan  Fund 
Program  conducts  its  annual  interview  about  Dec. 

1 for  those  students  who  wish  to  enter  medical 
school  the  following  September.  Those  approved 
for  assistance  are  accepted  on  a comparative  and 
competitive  basis.  Information  and  applications 
may  be  obtained  from  Roy  E.  Will,  secretary, 
Joint  Medical  Student  Loan  Fund  Board,  Illinois 
Agricultural  Association,  1701  Towanda  Ave.,  P.O. 
Box  901,  Bloomington. 


IMPARTIAL  MEDICAL  TESTIMONY 


The  Impartial  Medical  Testimony  program,  in 
which  the  Illinois  State  Medical  Society  partici- 
pates, is  designed  to  elicit  objective  medical  truth 
and  facilitate  the  equitable  disposition  of  injury 
cases  in  the  courts  of  Illinois. 

As  a technique  of  judicial  administration,  im- 
partial medical  testimony  examiners  are  ordered 


by  the  court  when  there  is  evidence  of  a wide  di- 
vergence of  medical  opinion  in  the  injury  which 
is  subject  to  litigation.  The  introduction  of  the 
IMT  examiner  and  subsequent  examination  of 
injuries  provide  the  court  with  objective,  impar- 
tial medical  data  for  use  in  pre-trial  conferences 
and  in  jury  trials. 

Authorization  for  the  use  of  IMT  examiners  was 


for  October,  1968 


449 


established  by  the  introduction  of  Illinois  Supreme 
Court  Rule  17-2  in  September  1961. 

In  the  new  Supreme  Court  Rules  which  became 
effective  January  1,  1967,  the  use  of  IMT  ex- 
aminers is  authorized  by  Rule  215  (d)  (1).  A 
substantial  change  was  made  in  the  Rule  to  allow 
the  use  of  IMT  examiners  in  any  “proper”  case. 
The  Rule  formerly  was  limited  to  personal  in- 
jury actions.  The  new  Rule  states:  “(1)  a 

reasonable  time  in  advance  of  the  trial,  the 
court  may  on  its  own  motion  or  that  of  any 
party  order  an  impartial  physical  or  mental  ex- 
amination of  a party  whose  mental  or  physical 
condition  is  in  issue,  when  in  the  court’s  discre- 
tion it  appears  that  such  an  examination  will  ma- 
terially aid  in  the  just  determination  of  the  case. 
The  examination  shall  be  made  by  a member  or 
members  of  a panel  of  physicians  chosen  for  their 
special  qualifications  by  the  Illinois  State  Medical 
Society. 

(2)  Examination  During  Trial.  Should  the  court 
at  any  time  during  the  trial  find  that  compelling 
considerations  make  it  advisable  to  have  an  ex- 
amination and  report  at  that  time,  the  court  may 
in  its  discretion  so  order. 

(3)  Copies  of  Report.  A copy  of  the  report  of 
examination  shall  be  given  to  the  court  and  to 
the  attorneys  for  the  parties. 

(4)  Testimony  of  Examining  Physician.  Either 
party  or  the  court  may  call  the  examining  physi- 
cian or  physicians  to  testify.  Any  physician  so 
called  shall  be  subject  to  cross-examination. 

(5)  Costs  and  Compensation  of  Physicians.  The 
examination  shall  be  made,  and  the  physician  or 
physicians,  if  called,  shall  testify,  without  cost  to 
the  parties.  The  court  shall  determine  the  com- 
pensation of  the  physician  or  physicians. 

(6)  Administration  of  Rule.  The  Administrative 
Director  and  the  Deputy  Administrator  Director 
are  charged  with  the  administration  of  the  rule.” 

Illinois  is  distinquished  in  this  matter  by  being 
the  only  state  which  has  a court  rule  permitting 
the  state-wide  use  of  impartial  medical  testimony. 
The  Illinois  State  Medical  Society  played  a sig- 
nificant role  in  the  creation  and  development  of 
the  IMT  program.  Impartial  medical  testimony  in 
other  states  is  limited  to  certain  jurisdictions  with- 
in the  states. 

The  Illinois  State  Medical  Society  panel  of 
impartial  medical  examiners  is  comprised  of  ap- 
proximately 250  physicians  who  are  grouped  into 
some  20  medical  specialties.  Composition  of  the 

INSURANCE 

Retirement  Investment  Program 

The  Board  of  Trustees  of  the  Illinois  State 
Medical  Society  has  approved  the  Retirement 
Investment  Program  which  makes  available  to 
members  a means  of  providing  for  retirement 
with  group  advantages  an  individual  physician 
could  not  otherwise  obtain.  The  group  annuity 


panel  is  reviewed  annually  to  maintain  the  high- 
est standards  for  the  courts  of  Illinois.  The  IMT 
examiners  are  selected  from  the  panel  in  rotating 
sequence. 

When  the  program  was  begun  in  1961,  the  IMT 
examiners  were  to  be  paid,  on  court  approval  of 
bills  submitted,  by  the  Illinois  State  Bar  Associa- 
tion Foundation,  which  was  the  custodian  and 
disbursing  agent  of  a special  IMT  fund.  This  fund 
had  been  made  possible  by  grants  from  the  Ford, 
Wieboldt,  Deere,  Woods  and  Lilly  Foundations. 
At  that  time,  it  was  anticipated  that  the  State 
would  later  assume  the  obligation  of  financing  this 
program.  As  of  July  1,  1967,  the  State  assumed 
the  financing  as  part  of  its  regular  court  budget, 
and  as  of  that  date  the  funds  have  been  dis- 
bursed by  the  Administrative  Office  of  the  Court. 

In  an  appropriate  case,  the  plan  evolves  as 
follows: 

1)  judge  invokes  Rule  215  (d)  (1)  (when  in  his 
judgment  introduction  of  an  IMT  examiner 
will  aid  materially  in  the  equitable  disposi- 
tion of  the  case); 

2)  judge  contacts  supreme  court  administrator, 
requesting  IMT  examiner  (special  forms  are 
used  for  this  purpose); 

3)  court  administrator  contacts  Illinois  State 
Medical  Society  for  IMT  examiner,  as  re- 
quired by  the  character  of  the  injury; 

4)  ISMS  selects  an  IMT  examiner  from  the 
panel  of  the  medical  specialty  relating  to  the 
injury  involved; 

5)  ISMS  relates  the  identity  of  the  IMT  exam- 
iner to  the  court  administrator; 

6)  court  administrator  schedules  the  examina- 
tion of  the  plaintiff,  and  obtains  pertinent 
medical  records  for  the  IMT  examiner. 

7)  IMT  physician  examines  plaintiff,  and  pre- 
pares medical  report.  This  report  is  sub- 
mitted to  the  court.  Copies  are  prepared  for 
the  attorneys  involved. 

8)  IMT  examiner  is  available  for  court  testi- 
mony, as  required. 

9)  IMT  examiner  submits  bill  to  the  Adminis- 
trative Office  of  the  Court. 

The  Illinois  State  Medical  Society  is  apprecia- 
tive of  its  role  in  offering,  in  conjunction  with 
the  Supreme  Court,  impartial  medical  service  for 
the  courts  of  Illinois.  The  IMT  Committee  of 
the  state  society  is  charged  with  the  responsibility 
of  maintaining  the  IMT  panel  of  qualified  physi- 
cians, as  required  by  the  court. 

PROGRAMS 

and  mutual  fund  portion  of  the  program  may 
also  be  used  as  funding  vehicles  for  Keogh  quali- 
fied investment  if  so  desired.  The  Tax  Qualified 
Retirement  Program  (Keogh)  and  the  Retirement 
Investment  Program  permit  balanced  investments 
to  counter  economic  fluctuations. 

Annuities  or  mutual  funds  alone  do  not  meet 


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the  problems  of  recession  and  inflation,  but  to- 
gether they  do  permit  a sound  retirement  plan. 

The  group  annuity  provides  a guaranteed  life- 
time income  at  retirement,  serving  as  a hedge 
against  periods  of  recesison  or  declining  prices, 
while  the  mutual  fund  provides  an  opportunity 
for  common  stock  investment  serving  as  a hedge 
against  periods  of  inflation  or  rising  prices. 

A member  physician  wishing  this  type  of 
retirement  protection  may  obtain  it  through  the 
Illinois  State  Medical  Society.  By  doing  so  he  not 
only  receives  advantages  he  would  not  otherwise 
have  but  he  is  able  to  benefit  from  the  collective 
opinions  and  research  facilities  of  the  insurance 
company  and  the  mutual  fund’s  investment  ad- 
visor. 

The  Retirement  Investment  Program  making 
available  the  group  annuity  at  a substantial  re- 
duction in  premium,  and  the  mutual  funds,  offered 
without  sales  commission  load,  is  one  of  the  most 
recent  of  its  kind  and  was  developed  after  several 
years  of  study  taking  into  consideration  other 
group  plans  and  retirement  alternatives. 

The  size  of  the  retirement  contribution,  the  pro- 
portion of  investment  between  the  group  annuity 
and  the  mutual  fund,  and  the  retirement  age  are 
determined  by  the  participating  physician. 

The  Continental  Illinois  National  Bank  and 
Trust  Co.  of  Chicago  receives  all  physicians’ 
contributions,  and  maintains  records. 

Group  Annuity 

The  group  annuity,  underwritten  by  the  Conti- 
nental Assurance  Co.,  participates  in  dividends 
which  are  reinvested  annually  at  compound  inter- 
est. 

The  group  annuity  may  provide  an  insurance 
death  benefit  and  a total  and  permanent  dis- 
ability guarantee.  In  the  event  of  death  prior  to 
retirement,  a member’s  beneficiary  would  receive 
the  death  benefit  or  the  cash  value  of  the  annuity 
whichever  is  greater. 

Six  options  for  settlement  at  retirement  are 
available  under  the  annuity.  The  most  frequently 
chosen  is  the  life  income  option  which  guar- 
antees a base  income  for  life  that  can  never  be 
outlived.  With  the  increase  of  life  expectancy  there 
is  a danger  of  depleting  capital  during  advanced 
years.  However,  the  group  annuity  assures,  at 
least,  a base  or  fixed  income  which  cannot  be 
outlived.  Of  equal  importance,  is  the  fact  that 
settlement  may  be  arranged  under  the  group 
annuity  to  guarantee  at  least  a return  of  the 
member’s  investment  to  his  beneficiary  if  he 
elects  a life  income  and  dies  shortly  after  re- 
tirement. 

Mutual  Fund 

The  no  load  open  end  mutual  fund,  consist- 
ing primarily  of  common  stocks,  is  managed  by 
Stein  Roe  & Farnham  of  Chicago,  which  has 
been  serving  as  investment  adviser  to  pension 


and  profit  sharing  trusts,  trustees,  individuals, 
and  other  investors  since  1932. 

The  Stein  Roe  & Farnham  Stock  Fund  is 
quoted  daily  in  most  major  newspapers  and  the 
Wall  Street  Journal.  The  fund  has  no  sales  com- 
missions. The  investment  adviser  receives  a quar- 
terly management  fee  of  Vs  of  1 per  cent  of  the 
average  net  asset  value  of  the  fund.  Management 
fees  are  common  to  all  mutual  funds  and  are 
distinct  from  sales  loads. 


Group  Disability  Program 

The  Illinois  State  Medical  Society  has  officially 
approved  a group  disability  program  which  is 
available  to  all  eligible  members  of  the  ISMS  up 
to  age  70  who  are  regularly  attending  all  of  the 
usual  duties  of  their  occupation.  Three  different 
types  of  coverage  are  available  under  the  program, 
with  an  over-70  conversion  privilege. 

Benefits  of  the  program  are  payable  regardless 
of  any  other  insurance  and  no  restrictive  riders 
may  be  attached.  The  master  contract  contains  a 
special  renewal  condition  whereby  the  individual 
coverage  cannot  be  terminated. 

Provision  has  been  made  for  an  adjudication 
committee  to  advise  the  carrier  on  claims  and 
other  administrative  problems.  The  adjudication 
committee  will  review  the  medical  data  and  make 
recommendations  regarding  coverage  which  the  in- 
surance company  might  otherwise  reject. 

The  program  is  explained  in  detail  in  a bro- 
chure which  is  available  by  writing  to  Parker, 
Aleshire  & Co.,  9933  Lawler  Ave.,  Skokie  60076. 

Group  Major  Medical  Expense  Plan 

The  $15,000  Group  Major  Medical  Expense 
Plan  designed  for  the  Illinois  State  Medical  So- 
ciety has  a 20%  co-insurance  feature  and  a $500 
or  $1,000  deductible,  whichever  the  physician  se- 
lects. For  hospital  room  and  board,  the  Plan  will 
pay  up  to  $30  a day  and  up  to  $45  a day  in  an 
intensive  care  unit.  It  will  pay  $20  a day  in  a 
convalescent  home  following  release  from  a hos- 
pital up  to  90  days.  The  Plan  also  provides  max- 
imum coverage  for  the  insured  in  the  event  of 
mental  illness  and  up  to  $2,000  for  dependents.  It 
will  also  cover  a congenital  anomaly  from  the 
first  day  of  birth  after  the  effective  date  of  the 
contract  up  to  $2,000. 

New  members  joining  the  Society  will  be  al- 
lowed to  enroll  without  evidence  of  insurability  or 
a health  statement  under  age  40  within  six  months 
after  notification  of  the  Plan’s  availability. 

The  Group  Major  Medical  Expense  Plan  is  out- 
standing and  will  provide  members  with  protec- 
tion against  catastrophic  illness. 

The  Plan  is  underwritten  by  the  Commercial 
Insurance  Co.  of  Newark,  N.J.,  and  is  administered 
by  Parker,  Aleshire  & Co.,  Skokie  60076.  Addi- 
tional information  may  be  obtained  from  the  Illi- 
nois State  Medical  Society,  Division  of  Public 
Relations  and  Economics. 


for  October,  1968 


451 


Tax-Qualified  Retirement  Program 

As  mentioned  above,  the  Board  of  Trustees 
has  also  approved  the  Society’s  Tax-Qualified  Re- 
tirement Program,  which  utilizes  a Continental 
Assurance  Company  Group  Annuity  and  the  Stein 
Roe  & Farnham  Stock  Fund.  This  Program  is 
intended  for  members  who  may  find  the  pro- 
visions of  the  Keogh  Act  to  their  advantage.  A 
recent  liberalization,  effective  in  1968,  which  will 
allow  contributions  made  by  self-employed  phy- 
sicians to  be  fully  deductible  is  expected  to  make 
this  Program  more  attractive  to  the  membership. 
The  principal  provisions  of  the  Koegh  Act  are  as 
follows: 

1.  A self-employed  physician  may  set  aside  10% 
of  his  net  income  from  the  practice  of  medi- 
cine or  $2,500.00  whichever  is  the  lesser, 
each  year  for  his  own  retirement. 

2.  A self-employed  physician  may  deduct  all  of 
this  amount  from  his  income  tax. 

3.  A self-employed  physician  must  include  all 
full  time  employees  with  three  or  more 


years  service  under  the  Plan.  A full  time 
employee  is  defined  as  an  employee  work- 
ing twenty  hours  or  more  a week  for  a 
period  of  five  or  more  months.  The  em- 
ployee’s contributions  are  made  by  the  phy- 
sician as  a percent  of  salary  at  least  equal 
to  that  percentage  of  net  income  put  aside 
by  the  physician  for  his  own  retirement. 

4.  Funds  invested  under  the  Tax-Qualified  Re- 
tirement Program  accumulate  tax  free  until 
distribution. 

Continental  Illinois  National  Bank  & Trust 
Company  of  Chicago  acts  as  Trustee  for  the 
Program’s  Annuity  and  Stock  Fund  shares  and 
receives  all  physicians’  contributions  and  main- 
tains the  Program’s  records. 

Members  wishing  additional  information  on 
the  Retirement  Investment  Program  and  the 
Tax-Qualified  Retirement  Program  may  write  the 
Illinois  State  Medical  Society,  Division  of  Public 
Relations  and  Economics,  360  N.  Michigan  Ave., 
Chicago  60601. 


PROFESSIONAL  LIABILITY  PROGRAM 


An  ISMS-sponsored  professional  liability  in- 
surance (malpractice)  program  became  available 
to  members  June  1,  1968  after  it  was  approved 
by  the  Board  of  Trustees  and  the  State  of  Illi- 
nois Insurance  Department.  Members  may  enroll 
in  it  at  any  time. 

The  program  was  devised  as  an  answer  to 
physicians’  complaints  of  arbitrary  policy  can- 
cellations due  to  high-risk  specialty  or  age,  abrupt 
increases  in  premium  rates  and  headlong  out-of- 
court  settlements. 

Underwriter  of  the  program  is  Employers’ 
Group  of  Insurance  Companies,  82-year-old  Bos- 
ton firm  which  had  been  highly  commended  as 
underwriter  of  the  Florida  Medical  Society’s  mal- 
practice plan.  The  administrator  is  Parker,  Ale- 
shire  & Company,  Skokie,  which  has  served  ISMS 
on  other  insurance  since  1946. 

Here  are  some  key  features  of  the  program: 

1.  Coverage  is  available  regardless  of  age  or  type 
of  specialty. 

2.  ISMS  directly  supervises  and  controls  the  pro- 
gram, in  conjunction  with  the  administrator 
and  underwriter.  No  policy  will  be  declined 
or  cancelled  without  just  cause  and  a review 
by  an  ISMS  designee.  Any  proposals  for 


premium-rate  increases,  or  other  changes,  will 
be  submitted  to  the  Economics  and  Insur- 
ance Committee  for  review  and  acceptance. 

3.  Firm  steps  are  being  taken  to  improve  the 
legal  climate  in  Illinois.  No  claims  will  be 
settled  without  the  written  approval  of  the  in- 
sured. Outstanding  defense  counsels,  expert  in 
malpractice  cases,  will  be  retained.  The  legal 
profession  will  be  notified  that  every  nuisance 
claim  will  be  fought.  An  educational  program 
among  the  members  will  emphasize  claim- 
prevention  techniques  and  malpractice  trends. 

4.  Coverage  up  to  $1,000,000  is  available. 

5.  Premium  rates  are  in  line  with  those  charged 
by  other  insurers,  A better  legal  climate  will 
help  stabilize  the  rates,  because  these  will  re- 
flect the  loss  experience  as  it  occurs  in  Illinois. 

Scores  of  members  applied  for  the  coverage 
immediately  after  it  was  announced.  Employers’ 
Group  hopes  to  have  at  least  4,000  members  en- 
rolled within  five  years,  to  assure  the  program’s 
optimum  strength  and  success. 

Full  details  and  application  forms  may  be  ob- 
tained from  Parker,  Aleshire  & Company,  9933 
North  Lawler,  Skokie,  111.  60076. 


RADIO-TV  PUBLIC  SERVICE  MATERIALS 


Radio  materials  available  from  the  Illinois  State 
Medical  Society  include: 

1)  “Today’s  Health  Tip” — a new  30-second 
health  message  every  day.  Available  on 
records  (30  messages  per  record)  which  fea- 
ture the  voice  of  Dr.  “SIMS.”  For  added 
local  appeal  scripts  are  also  available  which 
can  be  read  by  local  announcer  or  physician. 


2)  “Medical  Interview” — a five  minute  weekly 
interview  series  featuring  a different  doctor 
each  week,  discussing  subjects  on  practical 
health  matters  in  language  the  layman  can 
understand. 

3)  “Medicine,  Morals  and  You” — an  11-part, 
half  hour  series  combining  a pre-taped 
dramatic  introduction  and  live  interviews 
with  physicians  and  clergymen  who  discuss 


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Illinois  Medical  Journal 


such  vital  medical-moral  issues  as:  abor- 
tion, narcotics  addiction,  contraceptive  pills, 
suicide,  and  the  unwed  mother. 

Television  materials  currently  include  one-minute 
animated  spots  on  the  subjects  of  measles,  ar- 
thritis quackery,  pre-school  examinations,  and 
rheumatic  fever.  Subsequent  spots  stressing  pre- 
ventive medicine  will  be  produced  during  the 
course  of  the  year. 

In  addition,  the  Division  of  Public  Relations 
maintains  a radio  and  television  speakers’  bureau, 
which  obtains  physician-speakers  for  radio  and 
television  interview  shows  on  request. 

Doctor^s  Responsibility  to  the  Press 

Physicians  and  the  press  are  partners  in  provid- 
ing a line  of  communication  between  the  medical 
profession  and  the  public.  But,  the  press  cannot 
carry  out  its  traditional  responsibility  in  inform- 
ing the  public  in  the  area  of  medical  and  patient 
news  without  the  cooperation  of  the  medical  so- 
ciety and  individual  doctors.  The  inevitable  penal- 
ty of  silence  by  the  doctors  is  public  ignorance, 
misunderstanding  and  fear.  In  a democracy,  pub- 
lic ignorance,  misunderstanding  and  fear  can  be 
dangerous  to  professional  freedom. 

The  following  outline — based  on  a press  code 
adopted  by  the  Macon  County  Medical  Society — 
is  suggested  as  a pilot  guide  for  individual  phy- 
sicians and  county  societies  in  Illinois. 

Availability 

1)  The  officers,  committee  chairmen  or  desig- 
nated spokesmen  of  county  medical  societies  shall 
be  available  at  all  times  to  mass  media  personnel 
to  provide  authentic  information  on  medical  sub- 
jects. 

2)  A list  of  current  spokesmen  shall  be  sup- 
plied by  county  societies  to  the  executives  of  every 
newspaper,  radio  and  television  station  in  the 
country. 

3)  These  spokesmen  may  be  quoted  by  name. 
They  should  not  be  considered  by  their  colleagues 
as  self-seeking,  since  authoritative  attribution  is 
done  in  the  best  interests  of  the  public  and  the 
profession.  (In  addition,  physicians  are  private 
citizens  and  as  such  are  the  subjects  of  news 
stories  in  their  social  and  civic  activities  just  like 
any  other  citizen.) 

Physician  News 

Physicians,  as  scientists,  are  encouraged  to  give 
newspaper  interviews  and  appear  on  radio  and 
television  programs  on  medical  subjects.  Physi- 
cians may  report  on  new  or  unusual  diseases  or 


treatments  within  an  ethical  framework.  In  these 
instances,  they  should,  whenever  possible,  notify 
their  county  society  publicity  chairman  or  the  Il- 
linois State  Medical  Society. 

Physicians  may  be  asked  to  comment  as  indi- 
viduals on  politically  controversial  subjects  (such 
as  socialized  medicine).  In  this  event,  the  physi- 
cian should  clearly  indicate  that  he  is  expressing 
his  personal  viewpoint  which  should  not  be  con- 
strued as  a statement  of  medical  society  policy. 

A medical  society  officer,  however,  should  re- 
member that  any  comment  he  makes — whether  or 
not  intended  as  personal  viewpoint — is  generally 
accepted  as  official  policy. 

Patient  News 

As  the  patient’s  personal  physician,  the  doctor 
has  an  obligation  to  respect  confidences  that  come 
to  him  in  the  performance  of  his  duty  and  may 
not  release  news  except  with  the  patient’s  consent 
or  those  authorized  to  speak  for  him.  When  the 
press  learns  of  the  illness  of  private  patients  from 
other  sources,  the  physician  may  cooperate  with 
the  press  in  answering  any  inquiries  in  the  in- 
terest of  accuracy  and  to  avoid  embarrassment. 

When  news  of  patients  is  of  such  a nature  that 
it  automatically  falls  in  the  public  domain,  physi- 
cians should  feel  free  to  release  information  with- 
in the  framework  of  this  code. 

Patient  information  may  be  given  where  the 
nature  of  injuries,  illness  or  treatment  is  of  spe- 
cial interest.  The  report  of  such  information  shall 
be  more  in  the  nature  of  scientific  information, 
rather  than  an  expose  of  an  individual  affliction. 

Pre-Retirement  TV  and  Film  Series 

Recognizing  the  current  “retirement  revolution” 
in  which  persons  are  retiring  earlier  and  living 
longer,  the  ISMS  Committee  on  Aging  recently 
produced  a 13-part,  half  hour  weekly  television 
series  on  pre-retirement  planning  entitled,  “The 
Time  Of  Your  Life.” 

The  series — co-sponsored  through  a grant  from 
Blue  Shield  Plan  of  Illinois  Medical  Service — 
features  broadcast  personality  Norman  Ross  who 
interviews  guest  authorities  on  such  vital  topics 
as:  financial  and  estate  planning;  meeting  medical 
expenses;  where  to  live  in  retirement;  how  to 
cope  with  physical  and  emotional  problems;  and 
constructive  utilization  of  leisure  time.  Initially 
shown  on  Chicago  television,  the  series  is  now 
available  for  loan  on  16  mm.  film  to  industries, 
businesses,  and  other  organizations  throughout 
the  state  and  nation  as  a “ready  made”  course 
of  instruction. 


MEDICAL  SELF-HELP  TRAINING  PROGRAM 


The  Disaster  Medical  Care  Committee  of  the 
Illinois  State  Medical  Society  strongly  endorses 
the  training  of  at  least  one  person  in  each  family 
on  procedures  to  follow  in  the  event  of  a medical 
emergency.  This  would  be  of  value  not  only  in  the 


event  of  an  atomic  disaster,  when  physicians 
would  not  be  available,  but  also  in  caring  for  other 
emergencies  until  the  help  of  a physician  can  be 
obtained. 


for  October,  1968 


453 


For  this  reason  the  Society  presented  “Medical 
Self  Help  Training”  as  an  official  television  course 
over  educational  Channel  11  in  Chicago  early  in 
1964  and  again  in  1965.  Over  10,000  persons  en- 
rolled in  this  course.  Response  was  so  enthusiastic 
that  films  of  the  complete  15-part,  7 -hour  series 
have  been  made  available  to  county  medical  so- 


cieties, industries,  schools,  and  television  stations 
throughout  the  state. 

For  complete  information  on  this  film  course, 
as  well  as  a “live”  course  for  group  study  pres- 
entations, write  the  Public  Relations  Division  of 
the  state  society. 


ILLINOIS'  REVISED  VITAL  RECORDS-1968 


Revised  forms  for  recording  births,  deaths, 
fetal  deaths,  marriages  and  divorces,  developed 
by  the  Illinois  Department  of  Public  Health, 
were  introduced  Jan.  1,  1968.  Major  revisions  of 
vital  records  occur  approximately  every  10  years 
to  coincide  with  the  revised  recommendations  of 
the  United  States  Public  Health  Service  on  the 
content  of  vital  records.  These  recommendations 
to  the  states,  known  as  the  “standard  certificates,” 
along  with  the  international  classification  of  dis- 
eases, are  the  two  most  important  instruments  for 
achieving  the  nationwide  comparability  and  con- 
sistency that  are  so  essential  in  the  interpretation 
of  vital  statistics  data. 

A great  deal  of  study  and  planning  went 
into  the  1968  Illinois  revision.  The  topic  of  stand- 
ard certificates  appeared  on  the  1962  agenda  of 
the  biennial  Public  Health  Conference  on  Re- 
cords and  Statistics,  held  in  Washington,  D.  C. 
Since  that  time  resource  organizations,  medical 
societies,  hospitals,  administrative  organizations, 
law  enforcement  agencies  and  many  other  groups 
have  been  contacted  for  suggestions  and  recom- 
mendations. State  and  local  registrars  of  vital 
statistics,  statisticians,  and  other  consultants  served 
on  study  committees  to  develop  specific  recom- 
mendations to  the  United  States  Public  Health 
Service  on  content  and  format. 

Additional  work  was  required  to  adopt  these 
standard  certificates  to  Illinois  laws  and  practices. 
Valuable  assistance  and  advice  was  obtained  from 
a variety  of  special  committees.  Included  were 
the  Vital  Statistics  Committee  of  the  Illinois 
State  Medical  Society  and  special  committees  of 
the  Illinois  Hospital  Association,  the  Illinois  As- 
sociation of  Medical  Record  Librarians,  the  Fam- 
ily Law  Section  of  the  Illinois  State  Bar  As- 
sociation, the  Illinois  Coroners  Association,  the 
Illinois  Funeral  Directors  Association,  the  Illinois 
Association  of  County  Clerks  and  Recorders,  and 
the  Administrative  Office  of  the  Illinois  Courts. 

The  Illinois  certificates  of  live  birth  and  fetal 
death  contain  a section  for  health  and  statistical 
use  only.  Much  of  this  information  has  not  here- 
tofore been  collected.  It  is  vital  that  the  makers 
of  certificates  understand  their  importance,  and 
understand  that  these  items  do  not  appear  on 
certified  copies  of  the  certificate  and  will  not  be 
released  by  the  official  custodian  of  the  certificate 
except  upon  court  order. 

The  race  and  education  of  parents  are  used 
with  other  information  on  the  certificate  to  evalu- 


ate the  effect  of  socio-economic  factors.  Because 
of  differences  in  these  socio-economic  factors, 
various  groups  in  the  population  have  different 
birth  characteristics.  By  statistical  analysis  of 
these  characteristics,  the  influence  of  social  fac- 
tors bn  fertility  and  infant  survival  can  be  studied 
and  the  social  and  health  problems  of  these  groups 
can  be  evaluated. 

The  number  of  previous  deliveries,  both  births 
and  fetal  deaths,  assists  in  estimating  further  birth 
rates  and  examining  the  effect  of  changing  social 
and  economic  conditions  on  the  number  of 
children  couples  decide  to  have. 

The  dates  of  the  mother’s  last  live  birth  and 
last  fetal  death  allow  studies  of  the  time  interval 
between  children.  Understanding  patterns  of  child 
spacing  practices  is  necessary  to  interpret  changes 
in  birth  rate  trends.  In  addition,  the  outcome 
of  a pregnancy  following  a fetal  death  is  of  in- 
terest to  physicians  and  other  medical  research 
workers. 

The  weight  of  a fetus  is  closely  related  to  its 
gestational  age.  The  date  of  last  normal  menses 
also  is  used  to  calculate  gestational  age,  which  is 
useful  in  the  study  of  fetal  loss.  The  month  of 
pregnancy  in  which  a mother  began  her  prenatal 
care  and  the  number  of  prenatal  visits  she  had 
are  also  related  to  the  outcome  of  pregancy  as 
well  as  to  her  own  health.  Thus,  these  items  are 
important  to  those  interested  in  improving  health 
and  medical  services  for  mothers  and  babies. 

Illegitimate  births  are  an  important  social  prob- 
lem. The  item  about  legitimacy  helps  to  measure 
the  extent  of  the  problem  so  that  medical  and 
social  programs  can  be  designed  to  effectively 
assist  unwed  mothers. 

The  other  items  in  this  section  are  similarly 
useful  for  statistical  research  and  for  medical 
purposes. 

Available  from  the  Illinois  Department  of  Public 
Health  are  special  handbooks  giving  complete 
instructions  on  the  preparation  and  filing  of 
certificates  of  birth,  death  and  fetal  death.  These 
handbooks  consist  of  a Hospital  Handbook  on 
Birth  and  Fetal  Death  Registration;  a Funeral 
Directors  Handbook  on  Death  and  Fetal  Death 
Registration;  and  a Physicians  Handbook  on 
Medical  Certification:  Death,  Fetal  Death,  Birth. 
A Manual  for  Coroners  was  scheduled  to  be 
revised  to  incorporate  certain  new  instructions 
during  1968. 


454 


Illinois  Medical  Journal 


Woman's  Auxiliary 

To  The  Illinois  State  Medical  Society 


If  ‘life  begins  at  40’,  then  the  Woman’s  Auxi- 
liary to  the  Illinois  State  Medical  Society  is  start- 
ing a new  phase  of  its  existence  as  we  start  our 
41st  year.  On  our  membership  cards  are  these 
words  “Let  the  helping  hands  of  the  doctor’s  wife 
reflect  and  enrich  his  dedicated  service”  and  this 
is  what  we  ask  to  be  allowed  to  do.  We  hope 
that  every  doctor  will  encourage  his  wife  to  be 
an  interested  member.  Paul  R.  Whitener,  M.D., 
wrote  in  Missouri  Medicine,  “The  modern  doc- 
tor is  often  too  busy  to  take  an  active  role  in 
the  numerous  voluntary  health  organizations,  to 
get  acquainted  with  the  local  newspaper  editor 
or  radio-TV  manager,  or  to  establish  a personal 
contact  with  his  own  legislators  and  political 
leaders.  Such  a doctor  may,  however,  have  a wife 
who  would  be  more  than  glad  to  at  least  try 
some  of  these  community  activities.” 

Community  Health  does  concern  us  whether 
we  live  in  a large  city,  a small  town  or  a rural 
area — and  we  can  do  something  about  it.  With 
the  “Accent  on  Youth”  there  are  prepared  pack- 
age programs  and  directions  for  presentation  in 
these  categories.  1.  Teenage  venereal  disease.  2. 
Alcoholism  3.  LSD  and  other  drug  abuses  4. 
Sex  education  5.  Preventing  the  smoking  habit. 
We  can  work  with  other  groups  in  health  ca- 
reer clubs,  health  career  workshops  for  student 
and  councilors,  loan  and  scholarship  programs, 
to  stimulate  young  people  to  be  interested  in  and 


well  qualified  for  health  career  opportunities. 

Auxiliaries  can  help  in  the  blood  donor  pro- 
gram. There  is  a new  emphasis  in  the  Home  Cen- 
tered Health  Care.  Find  out  how  your  auxiliary 
can  promote  such  services  and  help  in  keeping 
medical  costs  down  and  prevent  over  taxing  hos- 
pital services.  Safety  projects  are  recommended 
for  both  urban  and  rural  areas,  as  well  as  Mental 
Health  programs.  Keep  up  the  fund  raising  for 
the  American  Medical  Association  Education  and 
Research  Foundation  and  Benevolence. 

Legislation  is  of  prime  importance  this  year. 
Let’s  be  sure  that  the  doctor’s  wife  is  well  in- 
formed on  what  is  at  stake  and  able  to  work  for 
what  we  believe  in — the  freedom  of  medicine. 
Every  doctor’s  wife  should  not  only  register  and 
vote  but  join  IMPAC  and  AMPAC. 

International  Health  programs  have  a great  ap- 
peal and  give  us  an  opportunity  to  have  a part 
in  the  endeavors  of  those  who  carry  on  these 
marvelous  achievements. 

Each  county  president  has  received  a Member- 
ship Orientation  Manual  which,  if  used,  will  be 
most  helpful  in  making  membership  more  mean- 
ingful! Then,  let’s  put  our  best  foot  forward  by 
keeping  informed  and  able  to  answer  adverse 
criticism — by  learning  to  listen  and  answer  in- 
telligently not  emotionally. 

Mrs.  Alden  Rarick 
President 


OFFICERS 

President:  Mrs.  Alden  Rarick,  6 Carriage  Lane, 
Danville,  61832 

President-Elect:  Mrs.  Sherman  C.  Arnold,  2416 
Brookwood  Dr.,  Flossmoor  60422 
Vice-President:  Mrs.  Harold  McCann,  55  Signal 
Hill  Blvd.,  East  St.  Louis  62203 
Vice-President:  Mrs.  Preston  Houk,  207  Park- 
view  Dr.,  Bloomington  61701 
Vice-President:  Mrs.  Michael  G.  Maitino,  601 
N.  Taylor  Ave.,  Oak  Park  60302 
Recording  Secretary:  Mrs.  Arnold  Moe,  4226 
North  Belt  West,  Belleville  62223 
Corresponding  Secretary:  Mrs.  A.  R.  Matteson 
417  Swisher,  Danville  61832 
Treasurer:  Mrs.  G.  T.  Buttice,  226  Stonegate 
Rd.,  Clarendon  Hills  60514 

DIRECTORS 

Mrs.  Mitchell  Spellberg 

7408  S.  Clyde  Ave.,  Chicago  60649 
Mrs.  John  Van  Prohaska 

5830  S.  Stony  Island  Ave.,  Chicago  60637 
Mrs.  B.  E.  Montgomery 

100  W.  Walnut,  Harrisburg  62946 


for  October,  1968 


455 


1.  Boone,  DeKalb,  Jo  Daviess,  Kane,  Lake, 
Stephenson,  Winnebago 

Mrs.  L.  P.  Bunchman,  Stephenson  St.,  Free- 
port 61032 

2.  Bureau,  LaSalle,  Lee,  Livingston,  Whiteside 

Mrs.  Robert  Fanner,  403  W.  Santa  Fe, 
Toluca  61369 

3.  Cook 

Mrs.  Paul  P.  David,  151  W.  146th  St., 
Chicago  60627 

Mrs.  H.  C.  Schorr,  1317  E.  50th  St., 

Chicago  60615 

Mrs.  Jan  J.  Kukral,  860  N.  Lake  Shore  Dr., 
Chicago  60611 

4.  Henry,  Knox,  Mercer,  Peoria,  Rock  Island, 
Warren 

Mrs.  Richard  Icenogle,  Box  188, 

Roseville  61473 

5.  Logan,  McLean,  Sangamon,  Tazewell 
Mrs.  J.  L.  Bailen,  903  S.  Mercer  Ave., 
Bloomington  61701 

CHAIRMEN  OF 

AMA-ERF  Mrs.  J.  Ernest  Breed 

111  Linden  Ave.,  Wilmette  60091 

Archives  Mrs.  W.  J.  Wanninger 

7423  S.  Phillips,  Chicago  60649 
Benevolence  Mrs.  Michael  G.  Maitino 

601  N.  Taylor  Ave.,  Oak  Park  60302 

Community  Health  Mrs.  Preston  Houk 

207  Parkview  Dr.,  Bloomington  61701 

Convention  Mrs.  John  Van  Prohaska 

5830  S.  Stony  Island  Ave.,  Chicago  60637 

Vice  Chairman  Mrs.  Maurice  Goldstein 

6853  N.  Hiawatha  Ave.,  Chicago  60646 

Credentials  & Registration Mrs.  Paul  Palmer 

1511  Bigelow,  Peoria  61604 
Editorial  Mrs.  Eugene  L.  Vickery 

602  Oak  Street,  Lena  61048 

Finance Mrs.  Joseph  Shanks 

3121  Sheridan  Rd.,  Apt.  804,  Chicago  60657 

Health  Careers  Mrs.  Carl  E.  Clark 

649  E.  Cloverlane  Dr.,  Sycamore  60178 

Home  Centered  Health  Care 

Mrs.  Herbert  P.  Swartz 

575  S.  Wall  St.,  Kankakee  60901 

Hospitality  Mrs.  George  L.  Pastnack 

1053  Crabtree  Lane,  DesPlaines  60016 

Vice  Chairman  Mrs.  Andrew  J.  McGee 

717  N.  Main  St.,  Pontiac  61764 
International  Health  Mrs.  Howard  A.  Lowy 

112  Pekin  Ave.,  East  Peoria  61611 

Legislation  Mrs.  Alan  Taylor 

1607  N.  Vermilion,  Danville  61832 


Adams,  Madison,  Morgan 

Mrs.  Maurice  Woll,  159  S.  9th  St. 

East  Alton  62024 

Christian,  Effingham,  Macon,  Marion-Clinton 
Mrs.  H.  E.  Schoonover,  Route  No.  4 
Salem  62801 

Champaign,  Cole  s-Cumberland,  Crawford, 
Vermilion 

Mrs.  E.  E.  McDonnell,  1126  Wilkin  Rd. 
Danville  61832 

J eff  erson-Hamilton 

Mrs.  Edward  C.  Wood,  1907  Broadway, 

Mt.  Vernon  62864 

St.  Clair,  St.  Clair-Belleville  Branch 
Mrs.  Wilson  West,  14  Oakwood  Dr. 
Belleville  62223 

DuPage,  Kankakee,  Will-Grundy 

Mrs.  Richard  Bowman,  600  Valley  Road 

Itasca  60143 


COMMITTEES 

Members-at-large  Mrs.  Robert  Hartman 

1040  W.  College,  Jacksonville  62650 

Vice-Chairman  Mrs.  Lewis  A.  Hare 

10811  S.  Fairfield  Ave.,  Chicago  60655 

Membership  & Organization  

Mrs.  Sherman  C.  Arnold 

2416  Brookwood  Dr.,  Flossmoor  60422 

Mental  Health  Mrs.  Thomas  Tourlentes 

State  Research  Hospital,  Galesburg  61401 

Vice-Chairman  Mrs.  Robert  Dancey 

State  Tuberculosis  Sanitarium 
Mt.  Vernon  62864 

Parliamentarian  Mrs.  Percy  M.  Clark 

5722  Franklin  Ave.,  LaGrange  60515 

Press  & Publicity Mrs.  Richard  Schaede 

401  Eden  Park,  Rantoul  61866 

Vice  Chairman  Mrs.  Joseph  A.  Cari 

9212  S.  Mozart,  Evergreen  Park  60642 
Program  Development  ....  Mrs.  Harold  E.  McCann 
55  Signal  Hill  Blvd.,  E.  St.  Louis  62203 

Public  Affairs  Mrs.  David  Kweder 

1432  N.  Sheridan  Rd.,  Waukegan  60085 
Revisions  & Resolutions  ....  Mrs.  Newton  DuPuy 
1842  Grove  Ave.,  Quincy  62301 

Rural  Health  Mrs.  John  W.  Ovitz 

427  S.  Main  St.,  Sycamore  60178 

Safety  Mrs.  Arthur  Smith 

206  Country  Club  Lane,  Belleville  62223 

Urban  Health  Mrs.  Franklin  D.  Yoder 

2 Lantern  Lane,  Springfield  62704 

WAS  AM  A Mrs.  John  W.  Koenig 

2518  Oakwood  Dr.,  Olympia  Fields  60461 


DISTRICT  COUNCILORS 

6. 


7. 


8. 


9. 


10. 


11. 


456 


Illinois  Medical  Journal 


Illinois  Medical  Political 
Action  Committee 
(IMPAC) 


The  Illinois  Medical  Political  Action  Commit- 
tee (IMPAC)  is  a voluntary,  non-profit,  unin- 
corporated, permanent  membership  organization 
founded  in  1960.  IMPAC  serves  as  the  unified  po- 
litical action  arm  of  Illinois  physicians  and  their 
wives.  It  cooperates  with  others  in  the  healing 
arts  professions.  Funds  collected  through  IMPAC 
memberships,  used  in  support  of  candidates,  are 
administered  independently  of  other  professional 
groups.  However,  the  program  is  operated  in 
harmony  with  the  legislative  objectives  of  the 
Ilhnois  State  Medical  Society.  Individual  partici- 
pation in  IMPAC  is  one  means  by  which  the 
individual  physician  and  his  wife  can  effectively 
participate  in  public  affairs. 

IMPAC  participates  primarily  in  election  con- 
tests for  legislative  offices — both  those  in  the 
Illinois  General  Assembly  and  in  the  U.  S.  Con- 


gress. It  cooperates,  both  in  election  efforts  and 
in  membership  solicitation  activities,  with  the 
American  Medical  Political  Action  Committee 
(AMPAC),  its  counterpart  on  the  national  level. 

IMPAC’s  organization  consists  of  a chairman, 
an  executive  committee,  and  a council.  Political 
action  activities  are  implemented  by  local  physi- 
cian support  committees  formed  on  behalf  of  can- 
didates in  U.  S.  Congressional  or  other  legislative 
districts.  Candidate  selection  and  support  are  de- 
termined on  the  basis  of  evaluations  and  recom- 
mendations submitted  to  the  council  and  ex- 
ecutive committee  by  the  local  committees,  thus 
assuring  members  of  a “grass  roots”  voice  in 
IMPAC  activities. 

Additional  information  about  IMPAC  may  be 
obtained  by  writing:  IMPAC,  Suite  2010,  360  N. 
Michigan  Ave.,  Chicago  60601. 


Illinois  Medical  Assistants  Association 


The  Illinois  Medical  Assistants  Association  is 
just  what  the  name  implies — an  Association  of 
Medical  Assistants  throughout  the  State  of  Illi- 
nois who  have  become  an  educational  organ- 
ization with  objectives  as  follows:  (a)  To  bring 
into  one  association  all  medical  assistant  or- 
ganizations of  the  State  of  Illinois;  (b)  to  pro- 
vide an  organization  for  those  residing  in  Ilhnois 
counties  where  no  medical  assistants  societies  are 
organized;  (c)  to  assist  the  physicians  in  im- 
proving medical  public  relations;  (d)  to  main- 
tain and  advance  the  standards  of  professional 
employment  and  to  give  honest,  loyal  and  ef- 
ficient service  to  the  medical  profession  and  the 
pubhc;  (e)  to  meet  from  time  to  time  to  secure 
interchange  of  ideas. 

The  medical  assistant  associations  are  educa- 
tional groups — not  social.  We  are  not  a union  and 
any  attempt  to  promote  the  unionization  of  this 
society  or  its  members  automatically  forfeits  the 
membership  of  the  person  or  persons  making 
such  an  attempt. 

Now  the  qualified  medical  assistant  has  the 
opportunity  to  pass  a special  board  examination 
and  thus  become  a “Certified  Medical  Assistant.” 


This  will  affect  directly  or  indirectly  every  phy- 
sician’s office.  Of  note  is  the  fact  that  you  do 
not  have  to  belong  to  the  Association  to  take 
this  examination.  For  further  information  as  to 
qualifications  necessary  to  take  the  examination 
write  to  American  Association  of  Medical  As- 
sistants, 510  N.  Dearborn  St.,  Chicago  60610. 

Local  programs  in  the  component  societies  of 
IMAA  are  geared  to  the  needs  of  that  particular 
area.  Obviously  the  strictly  specialist  areas  would 
have  entirely  different  problems  and  educational 
needs  than  the  area  of  the  general  practitioner 
where  the  office  is  staffed  by  one  or  two  medical 
assistants.  Hence  the  educational  programs  in  your 
area  would  be  decided  by  your  own  Medical  As- 
sistants and  supervised  by  the  doctors  in  your 
own  county  society. 

We  need  you.  Doctor,  to  encourage  your  medi- 
cal assistants  to  join  our  association.  But  also 
you  could  help  us  by  assisting  us  in  selecting  the 
proper  educational  programs  which  in  the  long 
run  would  be  of  most  benefit  to  you.  That  is  our 
whole  purpose,  to  become  better  medical  assistants 
so  we  can  help  you  to  help  your  patients. 


for  October,  1968 


457 


Association  Of  The  Professions 


The  Illinois  Association  of  the  Professions  is  a 
nonprofit  corporation,  incorporated  under  the 
laws  of  Illinois  on  Feb.  6,  1964.  Several  other 
states  such  as  Michigan,  New  York  and  North 
Carolina  have  already  organized  associations  of 
professions  with  the  same  basic  structure  and 
purpose  and  an  American  Association  of  the  Pro- 
fessions has  been  incorporated. 

The  lAP  was  created  to  provide  the  organiza- 
tional machinery  whereby  the  combined  strength 
and  counsel  of  all  professions  can  be  utilized  for 
the  advancement  of  professional  ideals  and  the 
promotion  of  professional  welfare.  This  should 
strengthen  the  traditional  rights,  privileges  and 
responsibilities  of  each  profession.  At  the  same 
time,  it  should  also  provide  more  effectively  to 
the  people  adequate  professional  services  based 
on  skill  and  integrity. 

The  close  relationships  between  members  of 
the  professions  place  them  in  a better  position  to 
be  “molders  of  public  policy.”  The  lAP  will  devise 
ways  and  means  of  better  utilizing  the  professional 
knowledge  and  skills  of  its  members  for  the 
benefit  of  society  and  attempt  to  create  the  kind 
of  relations  between  the  professions  which  will 
most  effectively  accomplish  this  objective. 

LAP  is  not  a political  organization.  It  is  non- 
partisan. But  it  serves  its  members  as  one  prac- 
tical medium  of  communication  between  the 
professions  and  legislative  bodies. 

lAP  supplements  efforts,  programs  and  services 
of  the  individual  state  professional  societies.  The 
professional  societies  must  function  for  the  pro- 
fession each  represents. 

The  lAP  benefits  the  individual  member  by 
helping  him  protect  and  perpetuate  the  individual 
privileges  and  responsibilities  of  the  professional 
person.  It  serves  as  a medium  of  communication 
between  the  professions,  devoting  its  activities  to 
professional  relations,  public  relations,  legislation, 
education,  and  business  services. 

Through  the  cooperation  of  the  professions  in 
Illinois,  who  are  members  of  the  lAP,  legislation 
in  the  name  of  HB  2432  was  enacted  in  the  75th 
General  Assembly  and  approved  by  Governor 
Otto  Kerner.  This  legislation  creates  a “Division 
of  Professional  Supervision”  in  the  Department  of 
Registration  and  Education. 


Eight  state  professional  societies  are  Charter 
Members  of  the  LAP. 

Illinois  Council  of  The  American  Institute  of 
Architects. 

Illinois  State  Dental  Society. 

Illinois  Society  of  Certified  Public  Accountants. 

Illinois  Society  of  Professional  Engineers. 

Illinois  State  Medical  Society. 

Illinois  Pharmaceutical  Association. 

Illinois  State  Veterinary  Medical  Association. 

Illinois  State  Bar  Association. 

Admission  of  other  professional  societies  to 
membership  is  provided  for  in  the  LAP  bylaws. 

The  LAP  is  governed  by  a board  of  directors. 
On  that  board  recognition,  rather  than  control,  is 
accorded  those  professions  having  larger  numbers 
of  individual  members.  lAP  bylaws  provide  that 
the  board  of  directors  of  each  state  organization 
shall  designate  two  of  its  members,  who  are  also 
members  of  LAP,  to  serve  as  directors.  In  addition 
to  those  thus  provided.  Directors  are  also  elected 
from  the  general  membership  at  the  lAP  Annual 
Meeting. 

Annual  dues  for  an  individual  member  in  LAP  is 
$10.  Annual  dues  for  a professional  society  or- 
ganization is  $100.  Applications  and  checks  are 
accepted  by  the  executive  secretary  of  state  pro- 
fessional associations  for  processing. 

LAP  is  a “horizontal”  type  of  organization  estab- 
lished to  answer  some  of  the  professional’s  prob- 
lems just  as  other  segments  of  society  are  organ- 
ized. Labor,  for  example,  has  the  AFL-CIO — 
cutting  across  all  trades  on  an  industry-wide  basis. 
State  and  national  Chambers  of  Commerce  were 
created  for  business  and  the  American  Federa- 
tion of  Farm  Bureaus,  one  of  the  greatest  forces 
in  our  nation,  is  the  voice  of  farming. 

The  Illinois  Veterinary  Medical  and  Medical 
professions  have  launched  a joint  project  to  es- 
tablish 70  package  disaster  hospitals  throughout 
the  state.  These  hospitals  are  strategically  located 
and  provide  all  residents  with  readily  available 
200  bed  units.  The  hospitals  can  be  functional 
within  two  hours  following  a disaster.  Several 
training  areas  have  been  established  at  Spring- 
field,  Elmhurst  and  Chicago  to  provide  veteri- 
narians and  physicians  to  service  these  hospitals. 
This  unique  program  and  the  first  for  the  U.S. 
is  under  the  direction  of  Dr.  Max  Klinghoffer, 
Elmhurst  Community  Hospital,  Chairman  of  Civil 
Defense  for  the  Association  and  Dr.  Dan  Parmer, 
Richton  Park,  representing  the  Veterinary  Medi- 
cal Profession. 


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Illinois  Medical  Journal 


ILLINOIS  STATE  GOVERNMENT 


The  state  government  is  divided  into  three 
branches — legislative,  executive,  and  judicial.  The 
legislative  power  is  vested  in  the  General  Assem- 
bly, which  is  composed  of  the  State  Senate  and 
the  House  of  Representatives  (a  bicameral  as- 
sembly) . 

For  representation  in  the  General  Assembly, 
there  are  58  senatorial  districts  and  59  represen- 
tative districts.  Each  senate  district  elects  one 
senator;  each  representative  district  elects  three 
representatives.  Thus,  the  Senate  has  58  members 
and  the  House  177.  The  senators  are  elected  for 
four-year  terms,  and  the  representatives  serve  two- 
year  terms.  Under  normal  procedure.  Senators  in 
the  districts  having  even  numbers  are  elected  in 
Presidential  election  years;  those  in  districts  with 
odd  numbers  are  chosen  at  elections  in  the  inter- 
vening even-numbered  years.  However,  recent  re- 
quirements for  reapportiomnent  have  created 
changes  in  this  pattern. 


The  General  Assembly  normally  meets  in  the 
first  six  months  of  each  odd-numbered  year,  al- 
though it  may  be  called  into  special  session  by  the 
Governor.  The  General  Assembly’s  functions  are 
to  enact,  amend,  or  repeal  laws  or  adopt  appro- 
priation bills,  act  on  amendments  to  the  United 
States  Constitution,  propose  and  submit  amend- 
ments to  the  State  Constitution,  and  to  act  to 
remove  public  officials. 

When  the  House  of  Representatives  is  organized, 
a Speaker  or  presiding  officer  is  elected  for  the 
biennium.  The  presiding  officer  of  the  Senate  is 
the  Lieutenant  Governor.  To  facilitate  the  hand- 
ling of  legislation,  the  members  of  the  Senate 
and  House  are  assigned  to  designated  committees 
to  consider  bills  of  like  subject  matter.  These 
committees  usually  hold  public  hearings  to  dis- 
cuss legislation  before  the  measure  is  taken  up 
by  the  entire  House  or  Senate.  There  are  approxi- 
mately 50  committees. 


for  October,  196S 


459 


EXECUTIVE  BRANCH 


The  Constitution  provides  that  the  Executive  ent  of  Public  Instruction,  and  Attorney  General. 
Department  shall  consist  of  the  Governor,  Lieu-  All  of  these  officials  are  elected  for  four-year 

tenant  Governor,  and  Secretary  of  State,  Auditor  terms.  The  Treasurer  is  the  only  elected  state 

of  Public  Accounts,  Treasurer,  and  Superintend-  official  who  cannot  succeed  himself. 


LEGISLATIVE 

Legislative  Procedure 

Each  member  of  the  General  Assembly  has  the 
right  to  introduce  bills  or  resolutions.  After  the 
introduction  of  the  bill,  it  is  referred  to  the 
appropriate  committee.  If  the  committee  recom- 
mends the  bill  favorably,  it  is  read  a first  time, 
usually  by  title,  before  the  house,  in  which  it 
was  introduced.  A second  reading  must  be  held 
on  a separate  legislative  day  when  amendments 
to  it  can  be  offered  for  consideration  by  the  entire 
membership.  The  bill  will  then  be  given  a third 
and  final  reading  when  it  is  acted  upon  by  the 
entire  membership  of  the  house  that  is  consider- 
ing it. 

Action  by  Both  Houses 

To  pass,  the  bill  must  receive  the  favorable  vote 
of  the  majority  of  the  members  elected  (89  in 
the  House;  30  in  the  Senate).  These  bills  are 
then  sent  to  the  other  house  where  essentially 
the  same  procedure  is  followed. 

If,  because  of  amendments  in  the  second  house, 
there  are  two  versions  of  the  same  bill,  confer- 
ence committees  may  be  appointed  to  work  out 
the  differences.  Both  houses  must  vote  favorably 
on  the  same  version  of  the  bill  before  it  can  be 
sent  to  the  Governor  for  his  consideration. 

If  the  Governor  thinks  the  bill  should  become 
a law,  he  can  either  sign  it  or  file  it  with  the 
Secretary  of  State  without  his  signature.  If  the 
Governor  decides  it  would  be  unwise  for  the  bill 
to  become  law,  he  can  veto  it.  If  he  vetoes  the 
bill,  he  must  file  a statement  of  objections.  Two- 
thirds  of  the  members  elected  to  the  House  can 
override  the  veto.  He  can  also  veto  specific  items 
of  an  appropriations  bill. 

Appropriation  Bills 

“Bills  making  appropriations  of  money  out  of 


BRANCH 

the  treasury  shall  specify  the  objects  and  purposes 
for  which  the  same  are  made,  and  if  the  Gover- 
nor shall  not  approve  any  one  or  more  of  the 
items  or  sections  contained  in  any  bill,  but  shall 
approve  the  residue  thereof,  it  shall  become  a law 
as  to  the  residue  in  like  manner  as  if  he  had 
signed  it.  The  Governor  shall  then  return  the 
bill  with  any  objections  to  the  items  or  sections 
of  the  same  not  approved  by  him  to  the  House 
in  which  the  bill  shall  have  originated,  which 
House  shall  enter  the  objections  at  large  upon 
its  journal  and  proceed  to  reconsider  so  much  of 
said  bill  as  is  not  approved  by  the  Governor.  Any 
item  or  section  of  said  bill  not  approved  by  the 
Governor  shall  be  passed  by  two-thirds  of  the 
members  elected  to  each  of  the  two  Houses  of 
the  General  Assembly,  it  shall  become  part  of 
said  law,  notwithstanding  the  objections  of  the 
Governor.  Any  bill  which  shall  not  be  returned 
by  the  Governor  within  ten  days,  Sundays  ex- 
cepted after  it  shall  have  been  presented  to  him, 
shall  become  a law  in  like  manner  as  if  he  had 
signed  it,  unless  the  General  Assembly  shall,  by 
their  adjournment,  prevent  its  return,  in  which 
case  it  shall  be  filed  with  his  objections  in  the 
office  of  the  Secretary  of  State  within  ten  days 
after  such  adjournment  or  become  a law.”  (Article 
V,  Section  16,  Illinois  Constitution) 

NOTE 

A Legislative  Directory  containing  the  names  and 
addresses  of  all  members  of  the  75th  Illinois 
General  Assembly  and  the  Illinois  Senators  and 
Representatives  in  the  Congress  is  available.  Re- 
quests should  be  directed  to:  Illinois  State  Medical 
Society,  Regional  Office,  520  S.  Sixth  St.,  Spring- 
field,  62701. 


STATE  OFFICERS 


Governor,  Samuel  H.  Shapiro,  Dem.,  Kankakee 
Lieutenant  Governor,  Vacant 
Secretary  of  State,  Paul  Powell,  Dem.,  Vienna 
Auditor  of  Public  Accounts,  Michael  J.  Howlett, 
Dem.,  Chicago 


State  Treasurer,  Adlai  E.  Stevenson,  III,  Dem., 
Chicago 

Attorney  General,  William  G.  Clark,  Dem.,  Chi- 
cago 

Superintendent  of  Public  Instruction,  Ray  Page, 
Rep.,  Springfield 


460 


Illinois  Medical  Journal 


DEPARTMENT  OF  MENTAL  HEALTH 

401  S.  Spring  St.,  Springfield  62706 


Harold  M.  Visotsky,  M.D.,  Director 
Mortimer  Brown,  Ph.D.,  Assistant  to  the  Director 
Mrs.  Anne  M,  Konar,  Executive  Assistant  to  the 
Director 

Mrs.  Christine  Dahlberg,  Secretary  to  the  Director 
Leo  Fitzgerald,  Administrative  Assistant 
John  B.  Acheson,  Special  Assistant 
Robert  Lanier,  Special  Assistant 
Margaret  Schilhng,  Special  Assistant 
William  Lewis,  Jr.,  Special  Assistant  (Public 
Information) 

Robert  Dahl,  Public  Information  Officer 
Jerome  Goldberg,  Special  Counsel 
Philip  Arben,  D.C.S.,  Management  Consultant 
Mrs.  Jo  Buchanan,  Office  Manager,  Chicago  Gen- 
eral Office 

Division  of  Planning 
and  Evaluation  Services 

Leo  Levy,  Ph.D.,  Division  Director 
Ralph  W.  Collins,  Assistant  Division  Director 
(Metropohtan) 

Samuel  Weingarten,  Ph.D.,  Assistant  Division 
Director  (Downstate) 

Allen  Herzog,  Supervisor,  Management  Informa- 
tion Section 

Mrs.  Elizabeth  Slotkin,  Chief,  Program  Analysis 
and  Evaluative  Research 
Joseph  R.  Godwin,  Ph.D.,  Behavioral  Scientist 
Louis  Rowitz,  Research  Sociologist 
Miss  Helen  Lambrakis,  Urban  Planning  Specialist 
Mrs.  Mary  Grossberg,  Communications  Specialist 

Division  of  Mental  Retardation 
Services 

William  Sloan,  Ph.D.,  Division  Director 
Lawrence  Bussard,  Assistant  Division  Director 
( Administration ) 

Charles  Jubenville,  Ed.D.,  Assistant  Division 
Director  (Extra-Mural  Programs) 

Richard  Scheerenberger,  Ph.D.,  Assistant  Division 
Director  (Prog.  Coordination) 

Ralph  Wagner,  Assistant  Project  Coordinator 
Christian  Simonson,  Administrator,  Waiting  List 
Donald  Kimbrell,  Ph.D.,  Consultant,  Day  Program 
— Mentally  Retarded 

Thomas  Villiger,  Administrator,  Individual  Care 
Grants 

Mrs.  Ruth  Bartle,  Private  Care  Consultant 

Institutions 

A.  L.  Bowen  Children’s  Center,  A.  J.  Shafter, 
Ph.D.,  Superintendent 

Dixon  State  School,  David  Edelson,  Superintend- 
ent 

William  W.  Fox  Children’s  Center,  Thomas  P. 

Crane,  M.D.,  Superintendent 
Lincoln  State  School,  Louis  Belinson,  M.D.,  Su- 
perintendent 

Warren  G.  Murray  Children’s  Center,  William 
B.  Bradley,  Acting  Superintendent 


Division  of  Professional  Services 

Abel  G.  Ossorio,  Ph.D.,  Division  Director 
Myrna  B.  Kassel,  Ph.D.,  Assistant  Division  Di- 
rector (Training) 

Mrs.  Annette  Calloway,  Chief,  Psychiatric  Social 
Services 

Paul  F.  Cole,  R.Ph.,  Supervising  Pharmacist 
Ira  D.  Cravens,  Chief,  Veterans  Services 
A.  A.  Kaluzny,  M.D.,  Medical  Services 
A.  A.  Kaluzny,  M.D.,  Chief,  Tuberculosis  Con- 
trol 

C.  P.  Macaluso,  Chief,  Clinical  Laboratories 
Mrs.  Louise  A.  Meyer,  R.N.,  Assistant  Chief, 
Nursing  Services 

Abel  G.  Ossorio,  Ph.D.,  Chief,  Psychology  Serv- 
ices 

Miss  Jane  Phillips,  Chief,  Volunteer  Services 
Rudyard  Propst,  Chief,  Rehabilitation  Services 
Paul  A.  Rittmanic,  Ph.D.,  Chief,  Speech  and 
Hearing  Services 

Lyman  Samo,  Chief,  Special  Education  Services 
Miss  Ruth  Vanderhorst,  R.N.,  Assistant  Chief, 
Nursing  Services 

Division  of  Comprehensive  Mental 
Health  Services,  Hospitals  and  Clinics 

Thomas  A.  Tourlentes,  M.D.,  Acting  Division 
Director 

Zones  and  Institutions 

ROCKFORD:  Ronald  W.  Johnson,  M.D.,  Zone 
Director,  H.  Douglas  Singer  Zone  Center,  4402 
N.  Main  St.,  Rockford  61103 
METROZONE:  Hyman  C.  Pomp,  Ph.D.,  Acting 
Director,  Chicago  State  Hospital,  6500  W.  Irv- 
ing Park  Rd.,  Chicago  60634 
North  Central  Chicago  Sub-Zone:  Hyman  C. 
Pomp,  Ph.D.,  Director,  Read-Chicago  State 
Mental  Health  Centers,  6500  W.  Irving  Park 
Rd.,  Chicago  60634 

CHARLES  F.  READ  ZONE  CENTER:  Hy- 
man C.  Pomp,  Ph.D.,  Superintendent,  4200 
N.  Oak  Park  Ave.,  Chicago  60634 
CHICAGO  STATE  HOSPITAL:  Hyman  C. 
Pomp,  Ph.D.,  Superintendent,  6500  W.  Irv- 
ing Park  Rd.,  Chicago  60634 
MENTAL  HEALTH  CENTER:  Hyman  C. 
Pomp,  Ph.D.,  Superintendent,  2449  W.  Wash- 
ington Blvd.,  Chicago  60612 
Northwest  Chicago  Sub-Zone:  Arthur  Woloshin, 
M.D.,  Director,  Madden-Elgin  Mental  Health 
Centers,  1200  S.  First  Ave.,  Hines  60141 
JOHN  J.  MADDEN  ZONE  CENTER:  (va- 
cant), Superintendent,  1200  S.  First  Ave., 
Hines  60141 

ELGIN  STATE  HOSPITAL:  Ernest  Klein, 
M.D.,  Superintendent,  Elgin  60120 
South  Chicago  Sub-Zone:  Bernard  Rubin,  M.D., 
Director,  Tinley  Park-Manteno  Mental  Health 
Centers,  Tinley  Park  60477 


for  October,  196S 


461 


MANTENO  STATE  HOSPITAL:  H.  C. 
Piepenbrink,  Superintendent,  Manteno  60950 
TINLEY  PARK  MENTAL  HEALTH  CEN- 
TER: John  F.  Lowney,  Jr.,  M.D.,  Superin- 
tendent, Tinley  Park  60477 

PEORIA:  Thomas  T.  Tourlentes,  M.D.,  Zone  Di- 
rector, George  A.  Zeller  Zone  Center,  Peoria 
61614  (address  mail  to  Galesburg  State  Re- 
search Hospital,  Galesburg  61401) 

GEORGE  A.  ZELLAR  ZONE  CENTER: 
James  Ward,  M.D.,  Superintendent,  5407  N. 
University,  Peoria  61614 
EAST  MOLINE  STATE  HOSPITAL:  Kon- 
stantin Dimitri,  M.D.,  Superintendent,  East 
Moline  61244 

GALESBURG  STATE  RESEARCH  HOSPI- 
TAL: Thomas  T.  Tourlentes,  M.D.,  Super- 
intendent, Galesburg  61401 
PEORIA  STATE  HOSPITAL:  Henry  D. 
Staras,  M.D.,  Superintendent,  Peoria  61607 

SPRINGFIELD:  Charles  E.  Beck,  M.D.,  Zone 
Director,  Andrew  McFarland  Zone  Center, 
Springfield  62707 

ANDREW  McFarland  zone  center: 

(vacant).  Superintendent,  1-55  & Toronto  Rd., 
Springfield  62707 

JACKSONVILLE  STATE  HOSPITAL:  Steve 
Pratt,  Ph.D.,  Superintendent,  Jacksonville 
62526 

DECATUR-CHAMPAIGN:  Lewis  Kurke,  M.D., 
Zone  Director,  Adolf  Meyer  Zone  Center,  De- 
catur 62526 

ADOLF  MEYER  ZONE  CENTER  (Adults) : 
Lewis  Kurke,  M.D.,  Acting  Superintendent, 
East  Mound  Rd.,  Decatur  62526 
HERMAN  M.  ADLER  ZONE  CENTER 
(Children) : Robert  Harden,  Acting  Super- 
intendent, 2204  Griffith  Dr.,  Champaign  61820 

EAST  ST.  LOUIS:  Ivan  Pavkovic,  M.D.,  Zone 
Director,  Anna  62906  (Zone  Office:  310  N. 
10th,  East  St.  Louis  62201) 

CARBONDALE:  Robert  C.  Steck,  M.D.,  Zone 
Director,  Anna  62906 

ANNA  STATE  HOSPITAL:  Robert  C.  Steck, 
M.D.,  Superintendent,  Anna  62906 
ILLINOIS  SECURITY  HOSPITAL:  Bert 

Rednour,  Superintendent,  Chester  62233 

Community  Services 

Charles  R.  Meeker,  Chief 
B.  W.  Tucker,  Chief,  Mental  Health  Education 
Joseph  B.  Lehmann,  Consultant,  Community 
Mental  Health  Clinics 
Muriel  Rietz,  Chief,  Interstate  Services 

Alcoholism  Programs 

Richard  S.  Cook,  M.D.,  Chief 
William  N.  Becker,  Jr.,  Assistant  Chief 
Howard  W.  Wolff,  Administrator  Warren  Clinic 
Peoria  State  Hospital,  Intensive  ITeatment  Unit 


Medical  Center  Complex 

Lester  H.  Rudy,  M.D.,  Director,  Medical  Center 
Complex 

Institute  for  Juvenile  Research 

John  E.  Halasz,  M.D.,  Acting  Director 
Noel  Jenkin,  Ph.D.,  Director  of  Research 
Downtown  Research  Branch 
William  Healy  School 

Theodore  E.  TePas,  M.D.,  Medical  Director 

Illinois  State  Pediatric  Institute 

Herbert  J.  Grossman,  M.D.,  Director 

Jeanette  Schulz,  M.D.,  Acting  Director  of  Research 

Illinois  State  Psychiatric  Institute 

Lester  H.  Rudy,  M.D.,  Director 

James  W.  Maas,  M.D.,  Director  of  Research 

Robert  C.  Drye,  M.D.,  Director  of  Education 

Division  of  Research  Services 

Noel  Jenkins,  Ph.D.,  Acting  Division  Director 

Field  Division,  Mental  Health, 
Department  of  Personnel 

Don  O’Donnell,  Division  Director 
David  Jenkins,  Assistant  Division  Director  (Pro- 
grams) 

Division  of  General  Services 

E.  F.  Merten,  Division  Director 
Joseph  L.  McGrath,  Deputy  Director,  Physical 
Plant  Services 

Frank  F.  Campbell,  Deputy  Director,  Administra- 
tive Services 
Reimbursement  Services 

Gerald  Hurd,  Deputy  Director,  Budgetary  Services 

Statutory  Boards 

1.  Board  of  Mental  Health  Commissioners 
Alex  Elson,  Chicago,  Chairman 

George  Borden,  M.D.,  Quincy 
Mrs.  James  Holland,  Rockford 
Willard  King,  Chicago 
Rabbi  Meyer  M.  Abramowitz,  Springfield 
Curtis  Small,  Harrisburg 
John  Adam  Zvetina,  Chicago 
Mrs.  L.  Trimble  Steinbrecher,  Chicago,  Execu- 
tive Secretary 

2.  Psychiatric  Training  and  Research  Authority 

Jules  H.  Masserman,  M.D.,  Chicago,  Chairman 
Ernest  A.  Haggard,  Ph.D.,  Chicago,  Vice  Chair- 
man 

Herbert  J.  Grossman,  M.D.,  Secretary 
Sidney  W.  Bijou,  Ph.D.,  Champaign 
Paul  C.  Bucy,  M.D.,  Chicago 
Roy  R.  Grinker,  M.D.,  Chicago 
Paul  E.  Neilson,  M.D.,  Chicago 
Peter  J.  Talso,  M.D.,  Chicago 


462 


Illinois  Medical  Journal 


Ex-Officio — Harold  M.  Visotsky,  M.D.,  Director 
of  Mental  Health;  Alex  Elson,  Chairman,  Board 
of  Mental  Health  Commissioners;  Herbert  J. 
Grossman,  M.D.,  Director,  Illinois  State  Pedi- 
atric Institute;  Lester  H.  Rudy,  M.D.,  Director, 
Medical  Center  Complex 

3.  Board  of  Reimbursement  Appeals 

Richard  L.  Thies,  Urbana,  Chairman 
Ben  W.  Gordon,  DeKalb 
Harold  Meitus,  Chicago 

4.  Mental  Health  Planning  Board 

Robert  S.  Daniels,  M.D.,  Chicago,  Chairman 
Edward  A.  Piszczek,  M.D.,  Forest  Park,  Vice 
Chairman 

Mrs.  Arnita  Boswell,  Chicago 
Donald  J.  Caseley,  M.D.,  Chicago 
Senator  Harris  W.  Fawell,  Naperville 
Paul  Fromm,  Chicago 
Philip  Hauser,  Ph.D.,  Chicago 
Commissioner  Lewis  Hill,  Chicago 
Jay  Hirsch,  M.D.,  Chicago 
LeRoy  Levitt,  M.D.,  Chicago 
Robert  S.  Mendelsohn,  M.D.,  Evanston 
Senator  Esther  Saperstein,  Chicago 
Representative  Anthony  Scariano,  Chicago  Heights 
Representative  Arthur  Telcser,  Chicago 
Ex-Officio — Roy  Brener,  Ph.D.,  Hines;  Alex  Elson, 
Chairman,  Board  of  Mental  Health  Commis- 
sioners; Leo  Levy,  Ph.D.,  Department  of  Men- 
tal Health;  Robert  L.  McFarland,  Ph.D.,  Chi- 
cago; Harold  M.  Visotsky,  M.D.,  Director,  De- 
partment of  Mental  Health;  A.  Bond  Woodruff, 
Ph.D.,  DeKalb. 

Mrs.  Paulette  K.  Hartrich,  Chicago,  Executive 
Secretary 

Statutory  Board — Administrative 
Appointment 

Psychiatric  Advisory  Council 
Benjamin  Boshes,  M.D.,  Chairman 

H.  H.  Garner,  M.D.,  Chicago,  Vice  Chairman 
Daniel  G.  Freedman,  M.D.,  Chicago 

Roy  R.  Grinker,  M.D.,  Chicago 
Gerhart  Piers,  M.D.,  Chicago 
Melvin  Sabshin,  M.D.,  Chicago 
Jackson  Smith,  M.D.,  Hines 
Ex-Officib — Harold  M.  Visotsky,  M.D.,  Director 
of  Mental  Health 

Advisory  Committees — Administrative 
Appointment 

I.  Advisory  Board  to  Division  of  Alcoholism 
Marvin  F.  Burt,  Freeport,  Chairman 

Paul  B.  Musgrove,  Peoria,  Secretary 

J.  Milton  Guy,  Chicago 

A.  A.  Kaluzny,  M.D.,  Chicago 
George  E.  Moredock,  Jr.,  Chicago 
James  H.  Oughton,  Jr.,  Dwight 
Guy  A.  Renzaglia,  Carbondale 
Jackson  A.  Smith,  M.D.,  Chicago 


2.  Committee  on  Chest  Diseases 
Edward  A.  Piszczek,  M.D.,  Hinsdale,  Chairman 
Robert  J.  Dancey,  M.D.,  Mt.  Vernon 
Kenneth  G.  Bulley,  M.D.,  Aurora 
Clifton  Hall,  M.D.,  Springfield 
Hiram  Langston,  M.D.,  Chicago 
M.  R.  Lichtenstine,  M.D.,  Chicago 
Dan  Morse,  M.D.,  Peoria 
Robert  Sykes,  M.D.,  Chicago 
Darrell  H.  Trumpe,  M.D.,  Springfield 
George  C.  Turner,  M.D.,  Chicago 
Ex-Officio — Harold  M.  Visotsky,  M.D.,  Director 
of  Mental  Health;  A.  A.  Kaluzny,  M.D.,  Chief, 
Tuberculosis  Control,  Department  of  Mental 
Health 


3.  Advisory  Committee  on  Grants  to  Local 
Communities  for  Mental  Health  Services 

Mrs.  Bernice  T.  Van  der  Vries,  Evanston,  Chair- 
man 

Rt.  Rev.  Msgr.  William  J.  Cassin,  Springfield 
O.  M.  Chute,  Ed.D.,  Evanston 
Robert  S.  Daniels,  M.D.,  Chicago 
Robert  L.  Farwell,  Chicago 
Honorable  Seely  P.  Forbes,  Rockford 
Vernon  F.  Frazee,  Springfield 
Mrs.  Gordon  L.  Monsen,  Barrington 
Rabbi  Joseph  L.  Ginsberg,  Highland  Park 
Donaldson  F.  Rawlings,  M.D.,  Springfield 
David  P.  Richerson,  M.D.,  Johnston  City 
Mrs.  H.  Langdon  Robinson,  Springfield 
Groves  B.  Smith,  M.D.,  Alton 


4.  Advisory  Council — Public  Law  88-164, 
Construction  Grants 

Francis  J.  Gerty,  M.D.,  Hinsdale,  Chairman 

Donald  J.  Caseley,  M.D.,  Chicago 

John  K.  Cox,  Bloomington 

David  Donald,  Springfield 

John  H.  Geiger,  Des  Plaines 

Robert  A.  Henderson,  Ed.D.,  Urbana 

George  K.  Hendrix,  Springfield 

Paul  A.  laccino,  Chicago 

David  M.  Kinzer,  Chicago 

Honorable  Peyton  Kunce,  Murphysboro 

Hans  O.  Mauksch,  Ph.D.,  Chicago 

Henry  S.  Monroe,  Winnetka 

Very  Rev.  Msgr.  James  V.  Moscow,  Chicago 

Hiram  Sibley,  Chicago 

Alfred  Sheer,  Springfield 

E.  D.  Stoetzel,  Washington 

Harold  O.  Swank,  Springfield 

Mrs.  Elbert  Tourangeau,  Hinsdale 

John  A.  Troike,  Springfield 

Mrs.  Bernice  T.  Van  der  Vries,  Evanston 

Edward  T.  Weaver,  Springfield 

Franklin  D.  Yoder,  M.D.,  Springfield 


for  October,  1968 


463 


5.  Narcotics  Advisory  Council 

Harold  M.  Visotsky,  M.D.,  Chicago,  Chairman 
Rev.  R.  Bruce  Wheeler,  Chicago,  Vice  Chairman 
James  B.  Moran,  Chicago,  Secretary 
Senator  Charles  Chew,  Chicago 
Senator  Clifford  Latherow,  Carthage 
Senator  Arthur  R.  Swanson,  Chicago 
Representative  Norbert  G.  Springer,  Chester 
Representative  John  Merlo,  Chicago 
Representative  Arthur  A.  Telcser,  Chicago 
Samuel  Andelman,  M.D.,  Chicago 
James  B.  Conlisk,  Jr.,  Chicago 


Daniel  X.  Freedman,  M.D.,  Chicago 

Kermit  Mehlinger,  M.D.,  Chicago 

George  Pontikes,  Chicago 

Ross  Randolph,  Springfield 

George  L.  Sisko,  River  Grove 

Joseph  S.  Skom,  M.D.,  Chicago 

Alfred  Sheer,  Springfield 

Harold  O.  Swank,  Springfield 

Judge  Kenneth  R.  Wendt,  Chicago 

Franklin  D.  Yoder,  M.D.,  Springfield 

Nicholas  Zagone,  Chicago 

John  B.  Acheson,  Chicago,  Executive  Secretary 


DEPARTMENT  OF  PUBLIC  HEALTH 

503  State  Office  Bldg.,  Springfield  62706 
Franklin  D.  Yoder  M.D.,  M.P.H.,  Director 
E.  L.  Wittenborn  M.P.H.,  Assistant  to  the  Director 


Division  of  General  Administration 

E.  L.  Wittenborn,  M.P.H.,  Chief 

Bureaus  of:  . - 

Administration — E.  L.  Wittenborn,  M.P.H., 
Chief 

Accounting  and  Finance — Ira  Shipley,  Acting 
Chief 

Electronic  Data  Processing — Isabelle  Crawford, 
Chief 

Health  Education — Lynford  L.  Keyes,  M.P.H., 
Chief 

Consultant  Section — Gordon  Rude,  M.P.H., 
Jerry  Sappington,  M.S.P.H. 

Injury  Control  Section— James  Diekroeger, 
M.S.P.H.,  Associate  Chief 

Nursing — Pearl  H.  Ahrenkiel,  R.N.,  B.S.,  Chief; 
Grace  Musselman,  R.N.,  M.P.H.,  Assistant 

Chief;  Alice  Starr,  R.N.,  M.A.,  Consultant 
Nurse 

Statistics — E.  L.  Wittenborn,  M.P.H.,  Acting 
Chief;  Don  D.  Vance,  M.A.,  Administrative 
Officer;  Leo  A.  Ozier,  Deputy  State  Registrar; 
Clyde  A.  Bridger,  M.S.,  Chief  Statistician 

Chicago  Offices : 

Benn  J.  Leland,  M.S.,  Division  of  Sanitary  En- 
gineering, 1919,  W.  Taylor  St.,  Chicago  60612 

Division  of  Dental  Health 

Carl  L.  Sebelius,  D.D.S.,  M.P.H.,  Chief 

John  D.  Thorpe,  D.D.S.,  M.P.H.,  Assistant  Chief 

Bureaus  of : 

Research  and  Special  Studies,  John  D.  Thorpe, 

D.D.S.,  M.P.H.,  Chief 

Continuing  Education — Robert  L.  Pokorney, 

D.D.S.,  M.P.H. 

Division  of  Foods  and  Drugs 

Roy  W.  Upham,  D.V.M.,  Chief 

James  V.  Burke,  Assistant  Chief 

William  A.  Grills,  M.P.H.,  Food  Sanitation  Con- 
sultant 


Division  of  Health  Care  Facilities 
And  Chronic  Illnesses 

R.  F.  Sondag,  M.D.,  M.P.H.,  Chief 
Bureaus  of : 

Chronic  Illness 

William  J.  Cassel,  Jr.,  M.D.,  M.P.H.,  Chief 
Edith  Heide,  R.N.,  B.S.,  Consultant  Nurse, 
Aging  and  Chronic  Illness 
Chronic  Renal  Diseases 

Ruth  Shriner,  A.S.C.W.,  Social  Service  Con- 
sultant 

Ted  Moore,  B.S.,  Public  Health  Advisor,  USPHS 
Rheumatic  Fever  Control  Program — ^William  J. 
Cassel,  Jr.,  M.D.,  M.P.H.,  Chief 
Health  Facilities 

Harold  E.  Josehart,  M.S.H.A.,  Chief 
Robert  R.  Cunningham,  B.S.,  Special  Assistant 
Licensure  and  Certification  Section 

Joseph  I.  Hutchinson,  M.S.H.A.,  Coordinator 
Frank  Moore,  A.B.,  Standards  Representative, 
Long-term  Care  Facilities 
Agnes  Burns,  R.N.,  Nurse  Consultant  Super- 
visor, Hospitals 

Donald  G.  Higgins,  Medicare  & Licensure,  Me- 
dicare Program  Representative 
Planning  and  Construction  Section 

Aden  H.  Clump,  M.A.,  Program  Executive 
Rehabilitation  Section 

Albert  R.  Siegel,  M.D.,  Physiatrist,  Consultant 
in  Physical  Medicine  and  Rehabilitation 
(Part-time) 

Janet  Chermak,  O.T.R.,  Supervisor  of  Reha- 
bilitation Education  Service 
Consultative  and  Analytical  Service 

Maternity  Statistics — ^Alice  S.  Flesch,  R.N. 
Reimbursable  Costs — Robert  J.  McMahon 
Packaged  Disaster  Hospital  Program — Earl  Mur- 
phy, B.A. 

Division  of  Laboratories 

Richard  A.  Morrissey,  M.P.H.,  Chief 
John  Francis  Clark,  Business  Administrator 


464 


Illinois  Medical  Journal 


Bureaus  of : 

Biologic  Products — John  Neal,  Ph.C.,  Chief 
Diagnostic  Services — Mary  Louise  Brown,  M.S., 
Chief 

Laboratory  Evaluation — Robert  G.  Martinek, 
Pharm.,  D.,  Acting  Chief 
Sanitary  Bacteriology — Robert  M.  Scott,  M.S., 
Chief 

Toxicology — ^Frank  F.  Fiorese,  Ph.D.,  Chief 
Virus  Diseases  and  Research — Richard  Mor- 
rissey, M.P.H.,  Chief 
Laboratories : 

Springfield  Diagnostic  Laboratory 
Kirby  Henkes 

134  N.  Ninth  St.,  Springfield  62706 
Springfield  Sanitary  Bacteriology  Laboratory 
Arnold  Westerhold,  B.S., 

6th  Floor  Capitol  Bldg.,  Springfield  62706 
Carbondale  Laboratory 
Nathan  Nagle,  M.P.H. 

Oakland  & Chautauqua  Sts.,  Carbondale 
62901 

Champaign  Laboratory 
Elizabeth  Frazee,  B.A. 

505  S.  Fifth  St.,  Champaign  61820 
Chicago  Laboratory 

Richard  A.  Morrissey,  M.P.H. 

1800  W.  Fillmore,  Chicago  60612 
East  St.  Louis  Laboratory 
Charles  S.  Puntney,  A.B. 

414  Missouri  Ave.,  East  St.  Louis  62201 
Rock  Island  Laboratory 
Bettie  Anne  Muffley,  B.S. 

121  Fourth  Ave.,  Rock  Island  61201 

Division  of  Milk  Control 

Enos  G.  Huffer,  B.S.,  Chief 
Paul  N.  Hanger,  B.S.,  Supervisor  of  Grade  A 
Production 

Grover  C.  Papp,  Supervisor,  Common  Carriers 
of  Grade  A Products 
Roy  Fairbanks,  Supervisor,  I.S.M.  Program 

Division  of  Preventive  Medicine 
D.  F.  Rawlings,  M.D.,  M.P.H.,  Chief 
- Norman  J.  Rose,  M.D.,  M.P.H.,  Assistant  Chief 
Bureaus  of  Epidemiology 
Norman  J.  Rose,  M.D.,  M.P.H.,  Chief 
Philip  R.  Wactor,  Jr.,  B.S.,  Public  Health  Ad- 
visor, USPHS,  Venereal  Disease  Control 
Section  on  Veterinary  Public  Health — Paul  R. 
Schnurrenberger,  D.V.M.,  M.P.H.,  Chief 
Public  Health  Veterinarian 
Russell  J.  Martin,  D.V.M.,  M.P.H.,  Regional 
Public  Health  Veterinarian 
Illinois  Immunization  Program — Richard  H. 

Shirley,  B.S.,  Project  Coordinator,  USPHS 
Trafic  Safety  Section— Norman  J.  Rose,  M.D., 
M.P.H. 

Hazardous  Substances  and  Poison  Control 
Norman  J.  Rose,  M.D.,  M.P.H.,  Chief 
James  J.  Boland,  B.A.,  Pesticide  Project  Co- 
ordinator, USPHS 


Maternal  and  Child  Health 

James  P.  Paulissen,  M.D.,  Ph.D.,  Chief 
Ethel  G.  Chapman,  R.N.,  B.S.,  Consultant 
Nurse  in  Maternal  and  Child  Health 
Vida  B.  Sloan,  R.N.,  B.S.,  Consultant  Nurse  in 
Maternal  and  Child  Health 
Iva  Aukes,  M.S.W.,  Social  Service  Consultant 
Maria  Baisier,  D.D.S.,  M.P.H.,  Statistical 
Epidemiologist 

Migrant  Health  Section — J.  Kent  Capps,  B.S., 
Coordinator 

Heritable  Metabolic  Diseases  Program — ^William 
J.  Dewey,  M.S.,  Chief 
School  Health 

D.  F.  Rawlings,  M.D.,  M.P.H.,  Chief 
Caroline  Austin,  M.Ed.,  Vision  Conservation 
Coordinator 

Phil  B.  Shattuck,  M.A.,  Hearing  Conservation 
Coordinator 

Harry  C.  Bostick,  M.P.H.,  Coordinator-School 
Health  Services 

Helen  H.  Natwick,  R.N.,  M.P.H.,  Consultant 
Nurse 

Mary  Zeldes,  M.D.,  Consultant  in  Pediatrics 

Division  of  Sanitary  Engineering 

Clarence  W.  Klassen,  B.S.,  Chief 
Verdun  Randolph,  M.P.H.,  Assistant  Chief 
R.  S.  Nelle,  B.S.,  Water  Resource  Engineer 
Bureaus  of : 

Air  Polution  Control — Robert  R.  French,  Ch.E., 
Chief 

General  Sanitation — O.  S.  Hallden,  B.S.,  Chief 
Public  Water  Supplies — William  H.  Honsa,  B.S., 
Acting  Chief 

Radiological  Health — Verdun  Randolph, 
M.P.H.,  Acting  Chief 

Stream  Pollution — D.  B.  Morton,  B.S.,  Chief 
Chicago  Office — Sanitary  Water  Board 
Benn  J.  Leland,  M.S.,  Engineer-in-Charge 

Division  of  Tuberculosis  Control 

Clifton  Hall,  M.D.,  M.P.H.,  Chief 
Alvin  B.  Grant,  B.S.,  Public  Health  Advisor, 
USPHS 

Chicago  State  Tuberculosis  Sanitarium — Herbert 
Neuhaus,  M.D.,  Medical  Director  and  Su- 
perintendent 

Mt.  Vernon  State  Tuberculosis  Sanitarium — 
Robert  J.  Dancey,  M.D.,  Medical  Director 
and  Superintendent 

Division  of  Local  Health  SerATces 

Charles  F.  Sutton,  M.D.,  M.P.H.,  Chief 
Claire  E.  Healey,  M.D.,  M.P.H.,  Assistant  Chief 
E.  E.  Diddams,  M.S.P.H.,  Executive  Assistant 
Sections  on ; 

Emergency  Health  and  Civil  Defense 

Earl  Murphy,  B.A.,  Civil  Defense  Coordi- 
nator, USPHS 

Mary  O’Donnell,  R.N.,  Medical  Self-Help 
Consultant 


for  October,  1968 


465 


Arthur  Jackson,  B.S.,  Public  Health  Advisor, 
USPHS 

John  Sturgeon,  Emergency  Health  Represen- 
tative 

Community  Health  Services  Promotion — Harold 
K.  Fuller,  M.P.H.,  Head 
Illinois  State  Wide  Public  Health  Committee 
Harold  K.  Fuller,  M.P.H.,  Executive  Secretary 

Regional  Offices 

Northeastern  Region  (I) — ^William  H.  Keeler, 
M.D.,  M.P.H.,  48  W.  Galena  Blvd.,  Aurora 
60504.  Counties  of  Boone,  Kane,  Kankakee,  La- 
Salle and  consultation  to  full-time  health  de- 
partments of  Cook,  DeKalb,  DuPage,  Grundy, 
Kendall,  Lake,  McHenry,  Will,  and  Winnebago 
Counties.  Urban;  Berwyn  Township  Public 
Health  District,  Evanston-North  Shore,  Rock- 
ford, Oak  Park,  Hygienic  Institute  of  LaSalle- 
Oglesby-Peru,  Skokie,  and  Stickney  Township 
Public  Health  District. 

East  Central  Region  (II) — Russell  L.  Bryant, 
B.S.  (Acting),  301  W.  Birch  St.,  Champaign 
61820.  Counties  of  Champaign,  Clark,  Coles, 
Cumberland,  Edgar,  Ford,  Iroquois,  and  Moul- 
trie and  consultation  to  full-time  health  depart- 
ments of  DeWitt-Piatt,  Douglas,  Effingham, 
Livingston  McLean,  Shelby,  Vermilion.  UR- 
BAN— Champaign-Urbana  Public  Health  Dis- 
trict. 

Northwestern  Region  (III) — ^Arthur  E.  Sulek, 
M.D.,  M.P.H.,  121  Fourth  Ave.,  Rock  Island 
61201.  Counties  of  Bureau,  Hancock,  Hender- 


son, Knox,  Marshall,  McDonough,  Putnam, 
Stark,  Tazewell,  Warren,  and  Woodford  and 
consultation  to  full-time  health  departments: 
Counties — Carroll,  Henry,  Jo  Daviess,  Lee,  Mer- 
cer, Ogle,  Peoria,  Rock  Island,  Stephenson,  and 
Whiteside,  City:  Peoria. 

West  Central  Region  (IV) — W.  M.  Talbert, 
M.D.,  M.S.P.H.,  1124  S.  Fifth  St.,  Springfield 
62706.  Counties  of  Brown,  Cass,  Greene,  Logan, 
Macoupin,  Mason,  Sangamon,  Schuyler,  and 
Scott  and  consultation  to  full-time  health  de- 
partments: Counties — ^Adams,  Calhoun,  Chris- 
tian, Fulton,  Jersey,  Macon,  Menard,  Mon- 
gomery,  Morgan,  and  Pike. 

South  Region  (V) — ^Elvin  L.  Sederlin,  M.D., 
P.O.  Box  722,  Carbondale  62901.  Counties  of 
Hamilton  and  Perry  and  consultation  to  full- 
time health  departments:  Counties — Egyptian, 
(Gallatin-Saline-W  h i t e,)  Franklin-Williamson, 
Jackson,  Quadri-County,  (Hardin-Johnson-Mas- 
sac-Pope),  Randolph,  (Tri-County,  Alexander- 
Pulaski-Union). 

Region  (VI) — E.  E.  Diddams,  M.S.P.H.  (Acting) 
435  Missouri  Ave.,  Room  410,  East  St.  Louis 
62201.  Counties  of  Clinton,  Crawford,  Edwards, 
Fayette,  Jasper,  Jefferson,  Madison,  Marion, 
Richland,  St.  Clair,  Wabash,  Washington,  and 
Wayne  and  consultation  to  full-time  health  de- 
partments: Counties — Bond,  Clay,  Lawrence, 
and  Monroe;  Urban — East  Side  Health  District 
(Canteen-Centreville-East  St.  Louis-Stites  Town- 
ship). 


County  and  Multiple-County  Health  Departments 


Adams  County,  Wayne  Messick,  M.P.H.,  333  N. 
6th,  Quincy  62301 

Bond  County,  Mrs.  Carole  Bone,  R.N.,  Acting 
Administrator,  100  N.  Locust,  Greenville  62246 

Calhoun  County,  Mrs.  Margaret  Hillen,  R.N., 
Acting  Administrator,  Hardin  62047 

Carroll  County,  Mrs.  Joyce  Daehler,  R.N.,  Act- 
ing Administrator,  Mt.  Carroll  61053 

Christian  County,  Clara  J.  Beaty,  R.N.,  Acting 
Administrator,  106  E.  Main  St.,  Taylorville 
62568 

Clay  County,  E.  D.  Foss,  M.D.,  104V2  W.  Second 
St.,  Flora  62839 

Cook  County,  John  B.  Hall,  M.D.,  M.P.H.,  Di- 
rector, 1425  S.  Racine  Ave.,  Chicago  60608 

North  District,  1755  Oakton  St.,  Des  Plaines 
60018 

South  District,  51  E.  154  St.,  Harvey  60426 

Southwest  District,  5410  W.  95th  St.,  Oak  Lawn 
60453 

West  District,  1907-09  Rice  St.,  Melrose  Park 
60160 

DeKalb  County,  Mrs.  Audre  Anderson,  R.N., 
B.S.,  Acting  Administrator  1731  Sycamore  Rd., 
DeKalb  60115 

DeWitt-Piatt  Bi-County,  Lelia  V.  Hyde,  R.N.,  Act- 
ing Director,  122  E.  Main  St.,  Clinton  61727 
Piatt  County,  Courthouse,  Monticello  61856 


Douglas  County,  Mary  Lou  Pflum,  R.N.,  B.S.,  Act- 
ing Administrator,  P.O.  Box  382,  Tuscola  61953 

DuPage  County,  Charles  A.  Lang,  M.D.,  M.P.H., 
Health  Officer,  222  E.  Willow  Ave.,  Wheaton 
60187 

Effingham  County,  Peter  C.  Supan,  M.D.,  M.P.H., 
Health  Officer,  112  E.  Section  Ave.,  Effing- 
ham 62401 

Egyptian  (Gallatin-Saline-White  Counties)  Allen 
Kelly,  B.S.,  Acting  Administrator,  1333  Locust 
St.,  Eldorado  62930 

White  County,  208  N.  Church,  Carmi  62821 
Gallatin  County,  Courthouse,  Shawneetown 
62984 

Franklin-Williamson  Bi-County,  David  P.  Richer- 
son,  M.D.,  M.P.H.,  Health  Officer,  217  E.  Broad- 
way, Johnston  City  62951 
Franklin  County,  P.O.  Box  461,  226  N.  Main, 
Benton  62812 

Fulton  County,  Wilma  Sturgeon,  R.N.,  Acting 
Health  Officer,  31  S.  Main  St.,  Canton  61520 

Grundy  County,  Mrs.  Mary  C.  Reed,  R.N.,  Acting 
Administrator,  Court  House,  Morris  60450 

Henry  County,  Grace  Van  Vooren,  R.N.,  Acting 
Administrator,  Court  House  Annex,  Cambridge 
61238 

Jackson  County,  Mrs.  Kathleen  B.  Vahn,  R.N., 
M.S.,  Acting  Health  Officer,  101514  Chestnut 
St.,  Murphysboro  62966 


466 


Illinois  Medical  Journal 


Jersey  County,  Mrs.  Nola  Kramer,  R.N.,  Acting 
Administrator,  Court  House,  P.O.  Box  69,  Jer- 
seyville  62052 

Jo  Daviess  County,  Alice  J.  Grimm,  R.N.,  Acting 
Administrator,  311  S.  Main  St.,  Galena  61036 
Kendall  County,  Mrs.  Nancy  J.  Larson,  R.N., 
Acting  Administrator,  Yorkville  60560 
Lake  County,  John  J.  Ring,  M.D.,  Acting  Director, 
2307  Grand  Ave.,  Waukegan  60085 
West  Sub-office,  330  N.  Milwaukee  Ave.,  Liber- 
tyville  60048 

Lawrence  County,  Maxine  Jackman,  R.N.,  Acting 
Director,  Court  House,  Lawrenceville  62439 
Lee  County,  E.  S.  Parmenter,  M.D.,  Health  Officer, 
316  W.  Third  St.,  Dixon  61021 
Livingston  County,  Mrs.  Ann  M.  Lavin,  R.N., 
Acting  Administrator,  Rm.  418,  Bank  of  Pon- 
tiac Bldg.,  Pontiac  61764 
Macon  County,  Leo  Michl,  Jr.,  M.S.,  1085  S. 

Main  St.,  Decatur  62521 
McHenry  County,  Ward  C.  Duel,  M.P.H.,  Ad- 
ministrator, 209  N.  Benton  St.,  Woodstock 
60098 

McLean  County,  R.  E.  Baxter,  M.D.,  Acting  Medi- 
cal Director,  401  W.  Virginia  Ave.,  Normal 
61761 

Menard  County,  Mrs.  Marjorie  White,  R.N.,  Act- 
ing Administrator,  Court  House,  Petersburg 
62675 

Mercer  County,  Mrs.  Meba  V.  Keeseen,  R.N.,  Act- 
ing Administrator,  Court  House,  Aledo  61231 
Monroe  County,  Mrs.  Edith  Trost,  R.N.,  Acting 
Administrator,  Court  House,  Waterloo  62298 
Montgomery  County,  Willis  L.  Whitlock,  Acting 
Health  Officer,  Box  149,  Hillsboro  62049 
Morgan  County,  William  D.  Meyer,  B.S.,  Admin- 
istrator, 234Vi  W.  State  St.,  Jacksonville  62650 
Ogle  County,  Sandra  L.  Greenfield,  R.N.,  Acting 


Administrator,  106  S.  Fifth  St.,  Oregon  61061 

Peoria  County,  Fred  Long,  M.D.,  M.P.H.,  Direc- 
tor of  Health,  2114  N.  Sheridan  Rd.,  Peoria 
61604 

Pike  County,  Mrs.  Martha  Lowry,  R.N.,  Acting 
Administrator,  Court  House,  Pittsfield  62362 

Quadri-County  (H  a r d i n-Johnson-Massac-P  ope 
Counties),  John  J.  Cipolla,  Acting  Health  Of- 
ficer, M.S.P.H.,  Box  437,  Golconda  62938 
Massac  County,  Courthouse,  P.O.  Box  133, 
Metropolis  62960 
Johnson  County,  Vienna  62995 
Hardin  County,  Gross  Bldg.,  Elizabethtown 
62931 

Randolph  County,  Mrs.  Marilynn  Murphy,  R.N., 
B.A.,  Acting  Administrator,  110  W.  Jackson 
St.,  Sparta  62286 

Rock  Island  County,  Court  House,  Rock  Island 
61201 

Shelby  County,  Peter  C.  Supan,  M.D.,  M.P.H., 
Health  Officer,  123  N.  Broadway,  Shelbyville 
62565 

Stephenson  County,  Mrs.  Fern  M.  Brown,  R.N., 
Acting  Administrator,  12  N.  Galena  Ave.,  Free- 
port 61032 

Tri-County  (Alexander-Pulaski -Union  Counties), 
Margaret  Cotton,  R.N.,  Health  Officer,  1115 
Cedar  St.,  Cairo  62914 

Vermilion  County,  Mrs.  Helen  Armantrout,  R.N., 
B.S.,  Acting  Administrator,  808  N.  Logan,  Dan- 
ville 61833 

Whiteside  County,  Mrs.  Romona  Stene,  R.N.,  Act- 
ing Administrator,  201  W.  First  St.,  Rock  Falls, 
61071 

Will  County,  Herbert  S.  Miller,  M.D.,  M.P.H., 
Health  Officer,  21  E.  Van  Buren  St.,  Joliet  60431 

Winnebago  County,  Robert  H.  Anderson,  Acting 
Health  Officer,  425  W.  State  St.,  Rockford  61101 


Urban  Health  Departments 


Berwyn  Health  Department,  Henry  S.  Swiontek, 
M.D.,  Health  Officer,  6600  W.  26th  St.,  Ber- 
wyn, 60402 

Champaign — Urbana  Public  Health  District,  L.  L. 
Fatherree,  M.D.,  M.P.H.,  Public  Health  Direc- 
tor, 505  S.  Fifth  St.,  Champaign  61820 
Chicago  Board  of  Health,  Morgan  J.  O’Connell, 

M. D.,  M.P.H.,  Acting  Commissioner  of  Health, 
Chicago  Civic  Center,  Chicago  60602 

East  Side  Health  District  (Canteen-Centerville- 
East  St.  Louis-Sites  Townships),  John  J.  Grego- 
wicz,  M.D.,  Acting  Public  Health  Director,  638 

N.  20th  St.,  East  St.  Louis  62205 
Evanston-North  Shore  Health  Department,  Allan 

A.  Filek,  M.D.,  M.S.P.H.,  Public  Health  Dir- 
ector, Box  870,  Evanston  60204 
Hygienic  Institute  (LaSalle-Oglesby-Peru),  Arling- 
ton Ailes,  M.D.,  M.P.H.,  Director,  LaSalle 
61301 


Oak  Park  Department  of  Public  Health,  Herbert 
Ratner,  M.D.,  Public  Health  Director,  Box  31, 
Oak  Park  60303 

Peoria  Department  of  Health,  Fred  Long,  M.D., 
M.P.H.,  Director  of  Health,  2116  N.  Sheridan 
Rd.,  Peoria  61604 

Rockford  Department  of  Public  Health,  Arlu  J. 
Anderson,  B.S.,  Acting  Commissioner  of  Health, 
City  Hall  Bldg.,  Rockford  61104 

Skokie  Health  Department,  Domingo  Leonida, 
M.D,.  M.P.H.,  Director  of  Health,  5127  Oak- 
ton  St.,  Skokie  60087 

Stickney  Township  Public  Health  District,  Gene 
J.  Franchi,  D.D.S.,  M.P.H.,  Acting  Public 
Health  Director,  5635  State  Rd.,  Oak  Lawn 
60459 


for  October,  1968 


467 


DEPARTMENT  OF  CHILDREN  AND 
FAMILY  SERVICES 


Director’s  Office; 

Room  404,  New  State  Office  Bldg., 
Springfield 

Room  1713,  160  N.  LaSalle  St., 

Chicago 

Edward  T.  Weaver,  Director 
Roman  L.  Haremski,  Deputy  Director 
Richard  S.  Laymon,  Administrative  Asst,  to 
Director 

J.  Keller  Mack,  M.D.,  Medical  and  Public 
Health  Officer 

Thomas  Londrigan,  Special  Counsel 
Don  H.  Schlosser,  Administrator  of 
Community  Relations 

Division  of  Administrative  Services : 

Matthew  J.  Finnell,  Division  Chief 

Room  404,  New  State  Office  Bldg.,  Springfield 

Division  of  Child  Welfare: 

Herschel  L.  Allen,  Division  Chief 
528  S.  Fifth  St.,  Springfield 
Regional  and  District  Offices — 

Rockford  Region  (Margaret  Kennedy, 

Reg.  Dir.),  428  Seventh  St.,  Rockford 

Ottawa  District,  628  Columbus  St.,  Ot- 
tawa 

Rock  Falls  District,  20314  First  Ave., 
Rock  Falls 

Chicago  Region  (Ralph  Baur,  Acting  Reg. 

Dir.)  1026  S.  Damen,  Chicago 
Aurora  Region  (Leland  Wright,  Reg. 

Dir.),  411  W.  Galena  Blvd.,  Aurora 

Joliet  District,  Rm.  309,  57  W.  Jeffer- 
son, Joliet 

Waukegan  District,  4 S.  Genessee, 
Waukegan 

Peoria  Region  (Francis  Paule,  Reg.  Dir.), 
608  N.  E.  Jefferson,  Peoria 

Peoria  District,  414  Hamilton  Blvd., 
Peoria 

Galesburg  District,  121  S.  Prairie,  Gales- 
burg 

Rock  Island  District,  21 1-1 8th  St.,  Rock 
Island 

Princeton  District,  22  E.  Marion,  Prince- 
ton 

Springfield  Region  (Wm.  Sanders,  Reg. 
Dir.),  1035  Outer  Park  Dr.,  Springfield 

Quincy  District,  410  N.  Ninth,  Quincy 

Carlinville  District,  49414  West  Side 
Square,  Carlinville 

Jacksonville  District,  602  Westgate,  Jack- 
sonville 


Champaign  Region  (Merle  Springer,  Reg. 
Dir.),  2125  S.  First  St.,  Champaign 
Bloomington  District,  309  W.  Market, 
Bloomington 

Decatur  District,  125  N.  Franklin,  De- 
catur 

Kankakee  District,  70  Meadowview  Cen- 
ter, Kankakee 

Mattoon  District,  1000  Broadway,  Mat- 
toon 

Carbondale  Region  (Paul  Nelson,  Reg. 
Dir.),  1202  W.  Main,  Carbondale 
Harrisburg  District,  10  S.  Vine  St.,  Har- 
risburg 

East  St.  Louis  Region  (Jack  Donahue, 
Reg.  Dir.),  417  Missouri  Ave.,  E.  St. 
Louis 

East  St.  Louis  District,  435  Missouri 
Ave.,  East  St.  Louis 
Olney  District,  1108  S.  West  St.,  Olney 
Salem  District,  205  E.  Locust,  Salem 

Division  of  Children’s  Schools ; 

Lee  A.  Iverson,  Division  Chief 

Room  404,  New  State  Office  Bldg.,  Spring- 
field 

Institutions — 

Illinois  Braille  and  Sight  Saving  School 
(Jack  Hartong,  Supt.),  Jacksonville 
Illinois  School  for  the  Deaf  (Kenneth 
Mangan,  Supt.),  Jacksonville 
Illinois  Children’s  Hospital-School  (Paul 
Kavanaugh,  Supt.)  1950  W.  Roosevelt 
Rd.,  Chicago 

Illinois  Soldiers’  and  Sailors’  Children’s 
School,  (Andrew  Spelios,  Supt.),  Nor- 
mal 

Southern  Illinois  Children’s  Service 
Center  (Paul  Nelson,  Supt.),  Hurst 

Division  of  Personnel  Administration ; 

Thomas  A.  Nickell,  Division  Chief 

Room  404,  New  State  Office  Bldg.,  Spring- 
field 

Division  of  Planning,  Research  and 

Statistics : 

William  H.  Ireland,  Division  Chief 

630  E.  Adams  St.,  Springfield 

Division  of  Rehabilitation  Services ; 

Charles  Adams,  Division  Chief 

Room  404,  New  State  Office  Bldg.,  Spring- 
field 


468 


Illinois  Medical  Journal 


Institutions — 

Illinois  Eye  and  Ear  Infirmary  (George 
Geocaris,  Supt.),  1855  Taylor,  Chi- 
cago 

Illinois  Soldiers’  and  Sailors’  Home  (James 
A.  Schapers,  Supt. ) , Quincy. 

Illinois  Visually  Handicapped  Institute 
(Thomas  Murphy,  Supt.)  1151  S. 
Wood  St.,  Chicago 


Visually  Handicapped  Services — 
Community  Services  for  the  Visually  Han- 
dicapped (I.  N.  Miller,  Supt.),  Room 
1700,  160  N.  LaSalle  St.,  Chicago 
(field  offices  located  in  each  regional  of- 
fice— see  listings  under  Division  of  Child 
Welfare) 

Coordinator  of  Visually  Handicapped 
Services  (Raymond  M.  Dickinson), 
404  New  State  Office  Bldg.,  Spring- 
field. 


DEPARTMENT  OF  PUBLIC  AID 


The  Illinois  Department  of  Public  Aid  admin- 
isters the  federally  aided  public  assistance  pro- 
grams: Assistance  to  the  Aged,  Blind  or  Disabled; 
Aid  to  Dependent  Children;  and  Medical  Assist- 
ance. In  addition,  the  department  allocates  state 
funds  to  qualified  governmental  units  for  the  ad- 
ministration of  General  Assistance;  and  in  co- 
operation with  the  United  States  Department  of 
Agriculture,  administers  the  Food  Stamp  program 
and  distributes  federally  donated  foods. 

Overall  responsibility  for  the  department’s  ad- 
ministrative responsibilities  are  delegated  by  the 
Governor  to  the  Director  of  the  Illinois  Depart- 
ment of  Public  Aid,  Springfield.  The  director  ad- 
ministers the  programs  through  the  staffs  of 
eight  major  divisions  located  in  the  state  offices, 
six  regional  offices,  and  102  county  departments. 

Administrative  Staff 

Harold  O.  Swank,  Director 

Gershom  Hurwitz,  Assistant  to  the  Director 

Robert  L.  Hyde,  Chief,  Division  of  Accounting 
and  Data  Processing 
Garrett  W.  Keaster,  Chief,  Division  of 
Administrative  Services 
Henry  L.  McCarthy,  Chief,  Division  of 
Community  Services 
James  M.  Brown,  Chief,  Division  of 
Downstate  Operations 
Henry  A.  Holle,  M.D.,  Medical  Director, 
Division  of  Medical  Services 
Robert  G.  Wessel,  Chief,  Medical  Administration 
Mrs.  Janet  P.  Kahlert,  Chief,  Division  of 
Program  Development 
Richard  N.  Hosteny,  Chief,  Division  of 
Special  Investigations 
Kenneth  E.  Doeblin,  Chief,  Division  of 
Special  Services 

Wayne  D.  Epperson,  Chief,  Division  of 
Research  and  Statistics 

Regional  Ofl&ces 

Region  I — Peoria  Frank  G.  Blumb,  Region- 

al Director 

Region  II — Champaign  C.  H.  Colwell,  Regional 

Director 

Region  III — Springfield  Robert  A.  Hamrick,  Re- 
gional Director 


Region  IV — Belleville  Armin  A.  Rippelmeyer, 

Regional  Director 

Region  V — Carbondale  Lawrence  E.  Duff,  Re- 
gional Director 

Region  VI — Rockford  Reno  L.  Lenz,  Regional 

Director 

Legislative  Advisory  Committee  on 
Public  Assistance 

The  Honorable  John  W.  Carroll,  Park  Ridge 
The  Honorable  Daniel  Dougherty,  Chicago 
The  Honorable  Walter  P.  Hoffelder,  Chicago 
The  Honorable  Fred  J.  Smith,  Chicago 
The  Honorable  Esther  Saperstein,  Chicago 
The  Honorable  Merle  K.  Anderson,  Durand 
The  Honorable  Corneal  A.  Davis,  Chicago 
The  Honorable  Robert  E.  Mann,  Chicago 
The  Honorable  Don  A.  Moore,  Midlothian 
The  Honorable  Meade  Baltz,  Joliet 
The  Honorable  Charles  M.  Campbell,  Danville 
The  Honorable  James  G.  Krause,  E.  St.  Louis 
Board  of  Public  Aid  Commissioners 
Robert  H.  MacRae,  Chicago 
Charles  A.  Davis,  Chicago 
Robert  G.  Gibson,  Chicago 
Chauncey  C.  Maher,  Jr.,  M.D.,  Springfield 
Mrs.  Woods  McCausland,  Winnetka 
Thomas  A.  Nieman,  Rockford 
Robert  W.  Weissmiller,  Mount  Carroll 
Medical  Care  Advisory  Committee 
Samuel  A.  Goldsmith,  Chicago 
Mrs.  Mary  L.  Ford,  Chicago 
Vernon  J.  Hass,  D.D.S.,  Bloomington 
George  K.  Hendrix,  Springfield 
Mrs.  Jeannette  Kramer,  Palatine 
Chauncey  C.  Maher,  Jr.,  M.D.,  Springfield 
B.  E.  Montgomery,  M.D.,  Harrisburg 
Robert  C.  Muehrcke,  M.D.,  Oak  Park 
Harold  W.  Pratt,  R.Ph.,  Chicago 
Murray  H.  Finley,  Chicago 
Frank  McCallister,  Chicago 

Ex-Officio  members 

Edward  F.  Lis,  M.D.,  Director, 

Division  of  Services  for  Crippled  Children 
University  of  Illinois,  Chicago 
Alfred  Sheer,  Director, 

Division  of  Vocational  Rehabilitation,  Springfield 


for  October,  1968 


469 


Harold  M.  Visotsky,  M.D.,  Director, 

Department  of  Mental  Health,  Springfield 
Edward  T.  Weaver,  Director, 

Department  of  Children  and  Family  Services, 
Springfield 

Franklin  D.  Yoder,  M.D.,  M.P.H.,  Director, 
Department  of  Public  Health,  Springfield 

Department  of  Public  Aid  Representative 

Henry  A.  Holle,  M.D.,  Medical  Director, 
Division  of  Medical  Services,  Department  of 
Public  Aid,  Springfield 
State  Medical  Advisory  Committee 
Fred  A.  Tworoger,  M.D.,  Chicago 
Rex  O.  McMorris,  M.D.,  Peoria 
Charles  E.  Baldree,  M.D.,  Belleville 
James  R.  Cooper,  M.D.,  Quincy 
George  T.  Mitchell,  M.D.,  Marshall 
Frank  B.  Norbury,  M.D.,  Jacksonville 
Alphonse  L.  Robinson,  M.D.,  Mounds 
William  Scanlon,  M.D.,  LaSalle 
John  H.  Steinkamp,  M.D.,  Belvidere 
R.  Kent  Swedlund,  M.D.,  Watseka 
Louis  Arp,  Jr.,  M.D.,  Moline 
Herbert  V.  Fine,  M.D.,  Carterville 
George  F.  Lull,  M.D.,  Chicago 
Robert  C.  Muehrcke,  M.D.,  Oak  Park 
State  Drug  Advisory  Committee 
Harold  W.  Pratt,  R.Ph.,  Chicago 
Miles  N.  Brown,  R.Ph.,  Mount  Vernon 
W.  Edwin  Brown,  R.Ph.,  Quincy 
Carl  V.  Daschka,  R.Ph.,  Chester 
H.  M.  F.  Doden,  Sr.,  R.Ph.,  Rock  Island 
Justin  Eisele,  R.Ph.,  East  St.  Louis 


Louis  Gdalman,  R.Ph.,  Chicago 

John  T.  Gulick,  R.Ph.,  Danville 

John  F.  Roller,  R.Ph.,  Berwyn 

Roy  B.  Maher,  R.Ph.,  Springfield 

Theodore  R.  Sherrod,  R.Ph.,  M.D.,  Chicago 

Harold  J.  Shinnick,  R.Ph.,  Chicago 

Charles  P.  Skaggs,  R.Ph.,  Harrisburg. 

State  Dental  Advisory  Committee 

John  C.  Barrett,  D.D.S.,  Freeport 

Ross  Bradley,  D.D.S.,  Jacksonville 

John  J.  Byrne,  D.D.S.,  Chicago 

John  C.  Clarno,  D.D.S.,  Peoria 

Vernon  J.  Haas,  D.D.S.,  Bloomington 

Lewis  K.  Holzman,  D.D.S.,  Chicago 

Eugene  J.  Jaffe,  D.D.S.,  Chicago 

D.  J.  McCullough,  D.D.S.,  Mt.  Vernon 

H.  B.  Riley,  D.D.S.,  Newton 

William  J.  Rogers,  D.D.S.,  Chicago 

Carl  L.  Sebelius,  D.D.S.,  M.P.H.,  Springfield 

Harold  H.  Sitron,  D.D.S.,  Chicago 

State  Advisory  Committee  on 
Group  Care  Facilities 

Don  T.  Barry,  Raymond 

Taylor  O.  Braswell,  Belleville 

Edward  Cannady,  M.D.,  East  St.  Louis 

Bert  Cohn,  Okawville 

Mrs.  Rachel  Dodson,  Herrin 

Markham  D.  Hay,  Rockford 

Mrs.  Bernice  Hover,  Chicago 

Elmer  Johnson,  Joliet 

Mrs.  Laverta  Johnson,  Chicago 

Mrs.  Jeannette  Kramer,  Palatine 

Robert  E.  Lanier,  Springfield 

Roger  F.  Sondag,  M.D.,  M.P.H.,  Springfield 


DIVISION  OF  VOCATIONAL 
REHABILITATION 


The  Board  of  Vocational  Education  and  Re- 
habilitation is  a statutory  body,  established  to  ad- 
minister, through  two  operating  divisions,  the 
state  program  of  vocational  and  technical  edu- 


cation pursuant  to  the  Federal  Vocational  Edu- 
cation Act  as  amended,  and  the  state  program 
of  vocational  rehabilitation  pursuant  to  the  Fed- 
eral Vocational  Rehabilitation  Act  as  amended. 


Board  of  Vocational  Education  and  Rehabilitation 


Ex  Officio: 

Director  of  Agriculture 
Director  of  Labor 
Director  of  Mental  Health 
Director  of  Public  Health 
Director  of  Registration  and  Education 
Superintendent  of  Public  Instruction 
Appointive  Members  (appointed  by  Governor)  : 
Lee  Chapman,  Springfield 
William  Gellman,  Ph.D.,  Chicago 
Edward  I.  Elisberg,  M.D.,  Highland  Park 
Gail  Warden,  Chicago 
Guy  R.  Renzaglia,  Ph.D.,  Carbondale 
William  R.  Rutherford,  Peoria 


Executive  Officers: 

For  vocational  education:  Ray  Page, 
Superintendent  of  Public  Instruction 
For  vocational  rehabilitation:  Alfred  Sheer 
Director,  Division  of  Vocational  Rehibili- 
tation 

Division  of  Vocational  Rehabilitation 

Alfred  Sheer,  Director 

623  East  Adams,  Springfield  62706 

Division  of  Vocational  and  Technical  Education 
Sherwood  Dees,  Acting  Director 
405  Centennial  Building,  Springfield  62706 


470 


Illinois  Medical  Journal 


STATUTORY  BOARDS  AND  COMMISSIONS 

(Allied  with  Public  Health  Operations) 


Air  Pollution  Control  Board 

John  G.  Warren,  Moline,  Chairman 
Dr.  Albert  Crewe,  Palos  Park 
Edgar  Peske,  Lake  Forest 
Franklin  D.  Yoder,  M.D.,  Springfield 
Samuel  T.  Lawton,  Jr.,  Highland  Park 
Richard  C.  Reinke,  Lemont 
Raymond  D.  Maxson,  Elmhurst 
Thomas  J.  Kelly,  M.D.,  Wood  River 
Paul  B.  Hodges,  Collinsville 
Clarence  W.  Klassen,  Springfield,  Technical 
Secretary 

Illinois  Legislative  Commission  on  Atomic 

Energy 

Ex-Officio 

Director  of  Agriculture 

Director  of  Business  & Economic  Development 
Director  of  Mental  Health 
Director  of  Labor 
Director  of  Public  Health 
Director  of  Civil  Defense 
Chairman  of  Commerce  Cimmission 
2 House  Members-2  Senate  Members 
John  A.  D.  Cooper,  M.D.,  Evanston 
David  Ferguson,  Chicago 
Robert  J.  Hasterlik,  M.D.,  Chicago 
Murray  Joslin,  Elmwood  Park 
Harvey  Pearson,  River  Grove 
William  H.  Perkins,  Jr.  Chicago 
John  F.  Ryan,  Westchester 
Cancer  Advisory  Board 
Caesar  Portes,  M.D.,  Chicago 
David  F.  Rendleman,  M.D.,  Carbondale 
James  D.  Majarakis,  M.D.,  Chicago 
J.  Ernest  Breed,  M.D.,  Chicago 
Edward  F.  Scanlon,  M.D.,  Evanston 
Harry  W.  Southwick,  M.D.,  Kenilworth 
Alfred  Kiessel,  M.D.,  Decatur 

Clinical  Laboratory  and  Blood  Bank  Advisory 
Board 

James  B.  Hartney,  M.D.,  Oak  Park,  Chairman 

Herbert  Dexheimer,  M.D.,  Belleville 

Robert  K.  Fiersten,  Springfield 

Hugh  J.  McDonald,  Sc.D.,  Skokie 

D.  Robert  Thornburg,  Wilmette 

Paul  Van  Pernis,  M.D.,  Rockford 

Hospital  Licensing  Board 

George  K.  Hendrix,  Springfield,  Chairman 

Elmer  E.  Abrahamson,  Chicago 

Newton  DuPuy,  M.D.,  Quincy 

Jack  B.  Edmundson,  Carbondale 

F.  Merrill  Lindsay,  Jr.,  Decatur 

Carl  Olssen,  Ph.D.,  Chicago 

Rt.  Rev.  Msgr.  Clement  Schindler,  Belleville 

Emil  O.  Stahlhut,  Lincoln 

Theodore  R.  Van  Dellen,  M.D.  Chicago 


Advisory  Hospital  Council 

Franklin  D.  Yoder,  M.D.,  Springfield,  Chairman 
Representatives  of  Public  Agencies 

Mortimer  Brown,  Ph.D.,  Springfield  (Mental 
Health) 

Henry  A.  Holle,  M.D.,  Chicago  (Public  Aid ) 
Odin  Anderson,  Chicago 
Francis  E.  Bihss,  M.D.,  East  St.  Louis 
Horace  G.  Brown,  Shawneetown 
William  Caples,  Chicago 
Everett  Coleman,  M.D.,  Canton 
Byron  DeHaan,  Peoria 
Raymond  A.  Dougherty,  M.D.,  Mattoon 
Leonard  P.  Goudy,  Peoria 
George  K.  Hendrix,  Springfield 
Francis  Hickey,  Rockford 
David  M.  Kinzer,  Chicago 
W.  Henderson  May,  Springfield 
Harris  Perlstein,  Chicago 
Paul  Plunkett,  Wilmette 
Lee  Pravatiner,  Chicago 
Mrs.  Louis  Rubin,  Rockford 
H.  Clay  Tate,  Bloomington 
Edward  C.  Thompson,  D.D.S.,  Urbana 
Rev.  John  Weisnar,  Peoria 
William  R.  Williams,  Hinsdale 
Mrs.  Ann  Zercher,  Lincolnwood 

Advisory  Board  of  Necropsy  Service  to 
Coroners 

Darrell  Holland,  Effingham,  Chairman 
Edwin  F.  Hirsch,  M.D.,  Chicago 
Grant  C.  Johnson,  M.D.,  Springfield 
Rep.  Bernard  McDevitt,  Chicago 
Jacob  E.  Reisch,  M.D.,  Springfield 
Andrew  J.  Toman,  M.D.,  Chicago 
E.  W.  (Barney)  West,  Tamaroa 
Guy  R.  Williams,  Jr.,  Havana 
Roger  B.  Ytterberg,  Springfield 

Advisory  Committee  for  Heritable  Metabolic 
Diseases 

Ralph  Kunstadter,  M.D.,  Chicago,  Chairman 

Stanley  Berlow,  M.D.,  Chicago 

Joseph  D.  Boggs,  M.D.,  Chicago 

Mrs.  Arlene  K.  Burroughs,  Chicago 

Joseph  P.  Greer,  Chicago 

Herbert  Grossman,  M.D.,  Chicago 

John  B.  Hall,  M.D.,  Chicago 

David  Y.  Hsia,  M.D.,  Chicago 

Joseph  Kraft,  M.D.  Chicago 

Mrs.  Carol  H.  Preucil,  Chicago 

Miss  Bernadine  Robb,  Chicago 

Ira  Rosenthal,  M.D.,  Chicago 


/or  October,  1968 


471 


Advisory  Nursing  Homes  and  Homes  for  the 
Aged  Council 

Franklin  D.  Yoder,  M.D.,  Springfield,  Chairman 

Joseph  Patton,  Springfield 

Robert  Wesse,  Springfield 

Arthur  L.  Almon,  Jr.,  Evanston 

William  Deems,  Lawrenceville 

P.  V.  Dilts,  M.D.,  Springfield 

Bernice  Hover,  R.N.,  Chicago 

Jeanette  R.  Kramer,  Palatine 

Mrs.  Gunhild  McAllister,  R.N.,  Forest  Park 

Russell  Moline,  Evanston 

Peter  Perrecone,  Rockford 

Board  of  Public  Health  Advisors 

E.  A.  Piszczek,  M.D.,  Forest  Park,  Chairman 
Elmer  Beadles,  D.D.S.,  Ashland 
Bernard  E.  Bolotoff,  M.D.,  Rockford 
Carl  A.  Brandy,  D.V.M.,  Urbana 
John  A.  D.  Cooper,  M.D.,  Evanston 
August  F.  Daro,  M.D.,  Chicago 
Robert  G.  Kesel,  D.D.S.,  Chicago 
Mrs.  F.  W.  Specht,  Wheaton 
Alex  Van  Praag,  Decatur 

Migrant  Labor  Advisory  Committee 

Phillip  Collins,  Morris 
Harold  Hartley,  Centralia 
Miss  Naomi  Hiett,  Springfield 
W.  D.  Jones,  Streator 
Walter  S.  Sass,  Chicago 
Dean  Sears,  Bloomington 

Ohio  River  Valley  Water  Sanitation  Commis- 
sion 

Clarence  W.  Klassen,  Springfield 
Franklin  D.  Yoder,  M.D.,  Springfield 
John  E.  Pearson,  Champaign 


Public  Water  Supply  Operators’  Advisory 
Board 

Elmo  Conrady,  Mt.  Carmel 
W.  R.  Gelston,  Quincy 
H.  Spence  Merz,  Rockford 
Franklin  D.  Yoder,  M.D.,  Springfield 
James  Vaughn,  Chicago 

Radiation  Protection  Advisory  Council 

Roger  A.  Harvey,  M.D.,  Chicago,  Chairman 

L.  H.  Lanzl,  Ph.D.,  Chicago 

Frank  E.  Demaree,  Lake  Forest 

Joseph  V.  Link,  D.D.S.,  Springfield 

Robert  M.  Schneider,  Springfield 

Robert  J.  Hasterlik,  M.D.,  Chicago 

John  E.  Rose,  Sc.D.,  Argonne 

John  E.  Cullerton,  Chicago 

James  W.  Karber,  Springfield 

Refuse  Disposal  Advisory  Board 

Samuel  M.  Clarke,  Chicago 
Willis  E.  Collins,  Addison 
J.  A.  Davis,  Salem 
Harold  Van  der  Molen,  Wheaton 
John  Vanderveld,  Jr.,  Palatine 

Sanitary  Water  Board 

Franklin  D.  Yoder,  M.D.,  Springfield,  Chairman 
C.  S.  Boruff,  Peoria 

Clarence  W.  Klassen,  Springfield,  Technical 
Secretary 

William  T.  Lodge,  Springfield 
Francis  S.  Lorenz,  Springfield 
A.  L.  Sargent,  Springfield 
Robert  M.  Schneider,  Springfield 


NON  STATUTORY  BOARDS 

(Allied  with  Public  Health  Operations) 


Committee  for  Revision  of  the  Rules  and 
Regulations  for  the  Control  of  Communicable 
Diseases 

Norman  J.  Rose,  M.D.,  M.P.H.,  Springfield, 
Chairman 

Huston  J.  Banton,  M.D.,  Champaign 

L.  L.  Fatherree,  M.D.,  Champaign 

John  B.  Hall,  M.D.,  Chicago 

Homer  H.  Hanson,  M.D.,  Carbondale 

Mark  Lepper,  M.D.,  Chicago 

Herbert  S.  Miller,  M.D.,  Joliet 

David  P.  Richerson,  M.D.,  Johnston  City 

R.  F.  Sondag,  M.D.,  Springfield 


Advisory  Committee  on  Hazardous  Substances 

Norman  J.  Rose,  M.D.,  M.P.H.,  Springfield, 
Chairman 

J.  R.  Christian,  M.D.,  Chicago 
Leon  Fennoy,  East  St.  Louis 
J.  H.  Hawke,  St.  Louis,  Mo. 

W.  S.  Jessop,  Chicago 
Robert  E.  Mason,  Jr.,  Chicago 

C.  J.  Nowak,  Chicago 
Edward  F.  O’Toole,  Chicago 

D.  F.  Rawlings,  M.D.,  Springfield 
Jerry  S.  Schain,  Chicago 


472 


Illinois  Medical  Journal 


Governor’s  Advisory  Committee  for  Heart 
Cancer  and  Stroke  Regional  Medical  Programs 

Oglesby  Paul,  M.D.,  Chicago  Chairman 
Donald  J.  Caseley,  M.D.,  Chicago,  Co-Vice  Chair- 
man for  Chicago  Metropolitan  Area 
Franklin  D.  Yoder,  M.D.,  Springfield,  Co-Vice 
Chairman,  State  at  Large 
Marshall  Alexander,  M.D.,  Rockford 
Leonidas  H.  Berry,  M.D.,  Chicago,  Consultant 
Henry  B.  Betts,  M.D.,  Chicago 
Charles  Branch,  M.D.,  Peoria 
Edward  Cannady,  M.D.,  East  St.  Louis 
John  Danielson,  Evanston 
Morris  Fishbein,  M.D.,  Chicago 
Robert  G.  Gibson,  Chicago 
Ronald  G.  Hansen,  Ph.D.,  Carbondale 
Irving  B.  Harris,  Chicago 
Leon  Jacobson,  M.D.,  Chicago 
Ormand  C.  Julian,  M.D.,  Chicago 
Theodore  K.  Lawless,  M.D.,  Chicago 
Mary  P.  Lodge,  R.N.,  Ed.D.,  Chicago 
B.  E.  Montgomery,  M.D.,  Harrisburg 
Dexter  Nelson,  M.D.,  Princeton 
George  O’Brien,  M.D.,  Chicago 
Caesar  Portes,  M.D.,  Chicago 
David  P.  Richerson,  M.D.,  Johnston  City 
Hiram  Sibley,  Chicago 
Harold  Sofield,  M.D.,  Oak  Park 
William  J.  Cassel,  Jr.,  M.D.,  Springfield,  Technical 
Secretary 

Robert  L.  Schmitz,  M.D.,  Chicago 
Wright  Adams,  M.D.,  Chicago 
Judge  William  Sylvester  White,  Chicago 

Foods  and  Dairies  Advisory  Committee 

Emmet  F.  Pearson,  M.D.,  Springfield 
Gail  M.  Dack,  Ph.D.,  M.D.,  Elgin 
Edward  King,  Chicago 
M.  G.  Van  Buskirk,  Chicago 
Dario  Toffenetti,  Chicago 
August  Van  Daele,  Hillside 
Ray  L.  Haase,  River  Forest 
Fred  Long,  M.D.,  Peoria 
Marion  B.  McClelland,  Decatur 
D.  Bruce  Hartley,  Chicago 
Eugene  Theios,  Waukegan 
Mrs.  Leufader  Walton,  Chicago 

Veterinary  Advisory  Board 

Guy  N.  Flater,  Jr.,  D.V.M.,  Galesburg,  Chairman 

Wallace  E.  Brandt,  D.V.M.,  Flanagan 

John  D.  Clayton,  D.V.M.,  Polo 

Robert  J.  Cyrog,  D.V.M.,  Skokie 

Paul  B.  Doby,  D.V.M.,  Springfield 

George  W.  Meyerholz,  D.V.M.,  Urbana 

Merrill  W.  G.  Ottwein,  D.V.M.,  Edwardsville 

George  T.  Woods,  D.V.M.,  Urbana 


Grade  A Milk  Advisory  Board 

Franklin  D.  Yoder,  M.D.,  Springfield, 

Chairman 

George  Baker,  Moline 
Willard  J.  Corbett,  M.D.,  Rockford 
Norman  Eisenstein,  Chicago 
Clyde  Fruit,  Edwardsville 
Gilbert  Gibson,  Chicago 
Fletcher  Gourley,  Springfield 
Vernon  Janes,  Champaign 
Floyd  M.  Keller,  Chicago 
J.  C.  McCaffrey,  Chicago 
Fred  Nonnamaker,  Chicago 
Joseph  F.  Reitz,  St.  Louis,  Mo. 

Ed  Rush,  Peoria 
Dale  Schaufelberger,  Highland 
Paul  Scherschel,  Chicago 
Bernard  Szidon,  Peoria 
M.  G.  Van  Buskirk,  Chicago 
L.  K.  Wallace,  Bloomington 
Louis  H.  Weiner,  Chicago 
Raymond  Weinheimer,  Highland 
Howard  K.  Wells,  Chicago 

Poliomyelitis  Technical  Advisory  Committee 

Norman  J.  Rose,  M.D.,  M.P.H.,  Springfield, 
Chairman 

Samuel  L.  Andelman,  M.D.,  Chicago 
W.  L.  Crawford,  M.D.,  Rockford 
John  B.  Hall,  M.D.,  Chicago 
Mark  Lepper,  M.D.,  Chicago 
E.  A.  Piszczek,  M.D.,  Forest  Park 
Caesar  Portes,  M.D.,  Chicago 
Herbert  Ratner,  M.D.,  Oak  Park 
Albert  Wolf,  M.D.,  Chicago 

Illinois  Committee  for  Medical  Residencies 
in  Public  Health 

Charles  F.  Sutton,  M.D.,  Springfield,  Chairman 

Clifton  Hall,  M.D.,  Springfield 

John  B.  Hall,  M.D.,  Chicago 

Charles  A.  Lang,  M.D.  Wheaton 

Mark  H.  Lepper,  M.D.,  Chicago 

Fred  P.  Long,  M.D.,  Peoria 

Edward  A.  Piszczek,  M.D.,  Forest  Park 

Donaldson  F.  Rawlings,  M.D.,  Springfield 

Eugene  L.  Wittenborn,  M.P.H.,  Springfield 

Advisory  Committee  on  Prevention  of 
Accidental  Poisoning  in  Children 
Norman  J.  Rose,  M.D.,  M.P.H.,  Springfield, 
Chairman 

Joseph  R.  Christian,  M.D.,  Chicago 
W.  L.  Crawford,  M.D.,  Rockford 
J.  Keller  Mack,  M.D.,  Springfield 
Paul  Pierce,  M.D.,  Alton 
John  S.  Stull,  M.D.,  Olney 
Walter  M.  Whitaker,  M.D.,  Quincy 

Illinois  Statewide  Public  Health  Committee 

David  W.  Meister,  Peoria,  Co-Chairman 
Mrs.  Pauline  Trelease,  Urbana,  Co-Chairman 


for  October,  1968 


473 


Governor’s  Tuberculosis  Advisory  Committee 

Franklin  D.  Yoder,  M.D.,  Springfield,  Chairman 

Walter  C.  Bornemeier,  M.D.,  Chicago 

K.  G.  Bulley,  M.D.,  Aurora 

Willard  Bunn,  Jr.,  Springfield 

Sen.  James  H.  Donnewald,  Breese 

Sen.  Harris  W.  Farwell,  Naperville 

George  K.  Hendrix,  Springfield 

James  H.  Hutton,  M.D.,  Chicago 


Mark  Lepper,  M.D.,  Chicago 
Edward  A.  Piszczek,  M.D.,  Forest  Park 
John  D.  Porterfield,  M.D.,  Chicago 
Rep.  Carl  Soderstrom,  Streator 
Adlai  E.  Stevenson,  III,  Chicago 
D.  H.  Trumpe,  M.D.,  Springfield 
W.  D.  Tuttle,  M.D.,  Harrisburg 
Ray  E.  Wachter,  Downers  Grove 


LEGISLATIVE  COMMISSIONS 

(Allied  with  Public  Health  Operations) 


Temporary  Legislative  Commissions 

Air  Pollution  Study 

Senator  Joseph  J.  Krasowski,  Chicago, 
Co-Chairman 

Rep.  J.  Theodore  Meyer,  Chicago,  Co-Chairman 

Sen.  Daniel  Dougherty,  Secretary 

Sen.  Albert  E.  Bennet 

Sen.  Robert  E.  Cherry 

Sen.  Jack  T.  Knuepfer 

Rep.  James  Y.  Carter 

Rep.  Leland  J.  Kennedy 

Rep.  Henry  J.  Klosak 

Rep.  Ed.  Lehman 

Rep.  J.  Theodore  Meyer 

Paul  W.  Reeder,  Staff  Consultant 

Food,  Drugs,  Cosmetic  and  Pesticide  Laws 
Rep.  George  M.  Burditt,  Chicago,  Chairman 
Rep.  Harvey  L.  Hensel,  Western  Springs 
(Foods) 

Rep.  Richard  W.  Kasperson,  Northbrook 
(Drugs) 

Esther  O.  Kegan,  Secretary 

Sen.  Dennis  J.  Collins 

Sen.  Clifford  B.  Latherow 

Sen.  Williams  Lyons 

Sen.  James  C.  Soper 

Sen.  Sam  Romano 

Rep.  Lewis  A.  H.  Caldwell 

Rep.  James  D.  Holloway 

Rep.  Raymond  J.  Kahoun 

Rep.  Louis  Janczak 

Richard  W.  Kasperson,  Northbrook 

Esther  O.  Kegan,  Evanston 

Dr.  Walter  Sikora,  Chicago 

Mrs.  Richard  E.  Olson,  Recording  Secretary 

Local  Government  Board  Selection 
Rep.  William  J.  Cunningham,  Pinckneyville, 
Chairman 

Sen.  Karl  Berning,  Secretary 
Sen.  Daniel  Dougherty 
Sen.  John  G.  Gilbert 
Sen.  Robert  W.  McCarthy 
Sen.  Howard  R.  Mohr 


Rep.  Edward  E.  Bluthardt 
Rep.  William  J.  Cunningham 
Rep.  John  S.  Matijevich 
Rep.  Frank  P.  North 
Rep.  William  M.  Zachacki,  Sr. 

Jerry  Corbett,  Hardin 
William  R.  Hayes,  DuQuoin 
O.  E.  Hirst,  Galena 
William  E.  LeCrone,  Shelbyville 
William  H.  Munch,  Decatur 
Paul  W.  Reeder,  Staff  Consultant 

Public  Health  Study  and  Survey  Commission, 
— ^Water  Pollution  and  Water  Resources  Com- 
mission— Water  Resources  and  Conservation 
Commission,  Northern  Illinois. 

Permanent  Legislative  Commissions 

Motor  Vehicle  Laws 

Rep.  H.  B.  Ihnen,  Chairman 

Sen.  Walter  P.  Hoflfelder,  Vice  Chairman 

Rep.  Elroy  C.  Sandquist,  Secretary 

Sen.  Edward  McBroom 

Sen.  Robert  W.  McCarthy 

Sen.  Sam  Romano 

Sen.  Arthur  R.  Swanson 

Rep.  Robert  Craig 

Rep.  Allen  T.  Lucas 

Rep.  Pete  Pappas 

Rep.  Elroy  C.  Sandquist 

Mary  Ellen  Kingery,  Recording  Secretary 

Illinois  Chronic  Renal  Disease 
Advisory  Committee 

Arthur  E.  Abney,  Chicago 

Dr.  Samuel  L.  Andelman,  Chicago 

Henry  P.  Banser  Jr.,  Addison 

Hayes  Beall,  Chicago 

Dr.  David  P.  Earle,  Chicago 

Dr.  H.  B.  Henkel,  Jr.,  Springfield 

Dr.  Alan  Kanter,  Chicago 

Dr.  Robert  M.  Kark,  Chicago 

Rev.  Beryl  Kinser,  Springfield 

Dr.  James  D.  Myers,  Peoria 

Dr.  Antonio  A.  Versaci,  Chicago 

Dr.  Franklin  D.  Yoder,  Springfield,  Chairman 


474 


Illinois  Medical  Journal 


Commission  on  Children 


Ex-officio  members: 

Roy  W.  Brooks 
Dr.  Emmet  Pearson 
Dr.  Henry  A.  Holle 
Miss  Minna  Hildebrand 
Staff  Advisors: 

Dr.  R.  F.  Sondag 

Dr.  William  J.  Cassel,  Jr. 

Immunization  Advisory  Commission 

Ralph  Kunstadter,  M.D.,  Chicago,  Chairman 

John  B.  Hall,  M.D.,  Chicago 

P.  M.  Schmidt,  M.D.,  Galva 

Joseph  R.  Kraft,  M.D.,  Chicago 

David  Greeley,  M.D.,  Chicago 

Mark  Lepper,  M.D.,  Chicago 

Walter  M.  Whitaker,  M.D. 

Norman  Rose,  M.D.,  M.P.H.,  Tech. 

Sec. 

Donaldson  Rawlings,  M.D.,  Springfield,  Staff 

Family  Study  Commission 

Bernard  B.  Wolfe,  Chairman 

Sen.  Walter  Duda,  Vice  Chairman 

Edward  D.  Rosenberg,  Secretary,  Chicago 

Mrs.  Jewel  LaFontant,  Chicago 

Sen.  Dennis  J.  Collins 

Sen.  Charles  Chew,  Jr. 

Sen.  Thad  L.  Kusibab 
Rep.  Henry  J.  Klosak 
Rep.  Leland  H.  Rayson 
Rep.  Genoa  S.  Washington 
Joseph  W.  Hickman,  Benton 
Norman  Inlander,  Highland  Park 
Prof.  Norval  Morris,  Chicago 
Victor  Neumark,  Glencoe 
Samuel  L.  Patterson,  Chicago 
Henry  Thrush  Synek,  Winnetka 
Karl  A.  Menninger,  M.D.,  Chicago 
Robert  McFarland,  M.D.,  Hinsdale 
Robert  G.  Granda,  Consultant 


PACKAGED  DISASTER 

Adams 

Quincy — 5 5080 

General  Stores  Bldg.,  Soldiers  & Sailors  Home 
Alexander 
Cairo — 55455 

City  Warehouse,  401  Ohio  St. 

Boone 

Belvidere — 01 0-50205 
Main  Hospital  Building,  1005  Julian  St. 
Bureau 

Princeton — 0 1 0-0052 

City  Hall,  2 S.  Main  St.  Ref:  Perry  Memorial 
Hospital 


Walter  Brissenden,  Chairman 
Joseph  Albrecht,  Vice  Chairman 
Rep.  John  W.  Alsop,  Secretary 
Sen.  Harris  W.  Fawell 
Sen.  Robert  E.  Cherry 
Rep.  Carl  Hunsicker 
Rep.  Elwood  Graham 
Conway  L.  Spanton,  Cambridge 
Ralph  Kunstadter,  M.D.,  Chicago 
Rev.  Ruben  Spannaus,  River  Forest 
Mrs.  Gordon  Hallstrom,  Evanston 
Mrs.  Thomas  Hunter,  Peoria 

Mental  Health 

Dr.  William  H.  Haines,  Chicago,  Chairman 

Sen.  Esther  Saperstein,  Vice  Chairman 

Sen.  Frank  M.  Ozinga,  Secretary 

Sen.  Harris  W.  Fawell 

Rep.  E.  J.  “Zeke”  Giorgi 

Rep.  David  W.  Johnson 

Rep.  Hellmut  W.  Stolle 

Ben  A.  Sears,  Northbrook 

Abner  Mikva,  Chicago 

Ex-officio 

Harold  M.  Visotsky,  M.D.,  Springfield 
Kenneth  Otten,  Springfield,  Executive  Secretary 

Public  Health  Needs 

Sen.  Robert  W.  Mitchler,  Chairman 

Sen.  Esther  Saperstein,  Vice  Chairman 

Rep.  Lawrence  J.  Bartels,  Secretary 

Sen.  John  W.  Carroll 

Rep.  J.  Theodore  Meyer 

Rep.  Frank  J.  Smith 

Miss  Helen  Hotchner,  La  Grange 

Otto  B.  Litwiller,  M.D.,  Peoria 

Fred  Long,  M.D.,  Peoria 

Dean  Sears,  Bloomington 

Harold  A.  Sofield,  M.D.,  Oak  Park 

Mrs.  Addie  Wyatt,  Chicago 


HOSPITALS  IN  ILLINOIS 

Carroll 

Savanna — 57264 

Army  Ordnance  Depot,  Savanna,  Gen:  Bldg. 
413,  Heated:  Bldg.  127,  Flam:  Bldg.  938,  Ref: 
Savanna  Frozen  Food  Locker,  1817  Chicago 
Ave. 

Champaign 

Champaign — 62409 

Illinois  Power  Company,  41  E.  University,  Ref: 
Univ.  Central  Food  Store:  1321  S.  Oak 
Christian 

Pana— 010-50580 

Pana  Comm.  Hospital,  S.  Locus  St. 


for  October,  1968 


475 


Cl  AY 

— 57262 

Ok!  Power  & Light  Bldg.,  221  W.  South  St. 
C'oii'S 

( lliarleMtoii — 57265 

Ha.stcrn  Illinois  University  Book  Store,  7th  St., 
Basement,  Ref:  Pemberton  Hall,  Gen:  Lanty 
Gym 

( iiiarIrNloii — 62406 

Jefferson  Jr,  High  .Sehool,  801  Jefferson  St., 
Ref:  Higgins  Groeery,  407-7th  St. 

IVlallooii — 5.52.54 

Moody  Mfg.  Co.,  1321  S.  19th  St.,  Ref:  Hornes 
Frozen  F’ood,  301  S.  18th  St. 

Cook 

Cliirafieo  lleiKlilM .5.509.5 

City  Hall,  1431  Chicago  Rd.,  Ref:  St.  James 
Hospital,  Chicago  Rd.  & 14 
Oak  — 62410 

C'ottage  #10,  Oak  Forest  Hospital,  159  & Ci- 
cero Ave.,  Ref:  South  Bldg, 
flak  F’orcMl — 62411 

Cottage  #10,  Oak  Forest  Hospital,  159  & Cicero 
Ave.,  Ref:  South  Bldg. 

I'alaliiie — 577«2 

Village  Hall,  54  S.  Brockway 

Skokie— .5402« 

(i.  O.  Scarle  & Co.,  Bldg.  A,  Scarle  Pkwy. 
OiKaui 

DcKalh— 010.50207 

OeKalb  Public  Hospital,  4th  & Grove  Streets 

Saiulwuh  010.50256 

City  Hall,  RailrotKl  and  Pearle  Sts.,  Narcotics 
Hospital 
Dougi.as 

'I'liseola — .57266 

Court  House,  Ref:  Tuscola  Locker  Serv. 
OuPACili 

Flinliiirsl— 010-50110 

Du  Page  Memorial  Hospital,  Avon  & Schiller 
Wlualon— 57550 

County  Convalescent  Home,  O.S.  370  County 
Farm  Rd.,  Flam:  County  CD  Office 
Win  fielcl— 01 0-50.565 
Central  DuPage  Ho.spital 
Edgar 

I’aris — 62408 

Houston  Bldg.,  120-126  E.  Wood,  Ref:  Co. 
Locker  Serv.,  301  W.  Blackburn 
Franki.in 

West  Frankfort — 55064 
New  Era  Bldg.,  105  S.  Monroe,  Ref:  Ice  Plant, 
305  S.  Logan 
Fui/roN 

Canton — 010-50106 

City  Garage,  Van  Buren  Court,  Ref:  Graham 
Hospital 
Grundy 

Gardner — 010-50445 

Garfield  Township  Bldg.,  Flam:  Fire  Depart- 
ment Bldg.,  Affiliation,  Morris  Hospital, 

Morris 


HliNDKRSON 

Oquawka — 5.508.5 

Old  Opera  House,  Ref:  Wm.  Lock’s  Tavern 
Iroquois 

Askuni-  -.5.5082 

Lawson  Contracting  Co.,  Ref:  Reichert  Locker 
Jackson 

Murphyshoro — 62469 
Courthouse,  1 1th  & Walnut,  Ref:  Memorial 
Hospital 
Jursey 

Jersey  ville — 010-.50298 

General  Highway  Garage,  Ref:  Raiky  Locker 
Plant 
Kane 

Aurora — 5.5.555 

East  Aurora  High  School,  779-5th  Ave., 

Ref:  Aurora  Locker  Co.,  36  N.  Lincoln 
Kane 

ElKin— 55076 

Elgin  State  Hospital  Adm.  Bldg.,  Ref:  General 
Stores,  Generator:  Garage 
Elgin— 010-50405 
Sherman  Hospital,  934  Center  St. 

St.  Charles— 010-50199 
Delmor  Hospital,  975  N.  Fifth,  Ref: 

111.  Cleaners  & Dryers,  315  E.  Main  St. 
Kankakee 

Kankakee — 55094 

Park  Div.  Garage,  100-5th  Ave.,  Ref:  St.  Mary’s 
Hospital 

Kankakee — 010-50566 

St.  Mary’s  Hospital 

Manleno— 010-50584 

Kankakee  State  Hospital,  100  E.  Jeffery 

Manteno— 010-50120 

Manteno  State  Hospital,  Silvis  Bldg.  #1,  Ref: 

& Inf:  Gen.  Stores  Bldg. 

Knox 

(Faleshurg — 5.507.5 

Knox  County  Courthouse,  Cherry  & E.  South 
St.,  Heat:  Ferris  Furn.  Co.,  471  S.  Mul- 
berry St.,  Ref:  Galesburg  Cottage  Hospital 
(;alesluirg— 55078 

Galesburg  State  Research  Hospital,  Warehouse 
Bldg.,  N.  Seminary  St.,  Ref:  Stores  Bldg. 
Galoslmrg — .5.5079 

Galesburg  State  Research  Hospital,  Warehouse 
Bldg.,  N.  Seminary  St.,  Ref:  Stores  Bldg. 

Lake 

Highland  Park— 57265 
Water  Filtration  Plant,  1701  St.  John  Ave. 
Lasalle 

Ottawa — 5.5.5.56 

Libby-Owens  Ford  Glass  Plant,  SA:  Old  Post 
Office  Bldg.,  309  Madison,  Ref:  Ottawa  Milk 
Product.,  1219  Fulton 
Lee 

Dixon — 010-500.51 

Dixon  State  School,  Garages  19-20-21,  Ref: 
Basement,  Gen.  Stores 


476 


lUinois  Medical  Journal 


Livingston 

Pontiac — 010-50157 
County  Nursing  Home,  R.R. 

Logan 

Lincoln — 55086 

Lincoln  State  School,  816  S.  State  St.,  Ref: 

Stores  Bldg. 

Lincoln — 55366 

Lincoln  Warehouse,  100  S.  Sangamon,  Ref: 

Cold  Storage  Bldg.  & Lincoln  State  School 
McLean 

Normal— 55091 

111.  Soldiers  & Sailors,  Children’s  School  Hos- 
pital, Ref:  General  Stores 
McHenry 

McHenry— 010-50939 

McHenry  High  School,  1012  N.  Green  St. 

Macon 

Decatur — 55347 

Macon  County  Building,  253  E.  Wood,  Ref: 
County  TB  Sanitorium,  400  Hay  St., 

Macoupin 

Carlinville — 010-50373 
Business  Building,  3516,  Daley  St.,  Ref:  Prairie 
Farm  Dairies  Store,  Rt.  4,  Generator:  High 
School 
Madison 

Alton — 55089 

County  Civil  Defense  Bldg.,  513  E.  Third  St. 
Edwardsville — 55398 

LeClair  Grade  School,  New  Franklin  Rd.,  Ref: 
LeClair  Grade  School,  Frozen  Food  Locker 
Plant 
Marion 

Centralia — 55117 

Chapel  Bldg.,  Elmwood  Cemetery,  Ref:  Frozen 
Food  Locker  Plant,  324  E.  Broadway 
Mason 

Havana — 56005 

C & I R.R.  Depot,  Rt.  136,  Heated:  High 
School,  Ref:  Morgan’s  Market,  305  E.  Main  St. 
Massac 

Metropolis — .5545.3 

Power  & Light  Building,  101  Front  St.,  Ref: 
Cummings  Spec.  Locker,  1210  E.  Fifth  St. 
Montgomery 

Litchfield— 010-50560 

Morgan 

Jacksonville — 010-50420 

Jacksonville  State  Hospital,  Basement,  Veterans 

Diag.  Bldg.  Ref:  2nd  Floor,  Stores  Bldg. 

Peoria 

Bartonville — 62407 

Civil  Defense  Center,  Abbott  Center,  Peoria 
State  Hospital 
Peoria — 6241 3 

Carson,  Pirie,  Scott  & Co.,  Central  Distribution 
801  S.  W.  Washington 
Perry 

DuQuoin — 55454 

Heat  Plant  & Ref:  Marshall  Browning  Hospital, 
900  N.  Washington,  General:  111.  Central  Depot, 
Oak  St. 


Randolph 

Chester — 010-50225 

Chester  Memorial  Hosp.,  1900  State  St. 

Red  Bud — 010-50152 

Gen:  Schreiber  Warehouse,  119  W.  Red  Bud  St., 
Heated:  Basement  of  City  Hall 
Richland 

OIney — 55412 

County  Court  House,  Main  St. 

Saline 

Muddy — 55090 
Old  Grade  School 
Schuyler 

Rushville — 5732.3 

Scripps  Park  Country  Club,  Ref:  Culbertson 
Hospital  and  Barllow  Packing  Co. 

Tazewell 

Pekin — 010-50603 

Pekin  High  School,  East  Campus,  Ref:  Me- 
morial Hospital 
Union 

Anna — 55092 

Anna  State  Hospital,  Bldg.  #4  and  Hamilton 
Hall 

Vermilion 

Danville — 55349 

St.  Elizabeth’s  Hospital,  600  Sager  Ave. 

Danville — 55.350 

St.  Elizabeth’s  Hospital,  600  Sager  Ave. 

Wabash 

Mt.  Carmel — 62404 

City  Bldg.,  3rd  and  Market  Sts.,  Ref:  Wabash 
General  Hospital 
Warren 

Monmouth — 010-50224 

Wakefield  Warehouse,  314  East  6th  St. 
Whiteside 
Erie — 57.304 

Erie  High  School  (Basement),  Ref:  Erie  Locker 
Plant,  Main  St. 

Sterling — 62405 

City  Hall,  212  Third  Ave.,  Ref:  Community 
General  Hospital 
Will 

Joliet— 54005 

Barrett’s  Hardware,  Bldg.  #4,  342  Henderson 
St.,  Heated:  Bldg,  next  to  Bldg.  #4,  Ref: 

Silver  Cross  Hospital 
Winnebago 

Rockford — 6240.3 

Whitehead  School,  2324  Ohio  Pkwy.,  Ref: 
Thomas  Jefferson  High  School 


PDH  Training  Units  In  Illinois 

Champaign 

Rantoul — 61866 
City  Civil  Defense 
DuPage 

Elmhurst — 53034 

York  Community  High  School 


for  October,  1968 


477 


Jackson 

Carbondale — 53031 
Southern  Illinois  University 
Marion 

Salem — 56006 

Salem  CD  Headquarters,  Bryan  Park 
Peoria 

Peoria — 53036 
Peoria  State  Hospital 
St.  Clair 

Belleville — 53030 

1505  Caseyville  Avenue,  P.O.  Box  271 

APPROVED  LABORATORIES- 


ALTON 

Alton  Memorial  Hospital  Laboratory 
AURORA 

Clinical  Laboratory,  Aurora  Medical  Park 
BENTON 
Franklin  Hospital 
CHAMPAIGN 

Burnham  City  Hospital 
CHICAGO 

Chicago  Wesleyan  Memorial  Hospital 

Children’s  Memorial  Hospital  Laboratory 

Columbus  Hospital  Laboratory 

Edgewater  Hospital 

Mercy  Hospital 

Michael  Reese  Hospital 

Mt.  Sinai  Hospital 

Presbyterian-St.  Luke’s  Hospital 

Provident  Hospital 

State  Laboratory 

University  of  Illinois,  Research  and  Educa- 
tional Hospital 
Walther  Memorial  Hospital 
Weiss  Memorial  Hospital 
ELGIN 

Sherman  Hospital  Laboratory 
EVANSTON 

St.  Francis  Hospital  Laboratory 
DANVILLE 

Lake  View  Memorial  Hospital 


Sangamon 

Springfield — 53037 

Douglas  Grade  School,  444  W.  Reynolds  St. 
Vermilion 

Danville — 53032 

St.  Elizabeth’s  Hospital,  600  Sager  Ave. 
Winnebago 

Rockford — 53038 
Presidential  Court,  Loves  Park 


PKU-FLUOROMETRIC  TEST* 

ELGIN 

Sherman  Hospital 
EVANSTON 

Evanston  Hospital 
St.  Francis  Hospital 
FREEPORT 

Freeport  Memorial  Hospital 
MT.  CARMEL 
Wabash  General  Hospital 
NAPERVILLE 
Edward  Hospital 
OAK  LAWN 

Christ  Community  Hospital 
OAK  PARK 
Oak  Park  Hospital 
West  Suburban  Hospital 
PEORIA 

St.  Francis  Hospital 
ROCKFORD 

Swedish-American  Hospital 
SKOKIE 

Skokie  Valley  Community  Hospital 
URBANA 

Carle  Hospital  Clinic 
Mercy  Hospital  Clinic 

*These  laboratories  are  approved  for  the  use  of 
this  procedure  for  both  screening  and  quantitative 
determinations. 


POISON  CONTROL  CENTERS  IN  ILLINOIS 


AURORA 

Copley  Memorial  Hospital 
Lincoln  & Weston  Avenues 

896- 4611,  Ext.  725 
St.  Charles  Hospital 

400  E.  New  York  Street 

897- 8714,  Ext.  50 
BELLEVILLE 

Memorial  Hospital 
4501  North  Park  Dr. 
233-7750,  Ext.  286 
BERWYN 

MacNeal  Memorial  Hospital 
3249  S.  Oak  Park  Ave. 
484-2211  Ext.  311  and  312 


BLOOMINGTON 
Mennonite  Hospital 
807  North  Main  St. 
823-8241,  Ext.  311 
St.  Joseph’s  Hospital 
2200  E.  Washington  St. 
829-9481,  Ext.  354 
CAIRO 

St.  Mary’s  Hospital 
2020  Cedar  St. 

734-2400,  Ext.  45 
CANTON 

Graham  Hospital  Association 
210  W.  Walnut  St. 

647-5240,  Ext.  48 


478 


Illinois  Medical  Journal 


CARBONDALE 
Doctors  Hospital 
404  W.  Main  St. 

457-4101,  Ext.  23 
CENTRALIA 
St.  Mary’s  Hospital 
400  N.  Pleasant  Ave. 

532-6731,  Ext.  626 
CHAMPAIGN 

Burnham  City  Hospital 
3 1 1 E.  Stoughton  St. 

337-2533 

CHANUTE  AIR  FORCE  BASE* 

United  States  Air  Force  Hospital 
893-3111,  Ext.  6234  and  6233 
CHESTER 

Memorial  Hospital 
1900  State  St. 

826-2367,  Ext.  44 
CHICAGO 

Children’s  Memorial  Hospital 
2300  Children’s  Plaza 

348-4040,  Ext.  338 
Cook  County  Hospital 
1825  West  Harrison  St. 

633-6526;  Night  633-6541 
University  of  Illinois  Hospitals 
840  South  Wood  St. 

663-6801 
Mercy  Hospital 

2510  Martin  Luther  King  Dr. 

842-4700 

Michael  Reese  Hospital 
29th  Street  & Ellis  Ave. 

225-5525,  Ext.  761 

Night  Ext.  261 
Mt.  Sinai  Hospital 
15th  & California 

277-4000,  Ext.  297-8 
Municipal  Contagious  Disease  San. 

3026  South  California  Ave. 

247-5700 

Resurrection  Hospital 
7435  West  Talcott  Ave. 

774-8000,  Ext.  235-6 

Wyler  Silvain  and  Arma  Children’s  Hospital 
950  E.  59th  St. 

684-6100  Ext.  6231 

Night  5412 
DANVILLE 

Lake  View  Memorial  Hospital 
812  N.  Logan  Ave. 

446-7200,  Ext.  765-78 
St.  Elizabeth’s  Hospital 
600  Sager  St. 

442-6300 

DECATUR 

Decatur-Macon  County  Hospital 
2300  N.  Edward  St. 

877-8121,  Ext.  675-6 

^Limited  for  treatment  of  military  personnel  and 
families,  except  for  indicated  emergencies. 


St.  Mary’s  Hospital 

1 800  E.  Lake  Shore  Dr. 

429-2966,  Ext.  640 
DES  PLAINES 
Holy  Family  Hospital 
100  North  River  Road 
299-2281,  Ext.  856 
EAST  ST.  LOUIS 

Christian  Welfare  Hospital 
1509  Illinois  Ave. 

874-7076,  Ext.  231 
St.  Mary’s  Hospital 
129  North  8th  St. 

274-1900 

EFFINGHAM 

St.  Anthony’s  Hospital 
503  North  Maple  St. 

342- 2121,  Ext.  67 
ELGIN 

St.  Joseph’s  Hospital 
277  Jefferson  Ave. 

741- 5400,  Ext.  69 
Sherman  Hospital 

934  Center  St. 

742- 9800,  Ext.  681-3 
ELMHURST 

Memorial  Hospital  of  DuPage  County 
315  Schiller  St. 

833-1400 

EVANSTON 

Community  Hospital 
2040  Brown  Ave. 

869-5044,  Ext.  54 
Night  Ext.  58 
Evanston  Hospital 
2650  Ridge  Ave. 

492-6460 

St.  Francis  Hospital 
355  Ridge  Ave. 

492-2440 

EVERGREEN  PARK 

Little  Company  of  Mary  Hospital 
2800  W.  95th  St. 

422-6200,  Ext.  1211 
FAIRBURY 

Fairbury  Hospital 
519  South  Fifth  St. 

692-2346 

FREEPORT 

Freeport  Memorial  Hospital 
420  South  Harlem  Ave. 

233-4131,  Ext.  228 
GALENA 

Northwestern  Illinois  Community  Hospital 
Summit  Street 
777-1340 
GALESBURG 

Galesburg  Cottage  Hospital 
674  North  Seminary  St. 

343- 4121,  Ext.  356 
St.  Mary’s  Hospital 

239  South  Cherry  St. 

343-3161,  Ext.  203 


for  October,  1968 


479 


GRANITE  CITY 

St.  Elizabeth’s  Hospital 
2100  Madison  Ave. 

876-2020,  Ext.  224-257 
HARVEY 

Ingalls  Memorial  Hospital 
15510  Page  Ave. 

333-2300 

HIGHLAND 

St.  Joseph’s  Hospital 
1515  Main  St. 

654-2171 

HIGHLAND  PARK 

Highland  Park  Hospital  Foundation 

718  Glenview  Ave. 

432-8000,  Ext.  561-3 

HINSDALE 

Hinsdale  San.  & Hospital 
120  North  Oak  St. 

323-2100,  Ext.  336-8 
HOOPESTON 

Hoopeston  Community  Memorial  Hospital 
701  E.  Orange 
283-5531 

JACKSONVILLE 
Passavant  Memorial  Area  Hospital 
1600  West  Walnut 
245-9541 
JOLIET 

St.  Joseph’s  Hospital 
333  N.  Madison  St. 

725-7133,  Ext.  679-93 
Silver  Cross  Hospital 
600  Walnut  St. 

727-1711,  Ext.  731 
KANKAKEE 

St.  Mary’s  Hospital 
150  South  Fifth  St. 

939-2531,  Ext.  735 
KEWANEE 

Kewanee  Public  Hospital 

719  Elliott  St. 

3361,  Ext.  219 

LAKE  FOREST 
Lake  Forest  Hospital 

660  North  Westmoreland  Road 
234-5600,  Ext.  608 
LASALLE 

St.  Mary’s  Hospital 
1015  O’Conor  Ave. 

223-0607,  Ext.  84,  Night  Ext.  46 
LIBERTYVILLE 

Condell  Memorial  Hospital 
Cleveland  & Stewart  Aves. 

362-2900,  Ext.  325-6 
LINCOLN 

Abraham  Lincoln  Memorial  Hospital 
315  Eighth  St. 

732-2161,  Ext.  365 
MACOMB 

McDonough  District  Hospital 
525  East  Grant  St. 

833-4101 


MATTOON 

Mem.  Dist.  Hosp.  of  Coles  County 
2101  Champaign  Ave. 

234-8881,  Ext.  43, 

Night  Ext.  29 
McHenry 
McHenry  Hospital 

3516  West  Waukegan  Road 
385-2200,  Ext.  614 
MELROSE  PARK 
Westlake  Hospital 
1225  Superior  St. 

681-3000,  Ext.  239,  226 
MENDOTA 

Mendota  Community  Hospital 
Memorial  Drive  & Route  5 1 
2131,  Ext.  22;  Night  Ext.  20 
MOLINE 

Moline  Public  Hospital 
635-lOth  Ave. 

762-3651,  Ext.  232 
MONMOUTH 

Community  Memorial  Hospital 
W.  Harlem  Ave. 

734-3141,  Ext.  250 
MOUNT  CARMEL 
Wabash  General  Hospital 
1418  College  Drive 
262-4121 

MOUNT  VERNON 

Good  Samaritan  Hospital 
605  North  Twelfth  St. 
242-4600,  Ext.  303, 

Night  Ext.  385 
NAPERVILLE 
Edward  Hospital 

South  Washington  St. 

355-0450,  Ext.  26 
NORMAL 

Brokaw  Hospital 

Virginia  at  Franklin  Ave. 
829-7685,  Ext.  274 
OAK  LAWN 

Christ  Community  Hospital 
4440  West  95th  St. 

423-7000,  Ext.  659,  600,  601 
OAK  PARK 

West  Suburban  Hospital 
518  North  Austin  Blvd. 
383-6200,  Ext.  605 
OLNEY 

Richland  Memorial  Hospital 
800  East  Locust  St. 

395-2131,  Ext.  226 
OTTAWA 

Ryburn  Memorial  Hospital 
701  Clinton  St. 

433-3100 
PARK  RIDGE 

Lutheran  General  Hospital 
1775  Dempster  St. 

692-2210 


480 


Illinois  Medical  Journal 


PEKIN 

Pekin  Memorial  Hospital 
Comer  of  14th  & Court  St. 
347-1151,  Ext.  242 
PEORIA 

Methodist  Hospital 

221  Northeast  Glen  Oak  Ave. 
685-6511,  Ext.  250,  360 
Proctor  Community  Hospital 
5409  North  Knoxville  Ave. 
691-4702,  Ext.  791 
St.  Francis  Hospital 

530  Northeast  Glen  Oak  Ave. 
674-7731,  Ext.  514 

PERU 

Peoples  Hospital 
925  West  Street 
223-3300 
PITTSFIELD 

mini  Community  Hospital 
620  West  Washington  St. 
285-2113 
QUINCY 

Blessing  Hospital 
1005  Broadway 

222- 3270,  Ext.  211 
St.  Mary’s  Hospital 

1415  Vermont  St. 

223- 1200,  Ext.  275 
ROCKFORD 

Rockford  Memorial  Hospital 
2400  North  Rockton  Ave. 
968-6861,  Ext.  441 
St.  Anthony’s  Hospital 
6666  E.  State  St. 

398-7600 

Swedish-American  Hospital 
1316  Charles  St. 

968-6898,  Ext.  602 


ROCK  ISLAND 

St.  Anthony’s  Hospital 
767-30th  St. 

788-7631,  Ext.  771 
ST.  CHARLES 
Delnor  Hospital 

975  North  Fifth  Ave. 

584-3300,  Ext.  218 
SPRINGFIELD 
Memorial  Hospital 
First  and  MiUer  Sts. 

528-2041,  Ext.  333 
St.  John’s  Hospital 
701  E.  Mason  St. 

544-6451,  Ext.  375 
STREATOR 

St.  Mary’s  Hospital 
111  E.  Spring 

672-3189 
URBANA 
Carle  Hospital 
611  W.  Park  St. 

337-3311 
Mercy  Hospital 

1412  West  Park  Ave. 

337- 2131 
WAUKEGAN 

St.  Therese  Hospital 
West  Washington  St. 

688-6470 

Night  688-6471 
Victory  Memorial  Hospital 
1324  North  Sheridan  Road 

688-4181 

WOODSTOCK 

Memorial  Hospital  for  McHenry  County 
527  West  South  St. 

338- 2500,  Ext.  32 

ZION 

Zion-Benton  Hospital, 

2500  Emmaus  Ave. 

872-4561,  Ext.  240 


HOSPITALS 


The  Illinois  Department  of  Public  Health  is 
responsible  for  implementing  the  Hospital  Li- 
censing Act,  excerpts  from  which  follows: 

Section  2.  The  purpose  of  this  Act  is  to  provide 
for  the  better  protection  of  the  public  health 
through  the  development,  establishment,  and  en- 
forcement of  standards  (1)  for  the  care  of  indi- 
viduals in  hospitals,  (2)  for  the  constmction, 
maintenance,  and  operation  of  hospitals  which,  in 
light  of  advancing  knowledge,  wiU  promote  safe 
and  adequate  treatment  of  such  individuals  in 
hospitals,  and  (3)  that  will  have  regard  to  the 
necessity  of  determining  that  a person  estabhshing 


a hospital  have  the  quahfications,  background, 
character  and  financial  resources  to  adequately 
provide  a proper  standard  of  hospital  service  for 
the  community. 

Hospital  Licensing  Requirements 

To  implement  the  Hospital  Licensing  Act,  the 
Department  of  Public  Health  has  patient  re- 
quirements. The  following  cover  the  medical  staff. 

1.  The  medical  staff  shall  be  composed  only  of 
physicians  and  dentists  licensed  by  the  IlUnois  De- 
partment of  Registration  and  Education  in  ac- 
cordance, respectively,  with  provisions  of  the 
Medical  Practice  Act  and  Dental  Practice  Act. 


for  October,  1968 


481 


2.  The  medical  staff  shall  be  organized  in  ac- 
cordance with  written  bylaws,  rules  and  regula- 
tions, approved  by  the  governing  board.  The  by- 
laws, rules  and  regulations  shall  specifically  pro- 
vide: 

a.  for  eligibility  for  staff  membership; 

b.  for  such  divisions  and  departments  as  are 
warranted,  (as  a minimum.  Active  and  Con- 
sulting divisions  are  required) 

c.  for  such  officers  and/or  committees  as  are 
warranted;  however,  committees  shall  be 
designed  to  be  responsible  for  medical 
records  and  for  pharmacy  and  therapeutics; 

d.  for  determination  of  qualifications  and  privi- 
leges; 

e.  that  medical  staff  meetings  be  held  regularly, 
and  that  written  minutes  of  all  meetings  be 
kept; 

f.  for  review  and  analysis  of  the  clinical  ex- 
perience of  the  hospital  at  regular  intervals 
— the  medical  records  of  patients  to  be  the 
basis  for  such  review  and  analysis; 

g.  that  tissue  removed  at  operation  shall  be 


examined  by  a qualified  pathologist  and  that 
the  findings  shall  be  made  a part  of  the 
patient’s  medical  record; 

h.  for  consultation  between  medical  staff  mem- 
bers in  complicated  cases;  and 

i.  for  keeping  complete  medical  records. 
Section  B.  Supervision  of  Patient  Care 

All  persons  admitted  to  the  hospital  shall  be 
under  the  professional  care  of  a member  of  the 
medical  staff. 

Section  C.  Orders  for  Medication  and  Treatment 

No  medication  or  treatment  shall  be  given  to 
a patient  except  on  the  written  order  of  a mem- 
ber of  the  medical  staff. 

Section  D.  Tissue  Examination 

All  tissue  removed  at  operation  shall  be  exam- 
ined by  a qualified  pathologist  and  the  findings 
shall  be  made  a part  of  the  patient’s  hospital 
medical  record.  A tissue  committee  of  the  medi- 
cal staff  is  highly  recommended. 

The  governing  board  shall  provide  that  one  or 
more  physicians  shall  be  available  at  all  times 
for  emergencies. 


GENERAL  HOSPITALS 

(For  Identification — see  footnote,  page  488) 


ALEDO  (Mercer) 

Mercer  County  Hospital  (E-63) 

ALTON  (Madison) 

** Alton  Memorial  Hospital  (B-210) 

*St.  Anthony’s  Hospital  (B-140) 

**St.  Joseph’s  Hospital  (B-152) 

AMBOY  (Lee) 

Amboy  Public  Hospital  (B-15) 

ANNA  (Union) 

Union  County  Hospital  District  (F-67) 
ARLINGTON  HEIGHTS  (Cook) 

**Northwest  Community  Hospital  (B-223) 
AURORA  (Kane) 

**  Copley  Memorial  Hospital  (B-200) 

Kane  County  Springbrook  Sanitarium  (E-57) 
*St.  Charles  Hospital  (B-107) 

*St.  Joseph  Mercy  Hospital  (B-107) 

AVON  (Fulton) 

Saunders  Hospital  (B-24) 

BEARDSTOWN  (Cass) 

*Schmitt  Memorial  Hospital  (D-50) 
BELLEVILLE  (St.  Clair) 

**Memorial  Hospital  (B-151) 
t*St.  Elizabeth’s  Hospital  (B-294) 

BELVIDERE  (Boone) 

* Highland  Hospital,  Inc.  (B-65) 

*St.  Joseph’s  Hospital  (B-lOO) 

BENTON  (Franklin) 

*The  Franklin  Hospital  (F-125) 

BERWYN  (Cook) 

**MacNeal  Memorial  Hospital  (B-423) 
BLOOMINGTON  (McLean) 

*Mennonite  Hospital  (B-130) 

*St.  Joseph’s  Hospital  (B-158) 


BLUE  ISLAND  (Cook) 

**St.  Francis  Hospital  (B-220) 

BREESE  (Clinton) 

*St.  Joseph’s  Hospital  (B-42) 

CAIRO  (Alexander) 

Alexander  County  Tuberculosis  Sanitarium 
(E-36) 

*St.  Mary’s  Hospital  (B-130) 

CANTON  (Fulton) 

* Graham  Hospital  Association  (B-152) 
CARBONDALE  (Jackson) 

* Doctors  Hospital  (B-60) 

* Holden  Hospital  (B-55) 

CARLINVILLE  (Macoupin) 

*Carlinville  Area  Hospital  (B-68) 

CARMI  (White) 

*Carmi  Township  Hospital  (H-63) 
CARROLLTON  (Greene) 

Thomas  H.  Boyd  Memorial  Hospital  (B-43) 
CARTHAGE  (Hancock) 

* Memorial  Hospital  (B-80) 

CASEYVILLE  (St.  Clair) 

Pleasant  View  Sanitorium  (E-lOO) 
CENTRALIA  (Marion) 

**St.  Mary’s  Hospital  (B-117) 

CHAMPAIGN  (Champaign) 

** Burnham  City  Hospital  (D-161) 

*Cole  Hospital  (C-61) 

CHARLESTON  (Coles) 

^Charleston  Community  Memorial  Hospital, 
Inc.,  (B-65) 

CHESTER  (Randolph) 

*Memorial  Hospital  (F-52) 


482 


Illinois  Medical  Journal 


CHICAGO  (Cook) 

*Alexian  Brothers  Hospital  (B-240) 

=*=  American  Hospital  of  Chicago  (B-168) 
**Augustana  Hospital  (B-350) 

**Behnont  Community  Hospital  (B-157) 
♦Bethany  Brethren  Hospital  (B-59) 

♦Bethany  Methodist  Hospital  (B-157) 
♦Bethesda  Hospital  (B-99) 

♦Booth  Memorial  Hospital  (B-25) 

♦Central  Community  Hospital  (B-93) 

♦Cermak  Memorial  Hospital  (D-129) 

♦Charles  H.  & S.  Rachael  Schwab 
Rehabilitation  Hospital  (B-61) 

♦Chicago  Eye,  Ear,  Nose  and  Throat 
Hospital  (C-37) 

♦♦Chicago  Osteopathic  Hospital  (B-171) 
♦Chicago  Tuberculosis  Sanitarium  (1-330) 
t*Chicago  Wesley  Memorial  Hospital  (B-654) 
♦Children’s  Memorial  Hospital  (B-237) 
♦♦Columbus  Hospital  (B-407) 

♦Cook  County  Hospital  (E-2,747) 

Doctors  General  Hospital  (B-86) 

Doctors  General  Hospital,  Unit  II  (B-96) 
♦Edgewater  Hospital  (B-334) 

♦♦Englewood  Hospital  (B-159) 

♦Evangelical  Hospital  of  Chicago  (B-174) 
♦Forkosh  Memorial  Hospital  (B-150) 

♦♦Frank  Cuneo  Hospital  (B-178) 

♦Franklin  Boulevard  Community  Hospital 
(B-110) 

♦♦Garfield  Park  Community  Hospital  (B-141) 
♦Grant  Hospital  of  Chicago  (B-339) 

Halco  Sanitarium  Inc.  (C-10) 

♦Henrotin  Hospital  (B-95) 

♦♦Holy  Cross  Hospital  (B-330) 

♦Hospital  of  St.  Anthony  de  Padua  (B-209) 
Ida  Mae  Scott  Hospital  (C-15) 

♦Illinois  Central  Hospital  (B-301) 

!♦  ♦Illinois  Masonic  Hospital  (B-544) 

♦Jackson  Park  Hospital  (C-184) 

LaRabida  Jackson  Park  Sanitarium  (B-104) 
t♦♦Loretto  Hospital  (B-163) 

♦♦Louis  A.  Weiss  Memorial  Hospital  (B-250) 
♦Louis  Burg  Hospital  (B-114) 

♦Lutheran  Deaconess  Hospital  (B-183) 
♦Martha  Washington  Hospital  (B-58) 

♦♦Mary  Thomson  Hospital  (B-112) 
t^^Mercy  Hospital  (B-355) 
t ♦♦Michael  Reese  Hospital  and  Medical  Center 
(B-994) 

t*♦Mount  Sinai  Hospital  of  Chicago  (B-391) 
♦Municiple  Contagious  Disease  Hospital 
(D-lOO) 

♦Municiple  Tuberculosis  Sanitarium 
(D-1,081) 

♦Northwest  Hospital,  Inc.  (C-225) 
♦♦Norwegian- American  Hospital,  Inc.  (B-222) 
t♦♦Passavant  Memorial  Hospital  (B-351) 
f♦*Presb}’terian-St.  Luke’s  Hospital  (B-839) 
♦Provident  Hospital  and  Training  School 
(B-204) 

♦♦Ravenswood  Hospital  Association  (B-275) 


♦Rehabihtation  Institute  of  Chicago  (B-65) 
♦♦Resurrection  Hospital  (B-260) 

♦Roosevelt  Memorial  Hospital  (B-115) 
♦Roseland  Community  Hospital  (B-131) 

♦♦St.  Anne’s  Hospital  (B-405) 

♦St.  Bernard’s  Hospital  (B-229) 

♦St.  Elizabeth’s  Hospital  (B-322) 

♦♦St.  Frances  Xavier  Cabrini  Hospital  (B-200) 
♦St.  George  Hospital  (B-128) 
t**St.  Joseph  Hospital  (B-488) 

♦♦St.  Mary  of  Nazareth  Hospital  (B-280) 

♦St.  Vincent’s  Infant  Hospital  (B-65) 
♦Shriners  Hospital  for  Crippled  Children 
(Chicago  Unit)  (B-68) 

♦♦South  Chicago  Community  Hospital  (B-300) 
♦♦South  Shore  Hospital  (B-189) 

♦♦Swedish  Covenant  Hospital  (B-240) 
f ♦♦University  of  Chicago  Hospitals  and  Clinics 
(B-661) 

t ♦University  of  Illinois  Research  and  Educational 
Hospitals  (1-605) 

♦The  Von  Solbrig  Memorial  Hospital,  Inc. 
(A-102) 

♦Walther  Memorial  Hospital  (B-222) 
♦Woodlawn  Hospital  (B-145) 

CHICAGO  HEIGHTS  (Cook) 

♦♦St.  James  Hospital  (B-420) 

CHRISTOPHER  (Franklin) 

♦The  Miners  Hospital  (B-34) 

CLIFTON  (Iroquois) 

Central  Hospital  (B-40) 

CLINTON  (DeWitt) 

♦John  Warner  Hospital  (D-45) 

DANVILLE  (VermiHon) 

♦♦Lake  View^  Memorial  Hospital  (B-237) 

♦♦St.  Elizabeth  Hospital  (B-180) 

♦Vermilion  Cotmty  Tuberculosis 
Dispensary  and  Hospital  (E-61) 
DECATLTl  (Macon) 

♦♦Decatur  and  Macon  County  Hospital  (B-363) 
♦Macon  County  Tuberculosis  Sanitorium  (E-40) 
♦St.  Mary’s  Hospital  (B-389) 

♦The  Wabash  Memorial  Hospital  (B-61) 
DeKALB  (DeKalb) 

♦DeKalb  Public  Hospital  (D-110) 

DES  PLAINES  (Cook) 

♦♦Holy  Fanuly  Hospital  (B-236) 

DIXON  (Lee)^ 

♦Dixon  Public  Hospital  (B-120) 

DOLTON  (Cook) 

♦Thomsen  Clinic  Hospital  (B-6) 

DU  QUOIN  (Perry) 

♦Marshall  Browning  Hospital  (B-66) 

EAST  ST.  LOUIS  (St.  Clair) 

♦CentrevUle  Township  Hospital  (H-145) 
♦Christian  Welfare  Hospital  (B-194) 

♦St.  Maiy's  Hospital  (B-300) 
EDWARDSMLLE  (Madison) 

Madison  County  TB  Sanitorium  (E-87) 
EFFINGHAM  (E^gham) 

♦St.  Anthony  Memorial  Hospital  (B-126) 


for  October,  196S 


483 


ELDORADO  (Saline) 

Ferrell  Hospital  (C-48) 

Pearce  Hospital  Foundation  (B-33) 

ELGIN  (Kane) 

**St.  Joseph  Hospital  (B-154) 

** Sherman  Hospital  Association  (B-335) 

ELK  GROVE  VILLAGE  (Cook) 

*St.  Alexius  Hospital  (B-225) 

ELMHURST  (DuPage) 

**Memorial  Hospital  of  DuPage  County  (B-413) 
EUREKA  (Woodford) 

* Eureka  Hospital  (C-31) 

EVANSTON  (Cook) 

^Community  Hospital  of  Evanston  (B-54) 
f**Evanston  Hospital  Association  (B-467) 
*Northwestern  University  Student  Health 
Service  Hospital  (B-44) 

**St.  Francis  Hospital  (B-343) 

EVERGREEN  PARK  (Cook) 

t**Little  Company  of  Mary  Hospital  (B-559) 

FAIRBURY  (Livingston) 

*Fairbury  Hospital  (B-86) 

FAIRFIELD  (Wayne) 

^Fairfield  Memorial  Hospital  (B-104) 

FLORA  (Clay) 

*Clay  County  Hospital  (E-52) 

FREEPORT  (Stephenson) 

*Freeport  Memorial  Hospital  (B-186) 
GALENA  (Jo  Daviess) 

* Northwestern  Illinois  Community  Hospital 

(F-31) 

GALESBURG  (Knox) 

**  Galesburg  Cottage  Hospital  (B-191) 

*St.  Mary’s  Hospital  (B-134) 

GENESEO  (Henry) 

*Hammond-Henry  District  Hospital  (F-66) 
GENEVA  (Kane) 

** Community  Hospital  (B-116) 

GIBSON  CITY  (Ford) 

* Gibson  Community  Hospital  (B-45) 
GRANITE  CITY  (Madison) 

**St.  Elizabeth  Hospital  (B-248) 
GREENEVILLE  (Bond) 

* Edward  A.  Utlaut  Memorial  Hospital  (B-72) 
HARRISBURG  (Saline) 

Doctors  Hospital  of  Harrisburg,  Inc.  (C-80) 
HARVARD  (McHenry) 

^Harvard  Community  Memorial  Hospital  (F-40) 
HARVEY  (Cook) 

* Ingalls  Memorial  Hospital  (B-309) 

HAVANA  (Mason) 

*Mason  District  Hospital  (F-48) 

HAZEL  CREST  (Cook) 

*South  Suburban  Hospital  Foundation  (B-57) 
HERRIN  (Williamson) 

*Herrin  Hospital  (B-131) 

HIGHLAND  (Madison) 

*St.  Joseph’s  Hospital  (B-133) 

HIGHLAND  PARK  (Lake) 

**The  Highland  Park  Hospital  Foundation 
(B-196) 


HILLSBORO  (Montgomery) 

*Hillsboro  Hospital  (B-65) 

HINSDALE  (DuPage) 
t*Hinsdale  Sanitarium  and  Hospital  (B-353) 
HOOPESTON  (Vermilion) 

*Hoopestown  Community  Memorial  Hospital 
(B-44) 

HOPED  ALE  (Tazewell) 

*Hopedale  Hospital  (B-44) 

JACKSONVILLE  (Morgan) 

*Holy  Cross  Hospital  (B-122) 

Oaklawn,  Morgan  Co,  Tuberculosis 
Sanitorium  ( E-40 ) 

*Passavant  Memorial  Area  Hospital  (B-150) 
JERSEYVILLE  (Jersey) 

^Jersey  Community  Hospital  (F-54) 

JOLIET  (Will) 

t**St.  Joseph  Hospital  (B-429) 

* Silver  Cross  Hospital  (B-271) 

Sunny  Hill  Sanitorium  (E-60) 

KANKAKEE  (Kankakee) 

* Riverside  Hospital  (B-136) 

*St.  Mary’s  Hospital  (B-262) 

KEWANEE  (Henry) 

*Kewanee  Public  Hospital  (B-75) 

*St,  Francis  Hospital  (B-87) 

LA  GRANGE  (Cook) 

**  Community  Memorial  General  Hospital 
(B-223) 

LA  HARPE  (Hancock) 

LaHarpe  Hospital  (B-19) 

LAKE  FOREST  (Lake) 

**Lake  Forest  Hospital  (B-101) 

LASALLE  (LaSalle) 

*St.  Mary’s  Hospital  (B-123) 
LAWRENCEVILLE  (Lawrence) 

* Lawrence  County  Memorial  Hospital  (E-78) 
LIBERTYVILLE  (Lake) 

**Condell  Memorial  Hospital  (B-91) 
LINCOLN  (Logan) 

*Abraham  Lincoln  Memorial  Hospital  (B-154) 
LITCHFIELD  (Montgomery) 

St.  Francis  Hospital  (B-134) 

MACKINAW  (Tazewell) 

Oak  Knoll  Sanitorium  (E-40) 

MACOMB  (McDonough) 

*McDonough  District  Hospital  (F-104) 

St,  Francis  Hospital  (B-60) 

MANTENO  (Kankakee) 

Hillman  Memorial  Hospital  (C-26) 

MARION  (Williamson) 

*Marion  Memorial  Hospital  (D-75) 
MATTOON  (Coles) 

**  Memorial  District  Hospital  of  Coles  County 
(F-99) 

McHENRY  (McHenry) 

**  McHenry  Hospital  (B-43) 

McLEANSBORO  (Hamilton) 

*Hamilton  Memorial  Hospital  (F-32) 
MELROSE  PARK  (Cook) 

**  Gottlieb  Memorial  Hospital  (B-202) 
**Westlake  Community  Hospital  (B-141) 


48-4 


Illinois  Medical  Journal 


MENDOTA  (LaSalle) 

*Mendota  Community  Hospital  (B-58) 
METROPOLIS  (Massac) 

**Massac  Memorial  Hospital  (F-57) 

MOLINE  (Rock  Island) 

**Lutheran  Hospital  (B-270) 

*Moline  Public  Hospital  (D-240) 
MONMOUTH  (Warren) 

*Monmouth  Hospital  (D-81) 

MONTICELLO  (Piatt) 

*The  John  and  Mary  E.  Kirby  Hospital  (B-35) 
MOOSEHEART  (Kane) 

Mooseheart  Hospital  (B-43) 

MORRIS  (Grundy) 

*Morris  Hospital  (B-51) 

MORRISON  (Whiteside) 

*Morrison  Community  Hospital  (F-32) 
MOUNT  CARMEL  (Wabash) 

* Wabash  General  Hospital  District  (F-71) 
MOUNT  VERNON  (Jefferson) 

**Good  Samaritan  Hospital  (B-110) 

Jefferson  County  Memorial  Hospital  (B-50) 
Mt.  Vernon  State  Tuberculosis  Sanitarium 
(1-125) 

MURPHYSBORO  (Jackson) 

*St.  Joseph  Memorial  Hospital  (B-64) 
NAPERVILLE  (DuPage) 

*Edward  Hospital  (F-110) 

NASHVILLE  (Washington) 

* Washington  County  Hospital  (F-36) 
NORMAL  (McLean) 

*Brokaw  Hospital  (B-142) 

NORTHLAKE  (Cook) 

Northlake  Community  Hospital  (B-105) 

OAK  FOREST  (Cook) 

Oak  Forest  Hospital  (E-2,207) 

OAK  LAWN  (Cook) 

**Christ  Community  Hospital  (B-348) 

OAK  PARK  (Cook) 

*Oak  Park  Hospital  (B-246) 

**West  Suburban  Hospital  (B-389) 

OLNEY  (Richland) 

**  Richland  Memorial  Hospital  (E-150) 
OREGON  (Ogle) 

*Warmolts  Clinic  (C-25) 

OTTAWA  (LaSalle) 

Highland  Sanitorium  and  Convalescent  Home 
of  LaSalle  County  (E-19) 

Ottawa  General  Hospital  (C-42) 

**Ryburn  Memorial  Hospital  (D-117) 

PANA  (Christian) 

*Huber  Memorial  Hospital  (B-89) 

PARIS  (Edgar) 

*Hospital  & Medical  Foundation  of  Paris,  Inc. 
(B-66) 

PARK  RIDGE  (Cook) 
t*Lutheran  General  Hospital  (B-326) 

PAXTON  (Ford) 

*Paxton  Community  Hospital  (B-39) 

PEKIN  (Tazewell) 

*Pekin  Memorial  Hospital  (B-181) 


PEORIA  (Peoria) 

t*The  Methodist  Hospital  of  Central  Illinois 
(B-496) 

Peoria  Municiple  Tuberculosis  Sanitarium 
(D-79) 

* Proctor  Community  Hospital  (B-210) 
t**St.  Francis  Hospital  (B-623) 

PERU  (LaSalle) 

* Peoples  Hospital  (B-lOO) 

PINCKNEYVILLE  (Perry) 

* Pinckney  ville  Community  Hospital  ( F-52) 
PITTSFIELD  (Pike) 

*Illini  Community  Hospital  (B-lOO) 
PONTIAC  (Livingston) 

Livingston  County  Sanitorium  (E-46) 

*St.  James  Hospital  (B-65) 

PRINCETON  (Bureau) 

*Perry  Memorial  Hospital  (D-98) 

QUINCY  (Adams) 

**Blessing  Hospital  (B-237) 

Hillcrest,  Adams  County  Tuberculosis 
Sanitorium  (E-38) 
t**St.  Mary’s  Hospital  (B-246) 

RED  BUD  (Randolph) 

*St.  Clement’s  Hospital  (B-84) 

ROBINSON  (Crawford) 

*Crawford  Memorial  Hospital  (F-64) 
ROCHELLE  (Ogle) 

*Rochelle  Community  Hospital  (B-38) 
ROCKFORD  (Winnebago) 

* Rockford  Memorial  Hospital  (B-264) 
Rockford  Municiple  Tuberculosis  Sanitarium 

(D-44) 

*St.  Anthony  Hospital  (B-252) 
f* Swedish- American  Hospital  (B-321) 

ROCK  ISLAND  (Rock  Island) 

Rock  Island  County  Tuberculosis  Sanitorium 
(E-71) 

t**St.  Anthony’s  Hospital  (B-240) 

ROSICLARE  (Hardin) 

>Hardin  County  General  Hospital  (B-27) 
RUSHVILLE  (Schuyler) 

*Sarah  D.  Culbertson  Memorial  Hospital  (F-56) 
ST.  CHARLES  (Kane) 

**Delnor  Hospital  (B-105) 

SALEM  (Marion) 

*Salem  Memorial  Hospital  (B-39) 
SANDWICH  (DeKalb) 

^Sandwich  Community  Hospital  (B-63) 
SAVANNA  (Carroll) 

Savanna  City  Hospital  (D-44) 
SHELBYVILLE  (Shelby) 

*Shelby  County  Memorial  Hospital  (B-79) 
SKOKIE  (Cook) 

*Skokie  Valley  Community  Hospital  (B-153) 
SPARTA  (Randolph) 

*Sparta  Community  Hospital  (F-30) 
SPRINGFIELD  (Sangamon) 
t*Memorial  Hospital  (B-402) 
t**St.  John’s  Hospital  (B-723) 

St.  John’s  Sanitorium  (B-125) 


/or  October,  1968 


485 


SPRING  VALLEY  (Bureau) 

*St.  Margaret’s  Hospital  (B-141) 
STAUNTON  (Macoupin) 

*Community  Memorial  Hospital  (B-62) 
STERLING  (Whiteside) 

**Community  General  Hospital  (D-144) 
Home  Hospital  (B-24) 

STREATOR  (LaSalle) 

**St.  Mary’s  Hospital  (B-233) 

SYCAMORE  (DeKalb) 

*Sycamore  Municipal  Hospital  (D-70) 
TAYLORVILLE  (Christian) 

**St.  Vincent  Memorial  Hospital  (B-155) 
TUSCOLA  (Douglas) 

* Douglas  County  Jarman  Memorial  Hospital 

(E-42) 

URBANA  (Champaign) 

**Carle  Memorial  Hospital  (B-154) 

* McKinley  Memorial  Hospital  (1-62) 
t*Mercy  Hospital  (B-250) 

Outlook  Champaign  County  Tuberculosis 
Sanitorium  ( E-25 ) 

University  of  Illinois  Rehab.  Center  (I) 
VANDALIA  (Fayette) 

*Fayette  County  Hospital  (F-95) 


WATSEKA  (Iroquois) 

*Iroquois  Hospital  (B-72) 

WAUKEGAN  (Lake) 

*Lake  County  General  Hospital  (E-65) 

*Lake  County  Tuberculosis  Sanitorium  (E-90) 
*St.  Therese  Hospital  (B-280) 

* Victory  Memorial  Hospital  (B-352) 
WENDRON  (LaSalle) 

St.  Joseph’s  Health  Resort  and  Sanitarium 
(B-94) 

WEST  FRANKFORT  (Frankhn) 

UMWA  Union  Hospital  (B-38) 

WHITE  HALL  (Greene) 

White  Hall  Hospital,  Inc.  (B-18) 

WINFIELD  (DuPage) 

**Central  DuPage  Hospital  (B-113) 

WOOD  RIVER  (Madison) 

*Wood  River  Township  Hospital  (H-73) 
WOODSTOCK  (McHenry) 

* Memorial  Hospital  for  McHenry  County 

(B-lOO) 

ZION  (Lake) 

*Zion-Benton  Hospital  (C-107) 


HOSPITALS  WITH  SPECIAL  TYPE  OF  SERVICE 


AURORA  (Kane) 

CAIRO  (Alexander) 

CASEYVILLE  (St.  Clair) 
CHICAGO  (Cook) 


DANVILLE  (Vermilion) 


Kane  County  Springbrook 
Sanitarium  (E-57) 

Alexander  County  Tuberculosis 
Hospital  (E-36) 

Pleasant  View  Sanitorium  (E-lOO) 

*Booth  Memorial  Hospital  (B-25) 

^Charles  H.  and  Rachel  M.  Schwab 
Rehabilitation  Hospital  (B-61) 
^Chicago  Eye,  Ear,  Nose  and  Throat 
Hospital  (C-37) 

* Chicago  State  Tuberculosis 

Sanitarium  (1-336) 

*The  Children’s  Memorial 
Hospital  (B-237) 

Halco  Sanitarium,  Inc.  (C-10) 

Illinois  Children’s  Hospital-School  (1-96) 

* Illinois  Eye  and  Ear  Infirmary  (1-124) 
Illinois  Visually  Handicapped 

Institute  (1-52) 

*LaRabida  Jackson  Park 
Sanitarium  (B-104) 

*Martha  Washington  Hospital  (B-50) 

* Municipal  Contagious  Disease  Hospital 

(D-lOO) 

* Municipal  Tuberculosis  Sanitarium 

(D-1,081) 

* Rehabilitation  Institute  of  Chicago  (B-65) 
St.  Vincent’s  Infant  Hospital  (B-65) 

*Shriners  Hospital  for  Crippled 
Children  (B-68) 

Vermilion  County  Tuberculosis 
Dispensary  and  Hospital  (E-34) 


Type  of 
Service 
TB 

TB 

TB 

Maternity 

Rehabilitation 

EENT 

TB 

Pediatric 

Alcoholic 

Rehabilitation, 

Pediatric 

EENT 

Rehabilitation 

Pediatric 

Chronic 

Alcoholic 

Contagious 

Disease 

TB 

Rehabilitation 

Pediatric 

Orthopedic, 

Pediatric 

TB 


486 


Illinois  Medical  Journal 


Hospitals  with  Special  Type  of  Service  (Continued) 


DECATUR  (Macon) 

Macon  County  Tuberculosis 
Sanitorium  (E-75) 

TB 

EDWARDSVILLE  (Madison) 

Madison  County  TB  Sanitorium  (E-87) 

TB 

HINSDALE  (Cook) 

*The  Suburban  Cook  County  Tuberculosis 
Sanitarium  District  (G-206) 

TB 

JACKSONVILLE  (Morgan) 

Oaklawn,  Morgan  County 
Tuberculosis  Sanitorium  (E-40) 

TB 

JOLIET  (Will) 

Sunny  Hill  Sanitorium  (E-60) 

TB 

MACKINAW  (Tazewell) 

Oak  Knoll  Sanitorium  (E-40) 

TB 

MOOSEHEART  (Kane) 

Moosehart  Hospital  (B-43) 

Pediatric 

MOUNT  VERNON  (Jefferson) 

'■'Mount  Vernon  State 

Tuberculosis  Sanitarium  (1-125) 

TB 

OAK  FOREST  (Cook) 

Oak  Forest  Hospital  (E-2,463 ) 

Chronic, 

Rehabilitation 

OTTAWA  (LaSalle) 

Highland  Sanatorium  and  Convalescent 

TB, 

Home  of  LaSalle  County  (E-82) 

Nursing  Home 

* Ottawa  General  Hospital  (C-42) 

Chronic 

PEORIA  (Peoria) 

'"Peoria  Municipal  Tuberculosis 
Sanitarium  (D-79) 

TB 

PONTIAC  (Livingston) 

Livingston  County  Sanitorium  (E-46) 

TB 

QUINCY  (Adams) 

Hillcrest,  Adams  County 

Tuberculosis  Sanitorium  (E-38) 

TB 

ROCKFORD  (Winnebago) 

Rockford  Municipal  Tuberculosis 

TB, 

Sanitarium  (D-lOO) 

Nursing  Home 

ROCK  ISLAND  (Rock  Island) 

'■'Rock  Island  County 

Tuberculosis  Sanitorium  (E-71) 

TB 

SPRINGFIELD  (Sangamon) 

'“'St.  John’s  Sanitorium  (B-125) 

TB 

URBANA  (Champaign) 

Outlook  Champaign  County 
Tuberculosis  Sanitorium  (E-25) 

TB 

University  of  Illinois  Rehabilitation 
Center  (I) 

Rehabilitation 

WAUKEGAN  (Lake) 

*Lake  County  Tuberculosis 
Sanatorium  (E-90) 

TB 

WEDRON  (LaSaUe) 

St.  Joseph’s  Health  Resort 

Medical- 

and  Sanitarium  (B-94) 

Chronic 

STATE  MENTAL  HOSPITALS 


ALTON  (Madison) 

Alton  State  Hospital  (1,371) 

ANNA  (Union) 

Anna  State  Hospital  (1,838) 

CHICAGO  (Cook) 

Chicago  State  Hospital  (2,814) 

■Illinois  State  Psychiatric  Institute  (360) 
DANVILLE  (Vermilion) 

*Veterans  Administration  Hospital  (J-1,680) 
DOWNEY  (Lake) 

* Veterans  Administration  Hospital  (J-2,487) 
EAST  MOLINE  (Rock  Island) 

*East  Moline  State  Hospital  (1,343) 

ELGIN  (Kane) 

Elgin  State  Hospital  (3,910) 


GALESBURG  (Knox) 

*Galesburg  State  Research  Hospital  (1,843) 
JACKSONVILLE  (Morgan) 

* Jacksonville  State  Hospital  (2,002) 
KANKAKEE  (Kankakee) 

*Kankakee  State  Hospital  (2,493) 
MANTENO  (Kankakee) 

Manteno  State  Hospital  (5,841) 

MENARD  (Randolph) 

Illinois  Security  Hospital  (400) 

PEORIA  (Peoria) 

*Peoria  State  Hospital  (1,660) 

TINLEY  PARK  (Cook) 

Tinley  Park  State  Hospital  (480) 


/or  October,  1968 


487 


PRIVATE  MENTAL  HOSPITALS 


AURORA  (Kane) 

*Mercyville  Hospital  (B-160) 
CHICAGO  (Cook) 

*Fairview  Hospital  (C-100) 
^Nicholas  J.  Pritzker  Center  (B-40) 
spinel  Hospital  (B-70) 

* Ridgeway  Hospital  (B-92) 


DBS  PLAINES  (Cook) 

Forest  Hospital  (C-100) 
ELGIN  (Kane) 

*Resthaven  Hospital  (C-100) 
FOREST  PARK  (Cook) 
*Riveredge  (C-160) 
WINNETKA  (Cook) 

* North  Shore  Hospital  (C-100) 


STATE  SCHOOLS  FOR  MENTALLY  DEFECTIVE 


CENTRALIA  (Marion) 

Warren  G.  Murray  Children’s  Center  (558) 
CHICAGO  (Cook) 

^Illinois  State  Pediatric  Institute  (264) 
DIXON  (Lee) 

Dixon  State  School  (3,336) 


DWIGHT  (Livingston) 

William  W.  Fox  Children’s  Center  (250) 
HARRISBURG  (Saline) 

A.  L.  Bowen  Children’s  Center  (240) 
LINCOLN  (Logan) 

Lincoln  State  School  (3,828) 


Identification 

*The  hospitals  marked  with  an  asterisk  (*)  are 
those  which  are  accredited  by  the  Joint  Commis- 
sion on  Accreditation  of  Hospitals  as  of  Jan. 

1,  1968. 

The  presence  of  a hospital  on  this  list  means 
it  has  complied  in  the  main  with  the  standards 
of  the  Joint  Commission  on  Accreditation  of 
Hospitals  as  compiled  over  the  years  by  the 
medical  and  hospital  professions.  The  standards 
are  minimal  and  it  is  hoped  hospitals  will  make 
every  effort  to  exceed  them. 

Hospitals  with  less  than  25  beds  are  not  eligible 
for  accreditation. 

Accredited  hospitals  with  a functioning  utiliza- 
tion review  plan  are  eligible  providers  of  service 
under  Medicare.  Hospitals  ineligible  for  ac- 
creditation or  unable  to  meet  JCAH  requirements 
have  been  especially  surveyed  by  the  Illinois  De- 
partment of  Public  Health  and  virtually  all  have 
been  certified  as  eligible  providers  of  service  under 
Medicare. 

Inquires  about  this  listing  or  hospital  ac- 
creditation should  be  directed  to  the  office  of  the 


of  Hospitals 

Joint  Commission  on  Accreditation  of  Hospitals 
at  645  N.  Michigan  Ave.,  Chicago  60611. 
**Double  asterisk:  approved  to  admit  selected 
gynecological  patients  to  maternity  departments. 
tDagger  indicates  general  hospitals  having  psy- 
chiatric units  licensed  by  the  Illinois  Department 
of  Public  Health.  All  other  mental  facilities  are 
licensed  and/or  operated  by  this  department 
(federal  hospitals  excluded). 

Number  in  parenthesis  indicates  number  of 
beds  in  hospital.  Initial  preceding  number  refers 
to  the  type  of  control,  as  follows: 

A — Corporation 

B — ^Non-profit  association  or  corporation 
C — Privately  owned  and  operated 
D— City 
E — County 
F — Hospital  District 
G — Sanitarium  District 
H — Township 
I — State 
J — Federal 


488 


Illinois  Medical  Journal 


DIRECTORY  OF  LICENSED  HOMES 


The  following  list  of  homes  licensed  by 
the  Illinois  Department  of  Pubhc  Health  (as 
of  August,  1968)  is  divided  into  three  sections: 
nursing  homes,  sheltered  care  homes,  and  homes 
for  the  aged.  Ownership  of  these  homes  may  be 
individual,  partnership,  corporation  for  profit, 
non-profit  corporation,  government,  or  trust-en- 
dowment. 

A Nursing  Home  is  equipped  and  staffed  to 
provide  personal  and  nursing  care  to  all  resi- 
dents. 

A Sheltered  Care  Home  is  equipped  and  staffed 


to  provide  only  personal  services  such  as  assistance 
with  meals,  dressing,  bathing,  etc.,  but  not  nurs- 
ing care. 

A Home  for  the  Aged  is  operated  not-for- 
profit  under  rehgious  or  fraternal  auspices  or  un- 
der an  endowment.  It  is  operated  primarily  for 
persons  over  60  years  of  age  and  may  provide 
personal  care  only  or  nursing  and  personal  care. 
Some  of  these  homes  for  the  aged  provide  spe- 
cial services  over  and  above  nursing  care. 

Figure  in  parentheses  indicates  number  of  beds. 


NURSING  HOMES 


ABINGDON  (Knox  Cotmty) 

Abingdon  Nursing  Home  (74) 

W.  Martin  St. 

ALBION  (Edwards  County) 

Rest  Haven  Manor  (49) 

120  W.  Main  St. 

ALEDO  (Mercer  County) 

Mercer  County  Nursing  Home  (62) 

Rt.  4 

Oakview  Nursing  Home  (49) 

3rd  Ave.  and  12th  St. 

Twilight  Haven  (14) 

303  E.  Seventh  St. 

ALHAMBRA  (Madison  County) 

Haven  of  Rest  (19) 

ALTON  (Madison  County) 

College  Avenue  Nursing  Home  (19) 

920  College  Ave. 

Eunice  C.  Smith  Nursing  Home  (64) 

1251  College  Ave. 

Main  Street  Nursing  Home  (40) 

1216  Main  St. 

Riverview  Nursing  Home  (23) 

440  Jefferson  St. 

Villa  Terrace  Convalescent  Home  (26) 
510  Seminary  Sq. 

Yinger  Nursing  and  Convalescent 
Center,  Inc.  (55) 

2349  Virden  Dr. 

AMBOY  (Lee  County) 

Forman  Nursing  Home  (18) 

339  N.  Mason  Ave. 

ANNA  (Union  County) 

Union  County  Skilled  Nursing  Home  (60) 
517  N.  Main  St. 

ARCOLA  (Douglas  County) 

Fishel  Nursing  Home  (26) 

129  N.  Pine  St. 

ARLINGTON  HEIGHTS  (Cook  County) 
Arlington  Heights  Rest  Home  (40) 

414  N.  Van  St. 

AROMA  PARK  (Kankakee  County) 
Campbell  Nursing  Home  (32) 

Fourth  St. 

ARROWSMITH  (McLean  County) 

DeArms  Nursing  Home  (15) 

W.  Crosson  St. 


ARTHUR  (Moultrie  County) 

The  Arthur  Home  (42) 

423  Eberhardt  Dr. 

ATLANTA  (Logan  County) 

Atlanta  Nursing  Home  (16) 

Chatham  St. 

Bartmann  Nursing  Home  (30) 

R.  R.  1 

AUBURN  (Sangamon  County) 

Parks  Home  (54) 

304  Maple  St. 

AUGUSTA  (Hancock  County) 

Augusta  Nursing  Home  (18) 

E.  Main  St. 

AURORA  (Kane  County) 

Aurora  Borealis  Nursing  Center  (112) 
1601  N.  Farnsworth  Ave. 

Colonial  Nursing  Home  (19) 

422  N.  Lake 

Elmwood  Nursing  Home  (49) 

1017  W.  Galena  Blvd. 

AVON  (Warren  County) 

Avon  Nursing  Home,  Inc.  (48) 

BARRINGTON  (Cook  County) 
Barrington  Rest  Home,  Inc.  (50) 

145  W.  Main  St. 

BARRY  (Pike  County) 

Barry  Nursing  Home  (28) 

780  Grand  St. 

Churchill  Nursing  Home  (21) 

1038  Pratt  St. 

BATAVIA  (Kane  County) 

Kane  County  Home  (99) 

Averill  Rd. 

BEARDSTOWN  (Cass  County) 

Boyd  Nursing  Home,  Inc.  (41) 

209-215  W.  Third  St. 

Brierly  House  Nursing  Home,  Inc.  (34) 
604  State  St. 

Elmwood  Manor  (49) 

13th  & Grand  Ave. 

Parkview  Nursing  Home  (29) 

903  E.  Third  St. 

BEAVERVILLE  (Iroquois  County) 
Haven  of  Rest  Nursing  Home  (44) 


for  October,  1968 


489 


BELLEVILLE  (St.  Clair  County) 

Atkinson  Nursing  Home  (25) 

514  S.  Jackson  St. 

Herald  Nursing  Home  (24) 

506  Court  St. 

Hillcrest  Convalescent  Home  (24) 

420  Mascoutah  Ave. 

Memorial  Nursing  Home  (111) 

4315  Memorial  Dr. 

Rest  Haven  Old  Folks  Home  (36) 

44th  St.  and  N.  Belt  West 
St.  Elizabeth’s  Home  (72) 

211  S.  Third  St. 

BELLWOOD  (Cook  County) 

Elizabeth  Van  Gehr  Nursing  Home  (16) 

209  S.  22nd  Ave. 

BELVIDERE  (Boone  County) 

Maple  Crest  Nursing  Home  (48) 

Boone  County  Home 

R. R.  1,  Rt.  76 

Sutton’s  Nursing  Home  (34) 

226  N.  State  St. 

BEMENT  (Piatt  County) 

Bement  Rest  Haven  (27) 

101  S.  Sangamon  St. 

BENTON  (Franklin  County) 

Franklin  Hospital  Skilled  Nursing  Care  Unit 
(82) 

201  Bailey  Ln. 

Linwood  Nursing  Home,  Inc.  (30) 

N.  Main  and  Mitchell  Sts. 

Rest  Haven  Nursing  Home  (28) 

418  W.  Webster 
BERWYN  (Cook  County) 

Fairfax  Geriatric  & Convalescent  Center  (106) 
3601  S.  Harlem  Ave. 

Pershing  Convalescent  Home  (63) 

3900  S.  Oak  Park  Ave. 

R.  N.  Convalescent  Home  (51) 

6918  Windsor  Ave. 

BLANDINSVILLE  (McDonough  County) 
Newland  Nursing  Home  (42) 

Van  Buren  and  Breckenridge 
BLOOMINGDALE  (DuPage  County) 

Elaine  Boyd  Creche  (98) 

267  E.  Lake  St. 

Mark  Lund  Hilltop,  Inc.  (65) 

158  Prairie  St. 

BLOOMINGTON  (McLean  County) 

Heritage  Manor  (99) 

Walnut  at  Clinton  Blvd. 

Maple  Grove  Nursing  Home  (86) 

S.  Main  Street  Rd. 

Nel-Dor  Arms  Nursing  Home  (32) 

1116  E.  Lafayette  St. 

BLUE  ISLAND  (Cook  County) 

Bel -Air  Nursing  Home  (28) 

2418  W.  127th  St. 

Blue  Island  Nursing  Home  (35) 

2427  W.  127th  St. 


Burr  Oaks  Nursing  & Convalescent  Center  (38) 
2426  W.  Burr  Oaks  Ave. 

BLUFORD  (Jefferson  County) 

Schumm  Nursing  Home  (38) 

BRADLEY  (Kankakee  County) 

The  Hallmark  House  (98) 

700  N.  Kinsie,  Rt.  54 

BROOKFIELD  (Cook  County) 

Brookfield  Nursing  & Convalescent  Home  (21) 
9128  W.  31st  St. 

Hill  Haven  Nursing  Home  (13) 

4548  Deyo 

BUNKER  HILL  (Macoupin  County) 

Tower  View  Nursing  Home  No.  1 (37) 

403  Morgan  St. 

BURNHAM  (Cook  County) 

The  Homestead  (96) 

14500  Manistee  Ave. 

BUSHNELL  (McDonough  County) 

The  Elms  (40) 

McDonough  County  Home 
Heron  Nursing  Home  (30) 

708  N.  Dean  St. 

CAMP  POINT  (Adams  County) 

Grandview  Manor,  Inc.  (49) 

205  E.  Spring  St. 

CANTON  (Fulton  County) 

Canton  Nursing  Home,  Inc.  (33) 

N.  Main  St. 

Sherwood  Nursing  Home  (31) 

914  S.  Main  St. 

CARBONDALE  (Jackson  County) 

Styrest  Nursing  Home  (104) 

Rt.  4 on  Tower  Rd. 

CARLINVILLE  (Macoupin  County) 

Joiner  Nursing  Home  (35) 

706  N.  Oak  St. 

Lake  View  Nursing  Home  (74) 

R.R.  3 

Lee  Nursing  Home  (10) 

334  Orient  St. 

Macoupin  County  Nursing  Home  (98) 

R.R.  2 

Scherba’s  Nursing  Home  (16) 

817  N.  High  St. 

Weatherford  Nursing  Home  (85) 

318  Buchanan  St. 

Woodlawn  Acres  Convalescent  and 
Nursing  Home  (26) 

W.  Hard  Rd.,  State  Rt.  108 

CARMI  (White  County) 

White  County  Nursing  Home  (90) 

R.R.  3 

Wilmar  Restorium,  Inc.  (85) 

College  Blvd. 

CARROLLTON  (Greene  County) 

Tower  View  Nursing  Home  No.  2 (26) 

626  Maple  Ave. 


490 


Illinois  Medical  Journal 


CASEY  (Clark  County) 

Casey  Nursing  Home  (92) 

N.  10th  St. 

Rude’s  Goodwill  Home  (22) 

208  W.  Main  St. 

CASEYVILLE  (St.  Clair  County) 

Caseyville  Nursing  Home  (31) 

321  O’Fallon  St. 

CENTRALIA  (Marion  County) 

Centralia  Fireside  House,  Inc.  (92) 

1030  E.  McCord  St. 

CHAMPAIGN  (Champaign  County) 

American  Manor  Convalescent  Home  (26) 
1002  W.  Church  St. 

Greenbrier  Manor  (126) 

1915  S.  Mattis 

Leonard  Nursing  Home,  Inc.  (21) 

618  W.  Church 
OUver  Nursing  Home  (22) 

1102  W.  Church  St. 

CHARLESTON  (Coles  County) 

Adkins  Nursing  Home  (29) 

849  C St. 

Charleston  Nursing  Home  (24) 

216  Fifth  St. 

Hillcrest  Nursing  Home,  Inc.  (49) 

635  Division  St. 

Hilltop  Nursing  Home,  Inc.  (72) 

910  W.  Polk  St. 

Oakwood  Convalescent  Home  (28) 

1041  Seventh  St. 

Rennel’s  Nursing  Home  (15) 

214  Fifth  St. 

CHERRY  VALLEY  (Winnebago  County) 
Cherry  Valley  Rest  Home  (35) 

Box  123 

CHESTER  (Randolph  County) 

Three  Springs  Lodge  (63) 

R.R.  1 

CHICAGO  (Cook  County) 

A-1  Nursing  Home,  Inc.  (43) 

4247  N.  Hazel 
A-1  Nursing  Home,  Inc.  (8) 

4249  N.  Hazel 
Addison  Manor,  Inc.  (40) 

3526  N.  Reta  Ave. 

Albany  Park  Kosher  Nursing  Home,  Inc.  (30) 
3418  W.  Ainslie 

All  American  Nursing  Home  (144) 

5440-52  N.  Broadway 
Alshore  House  (53) 

2840  Foster  Ave. 

Anna  Hadley  Nursing  Home  (29) 

3209  W.  Douglas  Blvd. 

Arthur  W.  Devermann  Residence  (16) 

5746  N.  Sheridan  Rd. 

Austin  Congress  Nursing  Home  (136) 

901  S.  Austin  Blvd. 

Beach  view  Convalescent  Home,  Inc.  (47) 

6345  N.  Sheridan  Rd. 

Beacon  Hill  Nursing  Home  (33) 

4530  N.  Beacon  St. 


Beckwith  Nursing  Home  (36) 

3240  W.  Washington  Blvd. 

Bell  Nursing  Home  (28) 

11079  S.  Bell  Ave. 

Belmont  Rest  Home,  Inc.  (55) 

1936  W.  Belmont 

Beverly  Hills  Nursing  Home  (32) 

10347  Longwood  Dr. 

Birchwood  Beach  Convalescent  Home 
No.  1 (39) 

7350  N.  Sheridan  Rd. 

Birchwood  Beach  Convalescent  Home 
No.  2 (32) 

7364  N.  Sheridan  Rd. 

Bym  Mawr  House,  Inc.  (183) 

6141  N.  Pulaski  Rd. 

Burke  Nursing  Home  (10) 

11840  S.  Western  Ave. 

Burnside  Rest  Home  (49) 

9435  Langley  Ave. 

Carmen  Manor  (114) 

1470  W.  Carmen  Ave. 

Colonial  Towers  Nursing  Home  (30) 
6032  Kenmore  Ave.  North 

Davis  Nursing  Home,  Inc.  (85) 

725-29  Waveland  Ave. 

Dearborn  House,  Inc.  (128) 

2400  S.  Dearborn  St. 

Douglas  Park  Nursing  Home  (40) 
1518-22  S.  Albany  Ave. 

Doyle  Nursing  Convalescent  Home  (35) 
9624-32  S.  Vincinnes  Ave. 

Edgewater  Manor  (42) 

5838  N.  Sheridan  Rd. 

Elizabeth  Olivia  Home  (49) 

3952  S.  Ellis  Ave. 

Elsa  S.  Long  Convalescent  Home  (46) 
5250-5256  N.  Sheridan  Rd. 

Elston  Home,  Inc.  (114) 

4340  N.  Keystone  Ave. 

Englewood  Rest  Haven,  Inc.  (26) 

7253  Yale  Ave. 

Fargo  Beach  Home,  Inc.  (143) 

7445  N.  Sheridan  Rd. 

Farwell  Beach  Convalescent  Home  (27) 
1145  W.  Farwell  Ave. 

Feinstein’s  Rest  Home,  Inc.  (27) 

5960  N.  Sheridan  Rd. 

Fountainebleau  Manor,  Inc.  (60) 

6318  N.  Winthrop  Ave. 

Fox  River  Pavilion  (74) 

4700  N.  Clarendon  Ave. 

Fullerton  Convalescent  Home,  Inc.  (132) 
1400  W.  Monroe  St. 

Garden  View  Home,  Inc.  (130) 

6450  N.  Ridge  Ave. 

Garfield  Nursing  Home  (28) 

3834  W.  Washington  Blvd. 

Granville  Manor  (45) 

1021  Granville  Ave. 

Hampden  Manor  (40) 

2724  N.  Hampton  Ct. 


for  October,  196S 


491 


Harmon-Bragg  Nursing  Home,  Inc., 

No.  1 (25) 

6455  S.  Kimbark  Avc. 

Harmon-Bragg  Nursing  Home,  Inc., 

No.  2 (36) 

6463  S.  Kimbark  Ave. 

Hastings  Nursing  Home  (14) 

7241  S.  Princeton  Ave. 

Hearlhside  Nursing  Home,  Inc.  (73) 

1223  W.  87th  St. 

Hollywood  Convalescent  Home,  Inc.  (45) 
1054  W.  Hollywood  Avc. 

Howard  Convalescent  Home,  Inc.  (32) 
6522  S.  Harvard  Ave. 

Ivory  Nursing  Home,  Inc.  (39) 

5839  S.  Calumet  Avc. 

Johnson  Nursing  Home,  Inc.  (41) 

3321  W.  Fulton  St. 

Johnson  Rehabilitation  Nursing  Home,  Inc. 
(76) 

3456  W.  Franklin  Blvd. 

Kcnmorc  House  (109) 

5517  N.  Kenmore  Ave. 

Ken-Rose  Rest  Home  (44) 

6255  N.  Kenmore  Ave. 

Kostner  Manor  (119) 

1617  N.  Kostner  Ave. 

Lake  Shore  Nursing  Home,  Inc.  (27) 

7230  N.  Sheridan  Rd. 

Lakeside  Nursing  Home  (24) 

6330  N.  Sheridan  Rd. 

Lake  View  Manor  Rest  Home  (42) 

2824  N.  Sheridan  Rd. 

Lchrcr  Nursing  Home,  Inc.  (40) 

4636  N.  Beacon  St. 

Lincoln  Park  Home  (33) 

2042  N.  Orleans  St. 

Linderman  Nursing  Home,  Inc.  (25) 

3311  W.  Monroe  St. 

Malden  Nursing  Home,  Inc.  (26) 

4616  N.  Malden  Ave. 

Maple  Nursing  Home  (10) 

4743  W.  Washington  St. 

Mark  Howard  Home  (93) 

4938  S.  Drexel  Blvd. 

Martha  Washington  Manor,  Inc.  (99) 

4515  S.  Drexel  Blvd. 

Melbourne  Convalescent  Home  (188) 

4625  N.  Racine  Ave. 

Midwest  Rest  Haven,  Inc.  (32) 

3 10  S.  Hamlin  Ave. 

Miller  Nursing  Home  (46) 

3256  W.  Douglas  Blvd. 

Misericordia  Home  (136) 

2916  W.  47th  St. 

Monterey  Convalescent  Home  (56) 

4616  S.  Drexel  Blvd. 

Monterey  Convalescent  Home  (62) 

1919  S.  Prairie  Ave. 

Montgomery  Convalescent  Home  (80) 

5956  S.  Wabash  Ave. 

Mortkowicz  Kosher  Nursing  Home  (20) 


485 1 N.  Rockwell  Ave. 

Mt.  Pisgah  Nursing  Home  (49) 

4220-28  S.  Champlain  Ave. 

Nesbitt  Home  (34) 

943  W.  Foster  Ave. 

North  Shore  Rest  Haven,  Inc.  (49) 

7428  N.  Rogers  Ave. 

Ogden  Park  Convalescent  Home  (60) 
6617-25  S.  Racine  Ave. 

Panenka  Nursing  Home  (25) 

1901  S.  Lawndale  Ave. 

Park  House  (86) 

2320  S.  Lawndale  Ave. 

Patterson  Convalescent  Home  (32) 

3242  W.  Maypole  Ave. 

Pedraza  Nursing  Home,  Inc.  (31) 

3230  W.  Washington  St. 

Pedraza  Nursing  Home,  Inc.  (19) 

3234  W.  Washington  St. 

Peyton  Convelascent  Home  (44) 

4541  S.  Michigan  Ave. 

Rabbi  Meisels  Convalescent  Home,  Inc.  (49) 
4900  N.  Bernard  Ave. 

Ridge  Manor  Convalescent  Home  (35) 

5888  N.  Ridge  Ave. 

Rosewood  Terrace  Rest  Home,  Inc.  (69) 
6668  N.  Damen  Ave. 

Royal  Manor  (28) 

5640  N.  Sheridan  Rd. 

St.  Michael’s  Rest  Haven,  Inc.  (43) 

4815  S.  Drexel  Blvd. 

Schiller  Rest  Home,  Inc.  (30) 

1428  W.  Jarvis 

Sheridan  Gardens  Convalescent  Home,  Inc. 

(99) 

1426  W.  Birch  wood  Ave. 

Shorecrest  Convalescent  Home,  Inc.  (35) 
7331  N.  Sheridan  Rd. 

Shore  View  Manor  Convalescent  Home,  Inc. 
(31) 

2719  E.  75th  St. 

South  Shore  Kosher  Rest  Home,  Inc.  (Ill) 
7325  S.  Exchange  Ave. 

South  Shore  Pavilion  (113) 

7750  South  Shore  Dr. 

The  Sovereign  Home  (55) 

6159  N.  Kenmore  Ave. 

Stern’s  Convalescent  Home,  Inc.  (37) 

730  Waveland  St. 

Stewart  Nursing  Home,  Inc.  (23) 

6710  Stewart  Ave. 

Sunnyside  Nursing  Home  (47) 

4537  N.  Greenview  Ave. 

Sunset  Nursing  Home,  Inc.  (192) 

7270  South  Shore  Dr. 

Thorndale  Manor  (41) 

1020  W.  Thorndale  Ave. 

Uptown  Convalescent  Home  (55) 

4646  N.  Beacon  St. 

Vincinnes  Manor,  Inc.  (305) 

4724  Vincinnes  Ave. 

Wellington  Plaza  (91) 


492 


Illinois  Medical  Journal 


504  W.  Wellington  Ave. 

Wendt  Nursing  Home  (33) 

5914  N.  Sheridan  Rd. 

West  Side  Nursing  Home,  Inc.  (36) 

1900  S.  Kedzie  Ave. 

Westwood  Manor,  Inc.  (115) 

2444  W.  Touhy  Ave. 

Whitehall  Convalescent  and  Nursing 
Home,  Inc.  (91) 

1901  N.  Lincoln  Park  West 
Wincrest  Nursing  Home,  Inc.  (49) 

6326  N.  Winthrop  Ave. 

Winston  Manor  Convalescent  and  Nursing 
Home,  Inc.  (178) 

2155  W.  Pierce  Ave. 

Wrightwood  Nursing  Home,  Inc.  (90) 

2732  Hampden  Ct. 

CHICAGO  HEIGHTS  (Cook  County) 

Bel-Air  Nursing  Home  No.  2 (21) 

309  W.  16th  St. 

Riviera  Manor  Nursing  Home,  Inc.  (110) 

490  W.  16th  PI. 

CHILLICOTHE  (Peoria  County) 

Parkhill  Nursing  Home  (66) 

P.O.  Box  259 

CLINTON  (DeWitt  County) 

Crest  View  Nursing  Home,  Inc.  (48) 

U.  S.  Hwy.  51  N. 

DeWitt  County  Nursing  Home  (42) 

R. R.  1 

Pine  Crest  Nursing  Home  (41) 

North  Center  Limits 
COAL  VALLEY  (Rock  Island  County) 

Oak  Glen  Nursing  Home  (286) 
COLCHESTER  (McDonough  County) 

Helton  Nursing  Home  (15) 

East  St. 

COLLINSVILLE  (Madison  County) 

Pleasant  Rest  Nursing  Home  (89) 

614  Summit 

CREAL  SPRINGS  (Williamson  County) 

Creal  Springs  Nursing  Home  (45) 

S.  Line  St. 

CRESTWOOD  (Cook  County) 

Rest  Haven  Uliana  Christian 

Convalescent  Home,  Inc.  (99) 

13259  S.  Central  Ave.,  (P.O.  Palos  Heights) 
CRETE  (Will  County) 

Skylane  Acres  (10) 

Rt.  1,  Box  359-20 
DANVILLE  (Vermilion  County) 

Colonial  Manor,  Inc.  (55) 

629  Warrington  Ave. 

Danville  Care,  Inc.  (98) 

1701  N.  Bowman  Ave. 

Danville  Care,  Inc.  North  (72) 

1715  N.  Bowman  Ave. 

Margenette  (31) 

503  W.  North  St. 

Nance  Nursing  Home  (14) 

622  Bryan  Ave. 

Vermilion  County  Nursing  Home  (191) 


R.R.  1,  Box  13 

DECATUR  (Macon  County) 

American  Nursing  Center  of  Decatur  (95) 
444  W.  Harrison  St. 

Lakeshore  Manor  (77) 

1293  S.  34th  St. 

Mabel’s  Nursing  Home  (29) 

820  W.  North  St. 

Macon  County  Tuberculosis  Sanitorium 
& Nursing  Home  (34) 

400  W.  Hay 
Mary  Ann’s  (28) 

640  W.  Main  St. 

Muirheid  Nursing  Home  (20) 

23 1 E.  Condit  St. 

Muirheid’s  Nightingale  Manor  (21) 

805  E.  Johns  Ave. 

Strong’s  Nursing  Home  (18) 

936  N.  Church  St. 

Wakefield  Aged  Retreat  Home  (22) 

1504  N.  Water  St. 

Wakefield  Rest  Home  (26) 

800  W.  McKinley  Ave. 

West  View  Nursing  Home  (19) 

628  W.  Main  St. 

DeKALB  (DeKalb  County) 

DeKalb  County  Nursing  Home  (136) 
Sycamore  Rd.,  R.R.  23 
Pine  Acres  Retirement  Center  (60) 

1212  S.  Second  St. 

DESPLAINES  (Cook  County) 

Brookwood  Convalescent  Center,  Inc.  (Ill) 
Lyman  and  Dempster  Sts. 

Des  Plaines  Convalescent  Home  (28) 

866  Lee  St. 

Golf  Road  Pavilion  (142) 

9555  W.  Golf  Rd. 

Graceland  Home  of  DesPlaines,  Inc.  (41) 
545  Graceland  Ave. 

DIXMOOR  (Cook  County) 

Starnes  Nursing  Home  (39) 

14434  S.  Hoyne  Ave. 

DIXON  (Lee  County) 

Lee  County  Nursing  Home  (84) 

R.R.  4 

Orchard  Glen,  Inc.  (58) 

141  N.  Court  St. 

DOLTON  (Cook  County) 

Sandra  Memorial  Nursing  and  Convalescent 
Home  (61) 

14325  S.  Blackstone  Ave. 

DOWNER’S  GROVE  (DuPage  County) 
Highland  House  Nursing  Home,  Iiic.  (62) 
35th  St.  and  Highland  Ave. 

DUNDEE  (Kane  County) 

Bowes  Nursing  Home  (49) 

305  Oregon  St. 

Gregg  Nursing  Home  (31) 

417  E.  Hill  St. 

DUQUOIN  (Perry  County) 

Fair  Acres  Nursing  Home  (76) 

Jackson  and  Madison  Sts. 


for  October,  1968 


493 


DURAND  (Winnebago  County) 

Medina  Nursing  Center  (66) 

P.O.  Box  538 

EAST  ST.  LOUIS  (St.  Clair  County) 

Carr  Nursing  Home  (47) 

3110  Bond  Ave. 

Fletcher  Ann  Convalescent  Home  (38) 
2640  St.  Louis  Ave. 

Lively  Nursing  Home  (32) 

1303  Baugh  Ave. 

EDWARDSVILLE  (Madison  County) 
Anna-Henry  Nursing  Home  (84) 

637  Hillsboro 

Madison  County  Nursing  Home  (59) 

Main  St. 

EFFINGHAM  (Effingham  County) 

Marks  Nursing  Home  (20) 

406  E.  Jefferson 
Rollin  Hills  Rest  Home  (96) 

Rollin  Hills  Subdivision 

ELDORADO  (Saline  County) 

Eldorado  Nursing  Home,  Inc.  (49) 

Third  and  Locust  Sts. 

Good  Shepherd  Nursing  Home  No.  1 (61) 
First  and  Jasper  Sts. 

ELGIN  (Cook  County) 

Little  Angels  (45) 

Rt.  3,  Box  201A,  Rt.  58 

ELGIN  (Kane  County) 

Daybreak  Home  (27) 

420  Douglas  Ave. 

Elgin-Bowes  Nursing  Home  (49) 

105  N.  Gifford  St. 

Hillcrest  Convalescent  Home,  Inc.  (26) 

4 N.  Jackson  St. 

Isabelle  Home  (18) 

104  S.  State  St. 

Mary  Margaret  Manor  (94) 

134  N.  McLean  Blvd. 

Oliver  Nursing  Home,  Inc.  (25) 

325  Watch  St. 

Raloff  Nursing  Home  (10) 

316  Division  St. 

Simpson  House,  Ltd.  (67) 

170  S.  State  St. 

ELMHURST  (DuPage  County) 

Elmhurst  Nursing  Home  (42) 

200  E.  Lake  St. 

ELMWOOD  (Peoria  County) 

Elm  Haven,  Inc.  (75) 

EL  PASO  (Woodford  County) 

Lewis  Nursing  Home,  Inc.  (17) 

487  Elmwood  Ct. 

McDaniel  Nursing  Home  (33) 

404  E.  First  St. 

EVANSTON  (Cook  County) 

Broad  Nursing  Home  (25) 

2001  Orrington  Ave. 

Broad  Nursing  Home  (23) 

1 840  Asbury  Ave. 

Dobson  Plaza,  Inc.  (52) 

120  Dodge  Ave. 


Evanston  Convalescent  Center,  Inc.  (65) 

1300  Oak  Ave. 

Klingler  Nursing  Home  (5) 

2306  Ridge  Ave. 

Pembridge  House,  Inc.  (96) 

1406  Chicago  Ave. 

Ridge  Crest  Home  (21) 

1708  Ridge  Ave. 

Three  Oaks  Nursing  Center  (124) 

500  Asbury  Ave. 

EVERGREEN  PARK  (Cook  County) 

Bel  Air  Nursing  Home  (20) 

9307  S.  Crawford  Ave. 

Evergreen  Gardens,  Inc.  (162) 

9125  S.  Crawford  Ave. 

Evergreen  Manor  Nursing  Home  (22) 

3327  W.  95th  St. 

Gunderson’s  Convalescent  & Nursing 
Home  (17) 

2701  W.  95th  St. 

Peace  Memorial  Home  (160) 

10124  S.  Kedzie  Ave. 

FAIRBURY  (Livingston  County) 

Helen  Lewis  Smith  Pavilion  (23) 

519  S.  Sixth  St. 

FARMER  CITY  (DeWitt  County) 

Farmer  City  Nursing  Home,  Inc.  (22) 

326  Clinton  Ave. 

Jackson  Heights  Nursing  Home  (49) 
Brookview  Dr.  and  Crabtree  Ct. 

FLORA  (Clay  County) 

Raber  Nursing  Home  (28) 

402  E.  Fourth  St. 

FREEBURG  (St.  Clair  County) 

Marian  Nursing  Home  (17) 

406  State  St. 

FREEPORT  (Stephenson  County) 

Benjamin  Stephenson  Nursing  Home  (56) 
Walnut  Rd. 

Crestview  Manor,  Inc.  (42) 

565  N.  Turner  Ave. 

Van  Buren  Nursing  Home  (20) 

503  N.  Van  Buren 

FULTON  (Whiteside  County) 

Harbor  Crest  Home,  Inc.  (49) 

810  E.  17th  St. 

GALATIA  (Saline  County) 

Good  Shepherd  Nursing  Home  No.  2 (45) 
Main  and  Cross  Sts. 

GALENA  (Jo  Daviess  County) 

Sunny  Hill  Nursing  Home  (32) 

513  Bouthillier  St. 

GALESBURG  (Knox  County) 

Americana  Nursing  Center  of  Galesburg  (67) 
270  E.  Losey  at  Kellogg 
Campbell  Nursing  Home  (16) 

731  N.  Seminary 
Harvey  Nursing  Home  (19) 

774  N.  Broad  St. 

Powell  Nursing  Home  (17) 

620  S.  Academy 
Schrader  Nursing  Home  (17) 


494 


Illinois  Medical  Journal 


490  N.  Cherry 

GENESEO  (Henry  County) 

Wright  Nursing  Home  (28) 

426  W.  First  St. 

Heniy  County  Convalescent  Home  (126) 
R.R.  4 

GENEVA  (Kane  Cotmty) 

Anna  Baum  Home  (36) 

115  Campbell  St. 

GENOA  (DeKalb  County) 

Villa  Nursing  Home  (30) 

121  Main  St. 

GffiSON  CITY  (Ford  County) 

Gibson  Community'  Hospital  Annex  (40) 
430  E.  19th  St.' 

Gibson  Manor,  Inc.  (47) 

525  Hazel  Dr. 

GBLLFSPIE  (Macoupin  County) 

Tower  View  Nursing  Home  No.  3 (8) 
703  S.  Second  St. 

GLEN  ELLYN  (DuPage  County) 

Manor  Convalescent  Home,  Inc.  (49) 

818  DuPage  Rd. 

GLENVIEW  (Cook  County) 

Golf  Mill  Nursing  Home,  Inc.  (37) 

77  Greenwood  Ave. 

Whitehaven  Acres,  Inc.  (32) 

Greenwood  Ave.  and  Melody  Ln. 

GODFREY  (Madison  County) 

Blu-Fountain  Manor,  Inc.  (75) 

Rt.  100 

GRANITE  CITY  (Madison  County) 

The  Colonnades  (82) 

1 Colonial  Dr. 

GRAYVELLE  (White  County) 

Baldwin  Nursing  Home,  Inc.  (54) 

305  W.  North  St 

GREENTIELD  (Greene  County) 

Cedar  KnoU  Nursing  and  Convalescent 
Home  (29) 

711  Bluff  St. 

GREENWILLE  (Bond  County) 

Bourgeois  Nursing  Home,  Inc.  (32) 

100  W.  College  St 

GRIDLEY  (McLean  County) 

Dowell  Nursing  Home  (21) 

202  W.  Sixth  St. 

HAMPSHIRE  (Kane  County) 

Hampshire  Nursing  Home  (64) 

Jackson  and  Warner  Sts. 

Lydia  Nursing  Home  (20) 

25  W.  Jackson  St. 

H.\RDIN  (Calhoim  County  ) 

Sunrise  Nursing  Home  (20) 

R.R.  2 

H.\RRISBLTRG  (Saline  County) 

Bacons  Nursing  Home,  Inc.  (21) 

Box  269,  N.  Granger  St 
Countrv  Club  Manor  (68) 
lOOO'  W.  Sloan 

R\RVARD  (McHemy  County) 

Harvard  Rest  Home  (44) 


210  E.  Front  St. 

HARVEY  (Cook  County) 

Heather  Manor  Convalescent  Center  (49) 
15600  S.  Honore  Ave. 

HAVANA  (Mason  County) 

Havana  Nmsing  Home  (43) 

224  W.  Mound  St. 

Reid  Nursing  Home,  Inc.  (36) 

121  S.  Orange  St. 

HERRIN  (WUliamson  County) 

Hampton  Nursing  Home  (30) 

321  S.  14th  St 

Mattingly  Nursing  Home,  Inc.  (34) 

920  s"  14th  St 

HICKORY  HILLS  (Cook  County) 

Villa  Marie  Nursing  Home,  Inc.  (78) 
9246  S.  Roberts  Rd.,  (P.O.  Oak  Lawn) 

HIGHLAND  (Madison  County) 

Helvetia  Nursing  Home  (49) 

2510  Lemon  Street  Rd. 

Miles  Nursing  Home  (26) 

817  Ninth  St 

HIGHLAND  PARK  (Lake  County) 

Abbott  House  (65) 

405  Central  Ave. 

HIGHWOOD  (Lake  County) 

Pavilion  of  Highland  Park  (59) 

50  Pleasant  Ave. 

HILLSBORO  (Montgomery  County) 
Hillsboro  Nursing  Home  (51) 

624  S.  Main  St 

HILLSIDE  (Cook  County) 

Oakridge  Convalescent  Home  (42) 

323  Oakridge  Ave. 

HINSDALE  (DuPage  County  ) 

Oaks  Nursing  Home  (49) 

Rt.  83  and  91st  St 
Shank  Rest  Home  (31) 

525  W.  Ogden  Ave. 

HOPED  ALE  (TazeweU  County) 

Hopedale  Nursing  Home  (86) 

Second  St. 

INA  (Jefferson  Cotmty') 

Underwood  Ntu^ing  Home  (15) 

3 Elm  St 

IRVING  (Montgomery’  Cotmty) 

Rest  Haven,  Inc.  (30) 

JACKSONVILLE  (Morgan  County) 

Lasley  Nursing  Home  (20) 

844  W.  (2oiiege  Ave. 

Meline  Nursing  Center  (90) 

1024  W'.  W'alnut  St. 

Modem  Care  Convalescent  and  Nursing 
Home  (40) 

1500  W.  Walnut  St. 

JERSE^ATLLE  (Jersey  County) 

Garnet  Nursing  Home  (37) 

602  W.  Pearl  St. 

Green  Lawn  Nursing  Home  (35) 

518  S.  Slate  St. 

Waters  Nursing  Home  (21) 

408  N.  Giddings  St. 


for  October j 1968 


495 


JOLIET  (Will  County) 

Americana  Nursing  Center  of  Joliet  (92) 

300  N.  Madison 
Broadway  Nursing  Home  (70) 

216  N.  Broadway 
LeSan  Nursing  Home  (25) 

601  Campbell  St. 

Lincoln  Nursing  Home  (86) 

611  E.  Cass  St. 

Pleasant  Center  Nursing  Home  (38) 

5 S.  Center  St. 

Sunny  Hill  Nursing  Home  (41) 

501  Ella  Ave. 

KANKAKEE  (Kankakee  County) 

Americana  Nursing  Center  of  Kankakee  (92) 
900  W.  River  PI. 

Casper  Nursing  Home  (30) 

480  E.  Oak  St. 

Deerwood  Convalescent  Home  (57) 

R.R.  5,  Aroma  Park  Rd. 

KEWANEE  (Henry  County) 

Spoon  River  Residence  (41) 

401  Pine  St. 

KNOXVILLE  (Knox  County) 

Good  Samaritan  Nursing  Home  (49) 

407  N.  Hebart  St. 

Knox  County  Nursing  Home  (150) 

219  N.  Market  St. 

St.  Martha’s  Nursing  Home,  Inc.  (46) 

N.  Market  St. 

LACON  (Marshall  County) 

St.  Joseph’s  Nursing  Home  (54) 

401  Ninth  St. 

LaGRANGE  (Cook  County) 

LaGrange  Colonial  Manor  Convalescent  and 
Nursing  Center  (179) 

339  N.  Ninth  Ave. 

LaGrange  Convalescent  and  Nursing 
Center  (58) 

42  S.  Ashland  Ave. 

LAKE  BLUFF  (Lake  County) 

Hill  Top  Farm  (14) 

502  N.  Waukegan  Rd. 

LAKE  VILLA  (Lake  County) 

Hampstead  House  (28) 

601  S.  Rt.  59 

Lake  Villa  Nursing  Home  (30) 

201  Cedar  Ave. 

Venetian  Manor  Convalescent  Home  (30) 
1913  E.  Grand  Ave.,  Lindenhurst  Addition 

LAKE  ZURICH  (Lake  County) 

Bee  Dozier’s  Maple  Hill  Nursing  Home, 

Inc.  (86) 

P.O.  Box  288 

LANSING  (Cook  County) 

Tri-State  Manor  Nursing  Home  (56) 

2500— 175th  St. 

LAWRENCEVILLE  (Lawrence  County) 

Shidler  Nursing  Home  (22) 

1022  Twelfth  St. 

LEBANON  (St.  Clair  County) 

Bohannon  Nursing  Home,  Inc.  (24) 

404  S.  Fritz  St. 


LENA  (Stephenson  County) 

Ortiz  Convalescent  Home  (33) 

516  Schuyler  St. 

LEWISTOWN  (Fulton  County) 

Clarytona  Manor,  Inc.  (96) 

Sycamore  Dr. 

Stephens  Nursing  Home  (23) 

305  S.  Main  St. 

LEXINGTON  (McLean  County) 

Three  Oaks  Nursing  Home  (48) 

301  S.  Vine  St. 

LIBERTYVILLE  (Lake  County) 

Lake  County  Nursing  Home  (153) 

1125  N.  Milwaukee  Ave. 

Magnus  Rest  Home  (25) 

1206  S.  Milwaukee  Ave. 

LINCOLN  (Logan  County) 

Abraham  Lincoln  Memorial  Extended 
Care  (53) 

315  Eighth  St. 

Christian  Nursing  Home  (48) 

1507  Seventh  St. 

Mary  Henry  Nursing  Home  (52) 

1800  Fifth  St. 

Wasson  Nursing  Home  (19) 

1011  Third  St. 

LITCHFIELD  (Montgomery  County) 

Friendly  Haven  Nursing  Home  (28) 

823  Chapin  St. 

Litchfield  Nursing  Home  (48) 

628  S.  Illinois  St. 

LOUISVILLE  (Clay  County) 

Hill  Crest  Nursing  Home  (40) 

Chestnut  St. 

LOVES  PARK  (Winnebago  County) 

Fountain  Terrace  (49) 

6131  N.  2nd  St. 

MACOMB  (McDonough  County) 

Americana  Nursing  Center  of  Macomb  (58) 
120  Doctors  Ln. 

MARENGO  (McHenry  County) 

Florence  Nursing  Home  (46) 

546  E.  Grant  Hwy. 

MARION  (Williamson  County) 

Fountains  Nursing  Home  (68) 

1301  E.  DeYoung  St. 

MAROA  (Macon  County) 

Villa  Maria  Nursing  Home  (14) 

125  S.  Main  St. 

MARSHALL  (Clark  Coimty) 

Burnsides  Nursing  Home,  Inc.  (90) 

N.  Second  St. 

MASCOUTAH  (St.  Clair  County) 

Grange  Nursing  Home  (29) 

Tenth  St.  (R.R.  1,  Box  145) 

Mascoutah  Nursing  Home  (22) 

213  E.  Church  St. 

West  Main  Nursing  Home  (16) 

1244  W.  Main  St. 

MASON  CITY  (Mason  County) 

Christian  Care  Nursing  Home  (21) 

705  E.  Chestnut  St. 


496 


Illinois  Medical  Journal 


MATTOON  (Coles  County) 

Cunningham  Nursing  Home  (31) 

1312  Wabash  Ave. 

Douglas  Nursing  Center  (49) 

State  Hwy.  #121  West 

MAYWOOD  (Cook  County) 

Lendino  Nursing  Home,  Inc.  (14) 

1110  S.  Ninth  Ave. 

McHenry  (McHenry  County) 

Villa  Nursing  Home  (68) 

1201  W.  Rocky  Beach 

McLEANSBORO  (Hamilton  County) 
McLeansboro  Nursing  Home  (37) 

205  E.  Cherry  St. 

MENDOTA  (LaSalle  County) 

Sunrise  Nursing  Home  (49) 

1201  First  Ave. 

METROPOLIS  (Massac  County) 

Metropolis  Good  Samaritan  Home  (48) 
Box  145 

MIDLOTHIAN  (Cook  County) 

Bowman  Nursing  Home,  Inc.  (44) 

14731  S.  Turner  Ave. 

Bowman  Nursing  Home,  Inc.,  No.  1 (49) 
3249  W.  147th  St. 

Clover  Acres  (49) 

5252  W.  147th  St. 

Largent’s  Convalescent  Home  (69) 

4323  W.  147th  St. 

Maple  Farms  Convalescent  Home  (44) 
147th  & Long  Ave. 

MILAN  (Rock  Island  County) 

Comfort  Harbor  Nursing  Home  (39) 

114  W.  Second  Ave. 

MINONK  (Woodford  County) 

Minonk  Manor,  Inc.  (48) 

201  Locust  St. 

MOLINE  (Rock  Island  County) 

Americana  Nursing  Center  of  Moline  (67) 
833  Sixteenth  St. 

Fairhaven  Nursing  Home  (28) 

2525  Ninth  Ave. 

MONMOUTH  (Warren  County) 

Colonial  Nursing  Home,  Inc.  (23) 

303  E.  Broadway 
Monmouth  Nursing  Home  (28) 

116  South  H Street 
Warren  County  Nursing  Home  (39) 

R.R.  4 

MONTICELLO  (Piatt  County) 

Cozy  Haven  (10) 

713  W.  Bond  St. 

Piatt  County  Nursing  Home  (32) 

R.R.  2 

MORRIS  (Grundy  County) 

Morris-Lincoln  Nursing  Home  (87) 

916  Fremont  Ave. 

Grundy  County  Nursing  Home  (49) 

R.R.  4 

MORRISON  (Whiteside  County) 

Eveningside  Nursing  Home  (23) 

509  N.  Genesee  St. 


MORRISON VILLE  (Christian  County) 

Memorial  Nursing  Home  (47) 

200  W.  Fifth  St. 

MORTON  (Tazewell  County) 

Restmor,  Inc.  (78) 

925  E.  Jefferson 

MT.  CARMEL  (Wabash  County) 

Monticello  Nursing  Home,  Inc.  (97) 

Box  229 

Wabash  Nursing  Home  (30) 

R.R.  3 

MT.  STERLING  (Brown  County) 

Barker’s  Nursing  Home  (15) 

204-206  Railroad  Ave. 

Haley’s  Nursing  Home  (10) 

401  W.  Main  St. 

Whited  Nursing  Home  (20) 

308  N.  Capital  St. 

MT.  VERNON  (Jefferson  County) 

Hickory  Grove  Manor  (111) 

8 Doctors  Park  Rd. 

Lowry’s  Nursing  Home  (27) 

1304  Main  St. 

Setzekorn  Nursing  Home  (31) 

1300  Broadway 

MT.  ZION  (Macon  County) 

Woodland,  Inc.,  Nursing  Home  (70) 

MUNDELEIN  (Lake  County) 

North  Riverwood  Manor,  Inc.  (65) 

Rt.  1,  106  Milwaukee  Ave.,  (P.O.  Half  Day) 
Pine  Manor  (27) 

Rt.  1,  Box  185 

MURPHYSBORO  (Jackson  County) 

Jackson  County  Nursing  Home  (158) 

1441  N.  14th  St. 

Tyler  Nursing  Home,  Inc.  (69) 

1711  Spruce  St. 

NAPERVILLE  (DuPage  County) 

American  Nursing  Center  of  Naperville  (97) 
200  Martin  Dr. 

Brentwood  Nursing  Home  (29) 

1136  Mill  St. 

NASHVILLE  (Washington  County) 

Friendship  Manor,  Inc.  (125) 

Friendship  Dr. 

NEWTON  (Jasper  County) 

Newton  Rest  Haven  (92) 

300  S.  Scott  St. 

NILES  (Cook  County) 

Gross  Point  Manor  (99) 

6601  Touhy  Ave. 

Pleasantview  Convalescent  and  Nursing 
Center,  Inc.  (91) 

6840  W.  Touhy  Ave. 

Svithiod  Nursing  Home  (23) 

8800  Grace  St. 

NORMAL  (McLean  County) 

Americana  Nursing  Center  of 
Bloomington-Normal  (88) 

510  Broadway 
Brokaw  Home  (46) 

Virginia  and  Franklin  Sts. 


for  October,  1968 


497 


NORTHBROOK  (Cook  County) 

Eden  View  Convalescent  and  Geriatric 
Center  (142) 

222  Frontage  Rd. 

Northbrook  Nursing  Home  & Rehabilitation 
Center,  Inc.  (149) 

270  Skokie  Rd. 

OAK  LAWN  (Cook  County) 

Concord  Nursing  Home  (91) 

9401  Ridgeland  Ave. 

Doyle  Nursing  and  Convalescent  Homes, 

Inc.  (92) 

5432  W.  87th  St. 

Monticello  Convalescent  Center  (99) 

6300  W.  95th  St. 

Oak  Lawn  Convalescent  and  Geriatric 
Home  (95) 

9525  S.  Mayfield 

Parkside  Gardens  Nursing  Home  (77) 

5701  W.  79th  St. 

OAK  PARK  (Cook  County) 

Oak  Park  Nursing  Home,  Inc.  (41) 

637  S.  Maple  Ave. 

Patterson  Nursing  & Rehabilitation  Care  (22) 
130  N.  Austin  Blvd. 

Royal  Oak  Convalescent  and  Geriatric 
Center  (204) 

625  N.  Harlem  Ave. 

The  Woodbine  (59) 

6909  W.  North  Ave. 

ODIN  (Marion  County) 

Wutzler  Nursing  Home  (29) 

Kirkwood  St. 

Yaw  Nursing  Home  (61) 

Laury  St. 

O’FALLON  (St.  Clair  County) 

Parkview  Colonial  Manor  (107) 

300  Weber  Dr. 

OKAWVILLE  (Washington  County) 

Washington  Springs  Nursing  Home  (130) 

OLNEY  (Richland  County) 

Burgin  Nursing  Home  No.  1 (31) 

305  S.  Washington  St. 

Burgin  Nursing  Home  No.  2 (29) 

607  S.  Elliott  St. 

Burgin  Nursing  Manor  (75) 

928  E.  Scott  St. 

Golden  Years  Nursing  Home  (34) 

502  S.  Fair  St. 

Marks  Nursing  Home  (28) 

217  N.  Fair  St. 

ORANGEVILLE  (Stephenson  County) 

Krug  Convalescent  Home  (13) 

High  St. 

OTTAWA  (LaSalle  County) 

Hassley’s  Health  Haven  (16) 

Gentleman  Rd.,  R.R.  4 
Highland  Sanatorium  and  Convalescent 
Home  of  LaSalle  County  (63) 

800  Center  St. 

LaSalle  County  Home  (68) 

R.F.D.  1 


Susie  H.  Moore  Rest  and  Healing  Home  (13) 
627  Third  Ave. 

PALATINE  (Cook  County) 

Bee  Dozier’s  Palatine  Nursing  Home  (40) 

W.  Dundee  Rd. 

Plum  Grove  Nursing  Home,  Inc.  (48) 

24  S.  Plum  Grove  Ave. 

PALOS  HILLS  (Cook  County) 

Palos  Hills  Convalescent  Center  (130) 

10426  S.  Roberts  Rd. 

PANA  (Christian  County) 

DePaepe-Ashcraft  Nursing  Home  (83) 

10  Oak  St. 

PARK  RIDGE  (Cook  County) 

Park  Ridge  Terrace  (56) 

665  Busse  Hwy. 

PAXTON  (Ford  County) 

Ford  County  Nursing  Home  (74) 

R.R.  2 

Lyons  Nursing  Home  (21) 

440  E.  Pells  St. 

PEKIN  (Tazewell  County) 

Floy’s  Nursing  Home  (24) 

803  Park  Ave. 

Knollcrest  Nursing  Home  (49) 

Allentown  Rd. 

PEORIA  (Peoria  County) 

Americana  Nursing  Center  of  Peoria  (65) 
5600  Glen  Elm  Dr. 

Baker  Nursing  Home  (28) 

500-502  W.  Second  St. 

Bel-Wood  Nursing  Home  (237) 

7023  W.  Planck  Rd. 

High  View  Nursing  Home  (68) 

2308  W.  Nebraska  St. 

Mahoney  Nursing  Home  No.  1 (28) 

444  W.  Second  St. 

Mahoney  Nursing  Home  No.  2 (19) 

2149  N.  Knoxville  St. 

Walker  Nursing  Home  (16) 

1504  W.  Garden  St. 

PEORIA  HEIGHTS  (Peoria  County) 

Fireside  House,  Inc.  (108) 

1629  Gardner  Ln. 

Galena  Park  Home  (24) 

5533  N.  Galena  Rd. 

PERU  (LaSalle  County) 

Heritage  Manor  (59) 

22nd  and  Rock  Sts. 

Tri  City  Nursing  Home  (21) 

2804  Sixth  St. 

PETERSBURG  (Menard  County) 

Menard  Convalescent  Center,  Inc.  (54) 
Seventh  and  Antle  Sts. 

Sunny  Acres  (49) 

Rt.  3 

PITTSFIELD  (Pike  County) 

Couch  Nursing  Home  (35) 

521  E.  Washington  St. 

Pittsfield  Nursing  Home  (74) 

R.R.  3 


498 


Illinois  Medical  Journal 


PLYMOUTH  (Hancock  County) 

Myrtle  Sapp’s  Nursing  Home  (22) 

Main  St. 

PONTIAC  (Livingston  County) 

Livingston  County  Nursing  Home  (94) 

R.R.  1 

PRAIRIE  CITY  (McDonough  County) 

Westfall  K & C.  Nursing  Home  (9) 

Reed  and  Union  Sts. 

Westfall  Nursing  Home  (22) 

Madison  and  Union  Sts. 

PRINCETON  (Bureau  County) 

Prairie  View  Nursing  Home  (149) 

R.R.  5 

QUINCY  (Adams  County) 

Eloise  Nursing  Home  (13) 

1614  N.  Fourth  St. 

Hall  Nursing  Home  (23) 

1870  Vermont  St. 

Lincoln-Terrace  Nursing  Home,  Inc.  (92) 
1315  N.  Eighth  St. 

St.  Joseph  Hall  (72) 

1415  Vermont  St. 

Theda  Boll  Nursing  Home  (14) 

438  N.  Twelfth  St. 

RAYMOND  (Montgomery  County) 

Cottage  Nursing  Home  (33) 

W.  Sparks  St. 

ROANOKE  (Woodford  County) 

Roanoke  Manor,  Inc.  (79) 

1102  W.  Randolph  St. 

ROBBINS  (Cook  County) 

Esma  A.  Wright  Convalescent  Center  (206) 
139th  St.  at  Lydia 

ROBINSON  (Crawford  County) 

Gowen  Nursing  Home  (49) 

902  Mefford  St. 

Robinson  Nursing  Home  (44) 

503  E.  Main  St. 

ROCHELLE  (Ogle  County) 

Americana  Nursing  Center  of  Rochelle  (49) 
900  N.  Third  St. 

ROCK  FALLS  (Whiteside  County) 

Colonial  Acres  Rest  Home  (55) 

Rt.  2,  Dixon  Rd. 

ROCKFORD  (Winnebago  County) 

Alma  Nelson  Manor  (174) 

550  S.  Mulford  Rd. 

Americana  Nursing  Center  of  Rockford  (114) 
2313  N.  Rockton 
Deacon  Home  (17) 

611  N.  Court  St. 

Johnson’s  Hill  Top  Nursing  Home  (16) 

728  N.  Court  St. 

Lund  Nursing  Home  (17) 

1503  Fourth  Ave. 

North  Rockford  Convalescent  Home  (49) 
1925  Fremont  St. 

The  Restorium  (41) 

2800  S.  Main  St. 

River  Bluff  Nursing  Home  (204) 

N.  Main  Rd. 


River  Manor,  Inc.  (108) 

707  W.  Riverside  Blvd. 

Rockford  Municipal  Sanitarium  Nursing 
Home  (59) 

1601  Parkview  Ave. 

ROCK  ISLAND  (Rock  Island  County) 

Mrs.  Carroll’s  Nursing  Home  (26) 

4434  Seventh  Ave. 

Parkway  Rest  Home  (22) 

557— 30th  St. 

Shady  Lawn  Nursing  Home,  Inc.  (29) 
1018  Twelfth  St. 

ROSEVILLE  (Warren  County) 

Roseville  Nursing  Home  (18) 

N.  Main  St. 

ROSSVILLE  (Vermilion  County) 

Hedreeka  Nursing  Home  (32) 

R.R.  2 

ROUND  GROVE  (Whiteside  County) 
Whiteside  County  Nursing  Home  (75) 

RUSHVILLE  (Schuyler  County) 

Hills  Convalescent  Home  (20) 

717  E.  Adams 
Snyder’s  Home  (49) 

135  Morgan  St. 

RUTLAND  (LaSalle  County) 

Rutland  Nursing  Home,  Inc.  (27) 

E.  Front  St.  and  Chestnut  St. 

ST.  ELMO  (Fayette  County) 

Elm  Haven  Nursing  Home  (24) 

317  Cmnberland  Rd. 

ST.  CHARLES  (Kane  County) 

Valley  Rest  Home  (24) 

309  S.  Sixth  Ave. 

SANDWICH  (DeKalb  County) 

Sandhaven,  Inc.  (37) 

517  N.  Main  St. 

SALEM  (Marion  County) 

Twin  Willows  Nursing  Center  (72) 

Rt.  37  North 

SAYBROOK  (McLean  County) 

Kinsell’s  Nursing  Home,  Inc.  (16) 

205  N.  Main  St. 

SHANNON  (Carroll  County) 

Johnson’s  Nursing  Home  (59) 

418  Ridge  St. 

SHAWNEETOWN  (Gallatin  County) 

Loretta  Nursing  Home  (61) 

Logan  and  Lincoln  Sts. 

SHELBYVILLE  (Shelby  County) 

Young’s  Shelbyville  Restorium,  Inc.  (110) 
Rt.  128  North 

SHELDON  (Iroquois  County) 

Happy  Siesta  (40) 

220  E.  Center  St. 

SIDELL  (Vermilion  County) 

Fairview  Alliance  Home,  Inc.  (37) 

R.R.  1 

SILVIS  (Rock  Island  County) 

Happy  Haven  Rest  Home  (49) 

118  Tenth  St. 


for  October,  1968 


499 


SKOKIE  (Cook  County) 

Old  Orchard  Manor  (61) 

4660  Old  Orchard  Rd. 

Skokie  Valley  Manor,  Inc.  (115) 

4600  W.  Simpson  St. 

Village  Nursing  Home  in  Skokie,  Inc.  (128) 
9000  Lavergne  Ave. 

SMITHBORO  (Bond  County) 

American  Nursing  Home  (28) 

SOUTH  CHICAGO  HEIGHTS  (Cook  County) 
Suburban  Convalescent  Center  (99) 

120  W.  26th  St. 

SOUTH  HOLLAND  (Cook  County) 

Colonial  Convalescent  Home  (65) 

549  E.  162nd  St. 

SPARTA  (Randolph  County) 

Randolph  County  Nursing  Home  (158) 

W.  Belmont 

SPRINGFIELD  (Sangamon  County) 

Americana  Nursing  Center  of  Springfield  (116) 
707  N.  Rutledge 
Carver  Convalescent  Home  (61) 

1527  E.  Washington  St. 

Claudia’s  Nursing  Home  (51) 

409  N.  Grand  Ave.  East 
Colonial  Cottage  (4) 

116  S.  State  St. 

Edwards  Manor  Nursing  Home,  Inc.  (60) 
1625  E.  Edwards  St. 

Everett  McKinley  Dirksen  House  (152) 

555  W.  Carpenter 
Hamilton  Nursing  Home  (24) 

925  N.  Fifth  St. 

Haven  Nursing  Home  (72) 

2301  W.  Monroe 

Homestead  Convalescent  Home  and 
Nursing  Residence  (60) 

127  N.  Douglas  Ave. 

Myrick  Nursing  Home  (31) 

925  S.  Seventh  St. 

Phillips  Nursing  Home,  Inc.  (51) 

630  N.  Sixth  St. 

Ramshaw  Retirement  Home  No.  1 (47) 

631  N.  Sixth  St. 

Ramshaw  Retirement  Home  No.  2 (44) 

611  N.  Sixth  St. 

Ridgewood  Nursing  Home  (48) 

3400  Peoria  Rd. 

Rutledge  Manor  Care  Home,  Inc.  (121) 

819  N.  Rutledge 
Standage  Nursing  Home  (25) 

2205  E.  Capitol  Ave. 

STAUNTON  (Macoupin  County) 

Staunton  Nursing  Home,  Inc.  (36) 

215  W.  Pennsylvania  St. 

STERLING  (Whiteside  County) 

Colonial  Acres  Rest  Home  (70) 

Rt.  2 

STOCKTON  (Jo  Daviess  County) 

Morgan  Memorial  Home  (27) 

501  E.  Front  Ave. 


STREATOR  (LaSalle  County) 

Edgetown  Nursing  Home  (24) 

West  Chicago  St. 

Heritage  Manor  (57) 

1525  E.  Main  St. 

Star  Haven  Convalescent  and  Nursing 
Home  (21) 

405  N.  Wasson  St. 

SULLIVAN  (Moultrie  County) 

East  View  Manor  Nursing  Home  (52) 
Eastview  PI.,  Box  234 
Singiser  Nursing  Home  (30) 

817  E.  Jackson  St. 

SUMNER  (Lawrence  County) 

Red  Hills  Rest  Haven  (96) 

Pine  Lawn  Addition 

SWANSEA  (St.  Clair  County) 

Castle  Haven  Convalescent  Center  (154) 
225  Castellano  Dr. 

TAYLORVILLE  (Christian  County) 
Dexheimer  Nursing  Home  (21) 

216  E.  Franklin  St. 

Johnson  Nursing  Home  (12) 

1024  W.  Park 
Meadow  Manor,  Inc.  (56) 

Rt.  48  North 
Smith’s  Guest  Home  (40) 

305  E.  Adams  St. 

TINLEY  PARK  (Cook  County) 

Kosary  Nursing  Home  (73) 

6660  W.  147th  St. 

McAllister  Nursing  Home  No.  2 (45) 
183rd  and  LaVerne  Ave. 

TOULON  (Stark  County) 

Public  Nursing  Home  (18) 

219  S.  Franklin  St. 

TREMONT  (Tazewell  County) 

Tazewell  County  Nursing  Home  (125) 
R.R.  1 

TROY  (Madison  County) 

Rockwood  Rest  Home  (23) 

212  N.  Powell  St. 

TUSCOLA  (Douglas  County) 

Martin  Nursing  Home  (30) 

114  E.  Daggy  St. 

URBANA  (Champaign  County) 

Americana  Nursing  Center  of  Champaign- 
Urbana  (100) 

600  N.  Coler 

Champaign  County  Nursing  Home  (198) 
1701  E.  Main  St. 

Fontana  Nursing  Care  Center  (40) 

907  Lincoln  Ave.  ' 

Hubert  Nursing  Home  (19) 

505  W.  Green  St. 

VANDALIA  (Fayette  County) 

Fayette  County  Hospital  Annex  (33) 

727  W.  Jackson 

Fayette  County  Nursing  Home  (34) 

R.R.  3 

Ted  Mangner  Nursing  Home,  Inc.  (31) 
117  S.  Seventh  St. 


500 


Illinois  Medical  Journal 


VIENNA  (Johnson  County) 

Hill  View  (51) 

VILLA  PARK  (DuPage  County) 

Acre  View  Nursing  Home  (38) 

538  S.  Villa  Ave. 

VIRDEN  (Macoupin  County) 

Miller’s  Nursing  Home  (23) 

231  E.  Deane  St. 

VIRGINIA  (Cass  County) 

Kirkpatrick  Nursing  Home  (24) 

145  N.  Front  St.  x. 

Walker  Nursing  Home  (30) 

530  E.  Beardstown  St. 

WARREN  (Jo  Daviess  County) 

Daters  Nursing  Home  (18) 

Water  St. 

Lahey  Nursing  Home  (23) 

Burnett  St. 

Sunnyside  Nursing  Home  (15) 

206  Lions  St. 

WASHBURN  (Woodford  County) 

Washburn  Nursing  Home  (32) 

231  Parkside  Dr. 

WASHINGTON  (Tazewell  County) 

Washington  Home  (36) 

104  E.  Holland  St. 

Washington  Nursing  Center  (88) 

1110  New  Castle  Rd. 

WATERLOO  (Monroe  County) 

Monroe  County  Nursing  Home  (178) 

Illinois  Ave. 

WATSEKA  (Iroquois  County) 

Iroquois  Resident  Home  (58) 

830  S.  Fourth  St. 

WAUKEGAN  (Lake  County) 

The  Terrace  Nursing  Home  (112) 

1615  Sunset  Ave. 

Waukegan  Pavihon  Nursing  Home,  Inc.  (96) 
2217  W.  Washington  St. 

WAVERLY  (Morgan  County) 

Bridges  Nursing  Home  (18) 

200  E.  State  St. 

WENONA  (Marshall  County) 

Wenona  Rest  Haven,  Inc.  (31) 

Elm  St. 

WEST  CHICAGO  (DuPage  County) 

Hazelhurst  Nursing  Home,  Inc.  (29) 

Roosevelt  Rd.  and  Gary  Mill 

SHELTERED 

ALEDO  (Mercer  County) 

Fortner  Sheltered  Care  Home  (36) 

1006  E.  Fifth  St. 

ALTON  (Madison  County) 

Alby  Street  Sheltered  Care  Home  (30) 

1912  Alby  St. 

Burt  Sheltered  Care  Home  (29) 

1414  Milton  Rd. 

Mitchell  Sheltered  Care  Home  (5) 

1800  Belle  St. 

West  Shelter  Care  Home  (23) 

1914  Washington  Ave. 


Morton  Manor  Health  Home  (28) 

R.R.  1,  Box  753 
WHEATON  (DuPage  County) 

DuPage  Convalescent  Home  (288) 

O.  S.  262  County  Farm  Rd. 

Parkway  Terrace  Nursing  Home  (69) 

205  E.  Parkway  Dr. 

Wheaton  Health  Resort,  Inc.  (96) 

1325  Manchester  Rd. 

WHITE  HALL  (Greene  County) 

Hill  Top  Haven  (39) 

McCarthy  Ave.  and  U.S.  Rt.  67A 
WINFIELD  (DuPage  County) 

Abbey  Winfield  Geriatric  & Convalescent 
Home  (48) 

Wynwood  Rd.  and  Shady  Way 
Zace  Retirement  Home  (41) 

27  W.  141  Liberty  St. 

WITT  (Montgomery  County) 

Laura  Charles  Nursing  Home,  Inc.  (37) 
Allen  St. 

WOOD  DALE  (DuPage  County) 

Wood  Dale  Nursing  Home  (70) 

140  N.  Hemlock 

WOODSTOCK  (McHenry  County) 
Birchwood  Nursing  Home  (13) 

R.R.  1 

New  Woodstock  Residence  (112) 

309  McHenry  Ave. 

Valley  Hi  Nursing  Home  (61) 

2406  Hartland  Rd. 

Windgate  (32) 

11023  Rt.  14 

YORKVILLE  (Kendall  County) 

Hillside  Nursing  and  Convalescent  Home, 
Inc.  (33) 

Rt.  34  and  Game  Farm  Rd. 

Hillside  Nursing  and  Convalescent 
Home,  Inc.,  No.  2 (35) 

Rt.  34  and  Prairie  Ln. 

ZION  (Lake  County) 

Golden  Day  Nursing  Home  (32) 

923  Shiloh  Blvd. 

Parkview  Nursing  Home,  Ltd.  (70) 
1911— 27th  St. 

Zion  Nursing  Home  (144) 

2561  Sheridan  Rd. 

CARE  HOMES 

ANNA  (Union  County) 

Dodson  Shelter  Care  Home  (18) 

300  South  St. 

Galbraith  Shelter  Care  Home  (17) 

223  W.  Vienna  St. 

HS&D  Sheltered  Care  Home  (12) 

201  E.  Highland  St. 

Pitts  Sheltered  Care  Home  (19) 

310  E.  Davie  St. 

Walnut  Grove  Shelter  Care  (15) 

612  E.  Davie  St. 


for  October,  1968 


501 


ARROWSMITH  (McLean  County) 

Murrell’s  Guest  Home  (6) 

ASHLAND  (Cass  County) 

Burch  Home  (10) 

ASHMORE  (Coles  County) 

Ashmore  Estates  (42) 

BARTONVILLE  (Peoria  County) 

Martin’s  Sheltered  Home  (28) 

10  McClure  Ct. 

BARRY  (Pike  County) 

Tittsworth  Sheltered  Care  Home  (8) 

Rogers  St. 

BELLEVILLE  (St.  Clair  County) 

Gorski  Old  Folks  Home  (12) 

1412  W.  Main  St. 

Gribler  Sheltered  Care  Home  (15) 

511  S.  Charles  St. 

Heidelberg  Retirement  Home  (16) 

200  Abend  St. 

Weier  Retirement  Home  (28) 

5 Gundlach  PI. 

BENTON  (Franklin  County) 

Cockrum  Sheltered  Care  Home  (12) 

314  S.  Main  St. 

Good  Samaritan  Sheltered  Care  Home  (13) 
904  E.  Main  St. 

Higgerson’s  Home  (14) 

209  N.  Eighth  St. 

Mary  Grace  Sheltered  Care  Home  (12) 

112  Smith  St. 

Severin  Sheltered  Care  Home  (12) 

105  Mill  St. 

Shady  Rest  Sheltered  Care  (18) 

114  E.  Webster  St. 

Wertz’s  Sheltered  Care  Home  (13) 

217  Pope  St. 

BETHANY  (Moultrie  County) 

White  Shelter  Care  Home  (19) 

513  E.  Main  St. 

BLOOMINGTON  (McLean  County) 

Eden’s  Sheltered  Care  Home  (12) 

1108  N.  Prairie  St. 

Golden  Age  Home  (19) 

412  N.  Roosevelt  Ave. 

Hanson  Sheltered  Care  Home  (17) 

909  S.  Center  St. 

Lowry  Shelter  Care  Home  (10) 

903  W.  Mullberry  St. 

Rusk  Haven  Shelter  Home  (42) 

102  Greenwood  Ave. 

BLUE  ISLAND  (Cook  County) 

Stocker’s  Sheltered  Care  Home  (12) 

2346  Union  St. 

BRADFORD  (Stark  County) 

Bradford  Home  (23) 

214  E.  Main  St. 

BRADLEY  (Kankakee  County) 

Evans  Shelter  Care  Home  (7) 

496  S.  Wabash  St. 

BRIGHTON  (Jersey  County) 

Post  Sheltered  Care  Home  (12) 

Strack  St.,  P.O.  Box  161 


BUNKER  HILL  (Macoupin  County) 

Hammond  Shelter  Care  Home  (26) 

512  S.  Franklin 

BUSHNELL  (McDonough  County) 

Daly’s  Golden  Age  Home  (17) 

257  E.  Hail  St. 

CAMBRIDGE  (Henry  County) 

Pine  Lodge  Home  (17) 

112  E.  Center  St. 

CANTON  (Fulton  County) 

Sunset  Home  (46) 

135  S.  First  St. 

Sunset  Sheltered  Care  Home  No.  2 (52) 

129  S.  First  Ave. 

CARTHAGE  (Hancock  County) 

Welborn  Shelter  Care  Home  No.  2 (17) 

140  Main  St. 

CASEY  (Clark  County) 

Rude’s  Goodwill  Shelter  Home  (12) 

110  E.  Monroe  St. 

CENTRALIA  (Clinton  County) 

Brookside  Manor,  Inc.  (41) 

2000  W.  Broadway 

CENTRALIA  (Marion  County) 

Brewer  Shelter  Care  Home  (14) 

603  N.  Walnut  St. 

Centralia  Friendship  House,  Inc.  (58) 

1000  E.  McCord  St. 

Centralia  Shelter  Care  (20) 

620  E.  Broadway 

CHAMPAIGN  (Champaign  County) 

LaDow  Sheltered  Care  Home  (23) 

406  S.  Prairie  St. 

Pleasant  Manor  (15) 

211  E.  Clark  St. 

CHARLESTON  (Coles  County) 

Teaters  Sheltered  Care  Home  (32) 

Fifth  and  Jackson  Sts. 

Young  Sheltered  Care  Home  (18) 

763  Tenth  St. 

CHEBANSE  (Iroquois  County) 

Morgan  Manor  (10) 

243  S.  First  St. 

CHENOA  (McLean  County) 

Rose  Lawn  Sheltered  Care  Home  No.  2 (20) 
324  Weir  St. 

CHESTER  (Randolph  County) 

Padgett’s  Pot-A-Pourri  Rest  Home  (34) 

647  State  St. 

CHICAGO  (Cook  County) 

Boulevard  Home  (19) 

4533  W.  Washington  Blvd. 

Continental  Medical  Management  Corp.  (32) 
5148  S.  Prairie  Ave. 

Jewish  Peoples  Convalescent  Home  (37) 

6512  N.  California  Ave. 

Kraus  Home,  Inc.  (27) 

1620  W.  Chase  Ave. 

CLINTON  (DeWitt  County) 

Burns  Sheltered  Care  (5) 

930  N.  George 


502 


Illinois  Medical  Journal 


COBDEN  (Union  County) 

Tripp  Sheltered  Care  Home  (28) 

Box  323 

COLLE^JSVILLE  (Madison  County) 
Butler  Home  (16) 

413  Vandalia  St. 

COULTERVILLE  (Randolph  County) 
Coulterville  Sheltered  Care  Home  (21) 
Seventh  and  Cedar  Sts. 

DALLAS  CITY  (Henderson  County) 
Welborn  Sheltered  Care  Home  (10) 

69  E.  Main  St. 

DANVERS  (McLean  County) 

Holman  Shelter  Care  Home  (18) 

300  E.  Exchange  St. 

DECATUR  (Macon  County) 

Farrar  Sheltered  Care  Home  (14) 

1860  N.  Broadway  St. 

Gladville  Home  (12) 

1013  W.  Wood  St. 

Lindsey  Rest  Home  (7) 

737  W.  Wood  St. 

DONGOLA  (Union  County) 

Keller  Sheltered  Care  Home  (27) 

Box  634 

DUQUOIN  (Perry  County) 

Miller  Sheltered  Care  Home  (18) 

24  S.  Line  St. 

Open  Arms  Shelter  (21) 

200  N.  Franklin 

EAST  ST.  LOUIS  (St.  Clair  County) 
Carr  Sheltered  Care  Home  (9) 

3112  Bond  St. 

Popejoy’s  Retirement  Home  (27) 

1504  Illinois  Ave. 

EFFINGHAM  (Effingham  County) 
Ireland  Sheltered  Care  Home  (7) 

111  Forest  St. 

Marks  Sheltered  Care  Home  (22) 

500  Clinton  Ave. 

ELDORADO  (Saline  County) 

Murray  Hotel  (34) 

900  Fifth  St. 

ELGIN  (Kane  County) 

The  Oliver  Annex  (11) 

364  St.  Charles  St. 

EL  PASO  (Woodford  County) 

Elderly  Citizens  Home  (24) 

Main  St. 

Tobien  Elderly  Citizens  Home  (27) 
408  First  St. 

ENFIELD  (White  County) 

Fields  Shelter  Care  Home  (20) 

W.  Main  St. 

FAIRFIELD  (Wayne  County) 

Fair  Haven  Shelter  Care  Home  (9) 

507  W.  Elm  St. 

FLORA  (Clay  County) 

Anderson’s  Sheltered  Care  Home  (12) 

201  E.  Third  St. 

Cattengaim  Shelter  Care  (8) 

215  W.  North  Ave. 


Ferguson  Sheltered  Care  Home  (6) 

520  W.  North  Ave. 

Raber  Sheltered  Care  Home  (6) 

409  E.  Third  St. 

GALESBURG  (Knox  County) 

Barre’s  Sheltered  Care  Home  (13) 

1179  E.  Main  St. 

The  Evergreens  (14) 

1188  W.  Main  St. 

Lee’s  Sheltered  Care  Home  (14) 

736  N.  Kellogg  St. 

GALVA  (Henry  County) 

Galva  Manor  (27) 

309  N.  First  St. 

GOLCONDA  (Pope  County) 

Minis  Sheltered  Care  (10) 

Monroe  St. 

Rose  View  Sheltered  Care  Home  (10) 
Washington  and  Harrison  Sts. 

GRAYVILLE  (White  County) 

Hillcrest  Home  (13) 

320  W.  South  St. 

GREENFIELD  (Greene  County) 

Hospitality  House  Sheltered  Care  (21) 

212  Walnut  St. 

GREENUP  (Cumberland  County) 

Peters  Shelter  Care  Home  (32) 

308  N.  Kentucky  St. 

GREENVILLE  (Bond  County) 

Hilltop  House  (16) 

202  N.  Fourth  St. 

Horsfall  Sheltered  Care  Home  (52) 

201  S.  Second  St. 

HARDIN  (Calhoun  County) 

Hardin  Sheltered  Care  Home  (14) 

County  Road  St. 

HERRIN  (Williamson  County) 

Mattingly  Sheltered  Care  Home  (19) 

700  N.  14th  St. 

Park  Avenue  Sheltered  Care  Home  (33) 

Rt.  148,  P.O.  Box  68 
HEYWORTH  (McLean  County) 

Lush  Sheltered  Care  Home  (15) 

303  E.  Main  St. 

IRVING  (Montgomery  County) 

Mi-Edd  Shelter  Home  (12) 

JACKSONVILLE  (Morgan  County) 

Bell  Sheltered  Care  Home  (21) 

602  Jordan  St. 

Blue  Sheltered  Care  Home  (6) 

506  W.  Morton  Ave. 

Hardy  Sheltered  Care  Home  (14) 

830  W.  College  Ave. 

Hoots  Rest  Home  (16) 

717  E.  Douglas  St. 

Parker  Sheltered  Care  Home  (20) 

203  W.  Beecher  Ave. 

Rosedale  Sheltered  Care  Home  (16) 

220  Brown  St. 

Smith -Tucker  Sheltered  Care  Home  No.  1 (26) 
606  N.  Church  St. 

Smith-Tucker  Sheltered  Care  Home  No.  2 (14) 
616  N.  Church  St. 


for  October,  1968 


503 


JERSEYVILLE  (Jersey  County) 

Alma’s  Shelter  Care  Home  (26) 

301  W.  Pine  St. 

Stark’s  Sheltered  Care  Home  (20) 

600  N.  Liberty  St. 

JOHNSTON  CITY  (Williamson  County) 
Cazaleen’s  Sheltered  Care  Home  (13) 

207  E.  Fifth  St. 

Maple  House  Shelter  Care  (23) 

207  E.  Third  St. 

Maple  House  Sheltered  Care  Home  No.  2 (23) 
205  E.  3rd  St. 

Nellie  Ernfelt  Home  (31) 

R.  R.  1 

JONESBORO  (Union  County) 

City  Sheltered  Care  Home  (14) 

201  Broad  St. 

Gibbs  Sheltered  Care  Home  (6) 

204  S.  Pecan  St. 

Henard  Sheltered  Care  Home  (15) 

204  S.  Main  St. 

Spurlock  Shelter  Care  Home  (35) 

Jonesboro  Square 

KAMPSVILLE  (Calhoun  County) 

Smith  Sheltered  Care  Home  (12) 

KANKAKEE  (Kankakee  County) 

Bethel  Shelter  Home  (11) 

556  E.  Oak  St. 

Geeding  Shelter  Home  (16) 

139  S.  Greenwood  Ave. 

J.  C.  Good  Shelter  Home  (16) 

1 95  N.  Entrance  Ave. 

Oaklawn  Home  (16) 

191  N.  Washington  Ave. 

KEWANEE  (Henry  County) 

Kewanee  Manor  (22) 

218  S.  Tremont  St. 

LaHARPE  (Hancock  County) 

Gillett  Home  (7) 

W.  Main  St. 

Gillett  Home  No.  2 (12) 

W.  Main  St. 

Hoosier  Sheltered  Care  Home  (15) 

114  Archer  Ave. 

LeROY  (McLean  County) 

LeRoy  Home  (24) 

902  N.  Mill  St. 

LEXINGTON  (McLean  County) 

Rose  Lawn  Shelter  Care  Home  (22) 

207  N.  Elm  St. 

Three  Oaks  Sheltered  Care  Home  (20) 

306  W.  South  St. 

LOUISVILLE  (Clay  County) 

Twilight  Haven  (18) 

Hiriam  St.  & Rt.  45 

LOVINGTON  (Moultrie  County) 

Gaddis  Sheltered  Care  Home,  Inc.  (26) 

240  E.  State  St. 

MARION  (Williamson  County) 

Lee  Manor  (30) 

1305  W.  Main  St. 

Miner  Sheltered  Care  Home  (20) 

205  E.  Marion  St. 


MARSHALL  (Clark  County) 

Dunkel  Home  (20) 

325  S.  Sixth  St. 

Marshall  Christian  Hotel  (34) 

805  Archer  Ave. 

MARTINSVILLE  (Clark  County) 
Glendening  Home  (24) 

25  S.  Washington  St. 

McHENRY  (McHenry  County) 

Shan  Gra-La  Sheltered  Care  Home  (8) 
3820  W.  Idyldell  Rd. 

METROPOLIS  (Massac  County) 

Angelly  Sheltered  Care  (8) 

202  Metropolis  St. 

Care  Homes,  Inc.  (33) 

205  Metropolis  St. 

Senior  Citizens  Retirement  Home  (27) 
308  W.  Third  St. 

MILFORD  (Iroquois  County) 

Golden  Jubilee  Homes  (13) 

28  S.  West  Ave. 

MINONK  (Woodford  County) 

Minonk  Manor,  Inc.  (22) 

221  Locust  St. 

MOLINE  (Rock  Island  County) 
Hendren’s  Sheltered  Care  Home  (12) 
2602  Sixth  Ave. 

Hensley  Home  (13) 

1 1 1 1 Fifteenth  St. 

Paul’s  Boarding  Home  (14) 

849  Fifteenth  St. 

MORTON  (Tazewell  County) 

Morton  Home  (20) 

424  N.  Main  St. 

MT.  CARMEL  (Wabash  County) 
Chestnut  Sheltered  Care  Home  (24) 
218  Chestnut 
Ladies  Lodge  (21) 

318  W.  Second  St. 

Shurtleff  Annex  (24) 

416  Plum  St. 

Shurtleff  Shelter  Care  Cottage  (8) 

429  E.  Fifth  St. 

Williamson  Shelter  Care  Home  (17) 
407  W.  Fourth  St. 

MT.  OLIVE  (Macoupin  County) 

Albert  Sheltered  Care  Home  (13) 

101  W.  Fourth  St. 

MT.  STERLING  (Brown  County) 

Mt.  Sterling  Sheltered  Care  (15) 

117  E.  South  St. 

MT.  VERNON  (Jefferson  County) 
Hearthside  Sheltered  Care  Home  (21) 
318  N.  Ninth  St. 

MULBERRY  GROVE  (Bond  County) 
Smith’s  Sheltered  Care  Home  (17) 
ms.  Maple  St. 

MURPHYSBORO  (Jackson  County) 
River  Bend  Manor  (65) 

1501  Shomaker  Dr. 

NEWTON  (Jasper  County) 

duMont  Sheltered  Care  Home  (22) 

438  S.  Lafayette  St. 


504 


Illinois  Medical  Journal 


OBLONG  (Crawford  County)  jjjj 
Fouty’s  Sheltered  Care  Home  (16) 

507  S.  Garfield  St. 

Hart  Sheltered  Care  (14) 

403  N.  Range  St.  , 

ODELL  (Livingston  County) 

The  Odell  Shelter,  Inc.  (25) 

17  Henry  St, 

O’FALLON  (St.  Clair  County) 

Andricks  Shelter  Care  (8) 

135  Main  St. 

OLD  MARISSA  (St.  Clair  County) 

Old  Marissa  Sheltered  Care  Home  (17) 
OLNEY  (Richland  County) 

Braden  Sheltered  Care  (9) 

230  E.  North  Ave. 

Colonial  Manor  Sheltered  Care  (31) 

327  S.  Morgan  St. 

Marks  Sunset  Manor  (21) 

1044  Whittle 

Miller  Sheltered  Care  House  (11) 

103  E.  Lafayette  St. 

Rachel  Moore  Shelter  Care  (6) 

413  S.  Morgan 

ONARGA  (Iroquois  County) 

Jones  Sheltered  Care  (11) 

317  N.  Walnut 

OQUAWKA  (Henderson  County) 

Oquawka  Shelter  Home  (17) 
PALMYRA  (Macoupin  County) 

Light  House  Shelter  (10) 

PARIS  (Edgar  County) 

Colonial  Home  (6) 

623  N.  Central  Ave. 

Hefner  Shelter  Care  (6) 

210  Chestnut  St. 

Matthews  Shelter  Care  Home  (15) 

414  Douglas  St. 

Sanders  Sheltered  Care  Home  (11) 

813  Tenbrook 
PAW  PAW  (Lee  County) 

Pfeiffer  Sheltered  Care  Home  (10) 
PEKIN  (Tazewell  County) 

B.  J.  Perino  Shelter  Care  Home,  Inc.  (54) 
601-603  Prince  St. 

PEORIA  (Peoria  County) 

Senior  Citizens  Sheltered  Care  Home  (11) 
302  W.  Third  St. 

Waldo  Home  (45) 

405  N.  Perry  “ 

PERU  (LaSalle  County) 

Hillview  Manor  (12) 

2106  Market  St. 

PITTSFIELD  (Pike  County) 

Pittsfield  Sheltered  Care  House  (10) 

411  W.  Washington  St. 

PLANO  (Kendall  County) 

Wesley  Haven,  Inc.  (20) 

218  N.  Center 

PLYMOUTH  (Hancock  County) 

Thomas  Sheltered  Care  Home  (14) 

Box  323 


PONTIAC  (Livingston  County) 
Northcrest  Manor  (13) 

732  N.  Mill  St. 

PRINCEVILLE  (Peoria  County) 

Seven  Oaks  (13) 

Douglas  and  Tremont  Sts, 

QUINCY  (Adams  County) 

Bacon  Sheltered  Care  Home  (9) 
1435  N.  Fifth  St. 

Beever  Sheltered  Care  Home  (22) 
327  Elm  St. 

Frances  Shelter  Care  Home  (17) 

43 1 Locust  St. 

Sims  Shelter  House  (7) 

1619  N.  Fourth  St. 

ROCHELLE  (Ogle  County) 

Joyce  Old  Folks  Home  (16) 

609  N.  Sixth  St. 

ROCK  FALLS  (Whiteside  County) 
Riverview  Haven  (16) 

308  E.  2nd  St. 

ROCKFORD  (Winnebago  County) 
Bethany  House  (14) 

412  N.  Court  St. 

Parkview  Sheltered  Care  Home  (29) 
408  N.  Horsman  St. 

ROODHOUSE  (Greene  County) 
Dameron  Shelter  Care  Home  (12) 
114  E.  Palm  St. 

RUSHVILLE  (Schuyler  County)  - 
Lacey’s  Care  Home  (18) 

239  W.  Clay  St. 

ST.  JACOB  (Madison  County) 

Nolan  Sheltered  Care  Home  (25) 

R.  R.  1 

SALEM  (Marion  County) 

Hogge’s  Sheltered  Care  Home  (19) 
521  E.  Church  St. 

SANDOVAL  (Marion  County) 

Finn’s  Sheltered  Care  Home  (18) 

W.  North  Second  St. 

SAYBROOK  (McLean  County) 
Maplebrook  (15) 

Main  St. 

SESSER  (Franklin  County) 

Nixt  Sheltered  Care  Home  (4) 

303  W.  Mathew 

SHELDON  (Iroquois  County) 

Sheldon  Sheltered  Home  (44) 

170  W.  Concord 

SIMPSON  (Pope  County) 

Shawnee  Shelter  Care  (14) 

R.  R.  2 

SPARTA  (Randolph  County) 

Kirsby  Shelter  Home  (22) 

411  S.  St.  Louis  St. 

SPRINGFIELD  (Sangamon  County) 
Gannar  Cerebral  Palsy  Home  (11) 
910  S.  Second  St. 

Lane  Bryant  Retirement  Home  (14) 
1712  E.  Washington  St. 


for  October,  1968 


505 


Peart  Sheltered  Care  Home  (21) 

1010  S.  Second  St. 

Sunshine  Guest  Home  (16) 

607  S.  Fifth  St. 

Tomlin  Retirement  Home  (11) 

609  N.  Fourth  St. 

STOCKTON  (Jo  Daviess  County) 

Brog’s  Sheltered  Care  Haven  (13) 

205  E.  Benton  St. 

STREATOR  (LaSalle  County) 

Hillview  Sheltered  Care  Home  (18) 

5 1 8 S.  Bloomington  St. 

SULLIVAN  (Moultrie  County) 

Beals  Sheltered  Care  Home  (28) 

13  S.  McClellan  St. 

SYCAMORE  (DeKalb  County) 

The  Driscoll  Home  (15) 

309  N.  California 

TALLULA  (Menard  County) 

Garden  View  (13) 

N.  Ewing 

TILTON  (Vermilion  County) 

Smoot  Memorial  Home  (8) 

215  W.  Sixth  St. 

Mrs.  Etta  R.  Wangler  Anderson 
Sheltered  Care  Home  (7) 

605  E.  Fifth  St. 

URBANA  (Champaign  County) 

Clark  Sheltered  Care  Home  (13) 

8 1 1 W.  Oregon  St. 

Lustig  Sheltered  Care  Home  (16) 

904  W.  Clark  St. 

VANDALIA  (Fayette  County) 

The  Heritage  House  (44) 

Rt.  185  West 

VIRGINIA  (Cass  County) 

Virginia  Sheltered  Care  Home  (18) 

132  E.  mini  St. 

WARSAW  (Hancock  County) 

Carlson  Sheltered  Care  Home  (22) 

150  Main  St. 

WASHINGTON  PARK  (St.  Clair  County) 
Park  Retirement  Home  (33) 

2246  N.  57th,  East  St.  Louis 


WATSEKA  (Iroquois  County) 

Pleasant  Lodge  (28) 

590  E.  Grant  St. 

WAUKEGAN  (Lake  County) 

Marseilles  Retirement  Home,  Inc.  (28) 
604  N.  Genesee  St. 

WAVERLY  (Morgan  County) 

Witt  Sheltered  Care  Home  (18) 

405  S.  Miller  St. 

WEST  FRANKFORT  (Franklin  County) 
Peacock  Sheltered  Care  Home  (19) 

309  W.  Oak  St. 

Rankin  Sheltered  Care  Home  (6) 

312  E.  Fourth  St. 

Smith  Sheltered  Care  Home  (15) 

512  S.  Cherry  St. 

Wood  Sheltered  Care  Home  (7) 

609  S.  Monroe 

WEST  SALEM  (Edwards  County) 

Golden  Acres,  Inc.  (33) 

WHEATON  (DuPage  County) 

Tall  Tree  Guest  Home  (16) 

R.  R.  1,  Box  34 

WHITE  HALL  (Greene  County) 

Elliott  Sheltered  Care  Home  (14) 

601  N.  Main  St. 

Ford  Sheltered  Care  Home  (14) 

535  N.  Main  St. 

Powell  Sheltered  Care  Home  (7) 

144  E.  Lincoln  St. 

Shanahan  Sheltered  Care  Home  (10) 

43 1 Centennial  St. 

WINCHESTER  (Scott  County) 

Oak  Rest  Sheltered  Care  Home  (18) 

206  High  St. 

YORKVILLE  (Kendall  County) 

Himes  Sheltered  Care  Home  (11) 

N.  Bridge  St. 

ZION  (Lake  County) 

Robbins  Home  (9) 

3220  Emmans  Ave. 


HOMES  FOR  THE  AGED 

In  this  section,  the  following  symbols  are  used: 
A — sheltered  care  facilities,  B — nursing  care  fa- 
cilities, and  C — special  geriatric  facilities. 


ALHAMBRA  (Madison  County) 

Hitz  Memorial  Home — (AB-25) 

Belle  St. 

ALTON  (Madison  County) 

The  Loretto  Home — (A-60) 

417  Prospect  St. 

ARLINGTON  HEIGHTS  (Cook  County) 
Lutheran  Home  and  Service  for  the  Aged — 
(AB-203) 

800  W.  Oakton  St. 


AURORA  (Kane  County) 

Jennings  Terrace — (AB-106) 

275  S.  LaSalle  St. 

Sunnymere,  Inc. — (AB-48) 

925  Sixth  Ave. 

BELLEVILLE  (St.  Clair  County) 
Meredith  Memorial  Home — (A-85) 
Public  Square 
St.  Paul’s  Home — (AB-98) 

1021  W.  “E”  St. 


506 


Illinois  Medical  Journal 


BENSENVILLE  (DuPage  County) 

Bensenville  Home  Society — (AB-120) 

York  and  Memorial  Dr. 

BROOKFIELD  (Cook  County) 

The  British  Home — (AB-90) 

31st  and  McCormick  Ave. 

CANTON  (Fulton  County) 

Nancy  and  Ann  Kelley  Home  for  the 
Aged — (A-10) 

344  W.  Chestnut  St. 

CARLYLE  (Clinton  County) 

St.  Mary’s  Home  for  the  Aged — (A-42) 

501  Clinton  St. 

CHAMPAIGN  (Champaign  County) 

The  Garwood  Home — (A-29) 

1515  N.  Market  St. 

CHESTER  (Randolph  County) 

St.  Ann’s  Home — (AB-45) 

770  State  St. 

CHICAGO  (Cook  County) 

Augustana  Home  for  the  Aged — (AB-140) 
7540  Stony  Island  Ave. 

Bethany  Home — (AB-415) 

5015  N.  Paulina  St. 

Bohemian  Home  for  the  Aged — (AB-150) 
5061  N.  Pulaski  Rd. 

Chicago  Holland  Home  for  the  Aged — (A-140) 
240  W.  107th  PI. 

Church  Home  for  Aged  Persons — (AB-90) 
5435-45  Ingleside  Ave. 

Cosmopolitan  Community  Home — (A-25) 

51  E.  53rd  St. 

Covenant  Home — (AB-101) 

2725  W.  Foster  Ave. 

Drexel  Home,  Inc. — (ABC-230) 

6140  Drexel  Ave. 

Fridhem  Baptist  Home — (AB-95) 

11404  S.  Bell  Ave. 

George  J.  Goldman  Memorial  Home  for  the 
Jewish  Aged — (AB-37) 

1152  W.  Farwell  Ave. 

Home  for  the  Association  of  Jewish  Blind 
(A-43) 

3525  W.  Foster  Ave. 

Jane  Dent  Home — (A-22) 

4430-32  Vincennes  Ave. 

Jewish  Home  for  the  Aged — (ABC-286) 

1648  S.  Albany  Ave. 

Methodist  Old  Peoples  Home — (AB-191) 

1415  Foster  Ave. 

Northwest  Home  for  the  Aged — (AB-52) 

2201  N.  Sacramento  Ave. 

Norwegian  Lutheran  Bethesda  Home 
(AB-150) 

2833  N.  Nordica  Ave. 

Norwood  Park  Home — (AB-140) 

6016  N.  Nina  Ave. 

The  Old  People’s  Home  of  the  City  of 
Chicago — (AB-125) 

909  Foster  Ave. 

Park  View  Home — (ABC- 142) 

1401  N.  California  Ave. 


Sacred  Heart  Home — (AB-200) 

1550  S.  Albany  Ave. 

St.  Augustine — (AB-162) 

2358  N.  Sheffield  Ave. 

St.  Joseph’s  Home  for  the  Aged — (AB-178) 
2650  N.  Ridgeway  Ave. 

St.  Paul’s  House — (A-70) 

3831  N.  Mozart  St. 

Selfhelp  Home  for  the  Aged — (AB-42) 

4941  S.  Drexel  Blvd. 

Society  for  the  Danish  Old  People’s  Home 
(AB-89) 

5656  N.  Newcastle  Ave. 

Washington  and  Jane  Smith  Home — (ABC-190) 
2340  W.  113th  PI. 

DANVILLE  (Vermilion  County) 

Webster  Memorial  Home — (A-11) 

903  N.  Logan  Ave. 

ELBURN  (Kane  County) 

Fellowship  Deaconry — (A-1 1 ) 

526  N.  Main  St. 

ELGIN  (Kane  County) 

Oak  Crest  Residence — (AB-43) 

204  S.  State  St. 

EUREKA  (Woodford  County) 

Apostolic  Christian  Home  at  Eureka 
(AB-48) 

610  W.  Cruger  St. 

Maple  Lawn  Homes — (AB-96) 

Box  37,  R.R.  2 
EVANSTON  (Cook  County) 

Alonzo  Mather  Aged  Ladies  Home 
(AB-203) 

1615  Hinman  Ave. 

The  Georgian,  Division  of  Methodist  Old 
Peoples  Home — (AB-245) 

422  Davis  St. 

Homecrest  Foundation — (A-50) 

1430  Chicago  Ave. 

James  C.  King  Home  for  Old  Men 
(AB-84) 

1555  Oak  Ave. 

Lake  Crest  ViUa — (A-32) 

2601  Central  St. 

Pioneer  Place — (AB-113) 

2320  Pioneer  Rd. 

Presbyterian  Home — (AB-303) 

3200  Grant  St. 

FAIRBURY  (Livingston  County) 

Fairview  Haven,  Inc. — (AB-43) 

605-609  N.  Fourth 
FOREST  PARK  (Cook  County) 

Altenheim  (German  Old  Peoples  Home) 
(AB-250) 

7824  Madison  St. 

FREEPORT  (Stephenson  County) 
Freeport-Bensenville  Home — (A-20) 

822  W.  Stephenson  St. 

Park  View  Home — (A-25) 

South  Park  Blvd. 

St.  Joseph  Home  for  the  Aged — (AB-116) 

649  E.  Jefferson  St. 


for  October,  1968 


507 


GIRARD  (Macoupin  County) 

The  Home — (A-48) 

GLENVIEW  (Cook  County) 

Maryhaven  Village  for  Aged  and  Blind 
(AB-166) 

1700  E.  Lake  Ave. 

GOLDEN  (Adams  County) 

Golden  Good  Shepherd  Home,  Inc. — (AB-48) 
GURNEE  (Lake  County) 

Independent  Order  of  Vikings  Home  for 
Aged  Members — (AB-35) 

Grand  Ave. 

HIGHLAND  (Madison  County) 

Highland  Home— (A-27) 

1600  Walnut  St. 

HIGHLAND  PARK  (Lake  County) 

Villa  St.  Cyril— (AB-82) 
nil  St.  Johns  Ave. 

HINSDALE  (Cook  County) 

King-Bruwaert  House — (AB-79) 

6101  County  Line  Rd. 

HINSDALE  (DuPage  County) 

Godair  Home — (AB-53) 

6259  S.  Madison  St. 

JACKSONVILLE  (Morgan  County) 

Illinois  Christian  Home,  Inc. — (AB-110) 

873  Grove  St. 

JOLIET  (Will  County) 

Our  Lady  of  Angels  Retirement  Home 
(AB-100) 

1201  Wyoming  Ave. 

St.  Patrick  Retirement  Hotel — (AB-203) 

22  E.  Clinton  St. 

Salem  Home  for  the  Aged — (AB-82) 

1313  Rowell  Ave. 

JUSTICE  (Cook  County) 

Rosary  Hill  Convalescent  Home — (AB-75) 
9000  W.  81st  St. 

KEWANEE  (Henry  County) 

St.  Bernadette  Manor — (A-24) 

Elliott  St. 

The  Whiting  Home — (A-10) 

320  S.  Chestnut  St. 

KNOXVILLE  (Knox  County) 

Illinois  P.E.O.  Home — (A-35) 

415  E.  Main  St. 

LaGRANGE  PARK  (Cook  County) 

Plymouth  Place — (AB-182) 

315  N.  LaGrange  Rd. 

LAKE  VILLA  (Lake  County) 

American  Aid  and  Old  Peoples  Home 
Society — (A-18) 

Grand  Ave. 

LAWRENCEVILLE  (Lawrence  County) 

The  Methodist  Home — (AB-143) 

1601  S.  Sixteenth  St. 

LEMONT  (Cook  County) 

Holy  Family  Villa— (AB-1 12) 

123rd  St. 

Mother  Theresa  Home — (AB-54) 

1270  Main  St. 


LINCOLN  (Logan  County) 

Deaconess  Memorial  Home  Annex — (A -20) 

315  Eighth  St. 

MACOMB  (McDonough  County) 

Everly  House — (A-38) 

811  S.  Lafayette  St. 

MACON  (Macon  County) 

Eastern  Star  Home  at  Macon — (AB-1 11) 
MATTOON  (Coles  County) 

Illinois  I.O.O.F.  Old  Folk’s  Home — (AB-225) 
E.  Lafayette  St. 

MAYWOOD  (Cook  County) 

Maywood  Baptist  Home — (AB-229) 

316  Randolph  St. 

Maywood  Home  for  Soldiers  Widows — (A-32) 
224  N.  First  Ave. 

MEADOWS  (McLedn  County) 

Meadows  Mennonite  Home — (AB-58) 
MENDOTA  (LaSalle  County) 

Mendota  Lutheran  Home — (AB-42) 

504  Sixth  St. 

MORRISON  (Whiteside  County) 

Resthaven  Home  of  Whiteside  County — (A-23) 
Maple  Ave. 

MORTON  GROVE  (Cook  County) 

Bethany  Terrace  Retirement  and  Nursing 
Home — (AB-1 37) 

8425  N.  Waukegan  Rd. 

MT.  CARROLL  (Carroll  County) 

Caroline  Mark  Home — (A-16) 

222  E.  Lincoln  St. 

MT.  MORRIS  (Ogle  County) 

Pinecrest  Manor — (AB-122) 

414  S.  McKendrie  Ave. 

NEW  ATHENS  (St.  Clair  County) 

New  Athens  Home — (AB-36) 

203  S.  Johnson  St.  - 

NILES  (Cook  County) 

St.  Andrew  Home  for  the  Aged — (AB-225) 
7000  N.  Newark  Ave, 

St.  Benedict’s  Home  for  the  Aged — (AB-52) 
6930  W.  Touhy  Ave. 

NORMAL  (McLean  County) 

Shamel  Manor — (A- 100) 

509  N.  Adelaide 
NORRIDGE  (Cook  County) 

Central  Baptist  Home  for  the  Aged — (AB-94) 
7901  W.  Lawrence  Ave. 

NORTHLAKE  (Cook  County) 

Villa  Scalabrini — (AB-88) 

Wolf  Rd.  and  Palmer  St. 

NORTH  RIVERSIDE  (Cook  County) 

Scottish  Old  Peoples  Home — (AB-50) 

28th  St.  and  DesPlaines  Rd. 

OTTAWA  (LaSalle  County) 

Cora  J.  Pope  Home — (A-14) 

116  W.  Prospect  St. 

Pleasant  View  Luther  Home — (AB-1 46) 

505  College  Ave. 

PALATINE  (Cook  County) 

St.  Joseph’s  Home  for  the  Elderly — (AB-250) 
80  W.  Baldwin  Rd. 


508 


Illinois  Medical  Journal 


PARK  RIDGE  (Cook  County) 

St.  Matthew  Lutheran  Home — (AB-90) 

1601  N.  Western  Ave. 

PAXTON  (Ford  County) 

Illinois  Knight  Templar  Home  for  the 
Aged  Infirm — (B-29) 

706  S.  Washington  St. 

PEORIA  (Peoria  County) 

Apostolic  Christian  Home — (A-32) 

7023  Skyline  Dr. 

Christian  Buehler  Memorial  Home — (AB-223) 
3415  N.  Sheridan  Rd. 

Guyer  Memorial  Home — (A-18) 

201  W.  Columbia  Terr. 

John  C.  Proctor  Endowment  Home — (AB-224) 
1301  N.E.  Glendale  Ave. 

St.  Joseph’s  Home  for  the  Aged — (AB-200) 
2223  W.  Heading  Ave. 

PEOTONE  (Will  County) 

Peotone  Bensenville  Home — (AB-29) 

Wood  and  West  Sts. 

PONTIAC  (Livingston  County) 

Evenglow  Lodge — (A-151) 

201  E.  Washington  St. 

Humiston  Haven — (AB-74) 

300  W.  Lowell  St. 

PRICETON  (Bureau  County) 

Adeline  E.  Prouty  Home — (A-8) 

508  Park  Ave.  East 

QUINCY  (Adams  County) 

Anna  Brown  Home  for  the  Aged — (AB-35) 
1507  N.  Fifth  St. 

Good  Samaritan  Home — (AB-110) 

2130  Harrison  St. 

Methodist  Sunset  Home — (AB-144) 

418  Washington  St. 

St.  Vincent’s  Home — (A-130) 

1340  N.  Tenth  St. 

ROCKFORD  (Winnebago  County) 

Eastern  Star  Home  of  Rockford — (AB-102) 
2400  S.  Main  St. 

P.  A.  Peterson  Home — (AB-25) 

1301  Parkview  Ave. 


Wesley  Willows,  a Methodist  Retirement 
Home— (AB-228) 

4141  N.  Rockton  Ave. 

Winnebago  Home  for  the  Aged — (AB-39) 
Box  2,  Safford  Rd. 

ROCK  ISLAND  (Rock  Island  County) 
Cleveland  Home  for  the  King’s  Daughters 
of  Illinois,  Inc. — (A-23) 

805  Nineteenth  St. 

Huber  Memorial  Home — (A-23) 

1000— 30th  St. 

SPRINGFIELD  (Sangamon  County) 

Carrie  Post  King’s  Daughters  Home 
for  Women — (A-38) 

541  Black  Ave. 

Illinois  Presbyterian  Home — (A-61) 

W.  Lawrence  at  Chatham  Rd. 

Mary  Bryant  Home  for  the  Blind — (A-48) 
1100  S.  Fifth  St. 

St.  Joseph’s  Home  for  the  Aged — (A-125) 

S.  Sixth  Street  Rd. 

SULLIVAN  (Moultrie  County) 

Illinois  Masonic  Home — (AB-310) 

Rt.  121  East 

Titus  Memorial  Presbyterian  Home — (A-11) 
513  N.  Worth  St. 

TECHNY  (Cook  County) 

St.  Ann’s  Home  and  Infirmary — (AB-200) 
Waukegan  Rd. 

VIRDEN  (Macoupin  County) 

Mothers’  Memorial  Baptist  Home — (AB-27) 
402  W.  Loud  St. 

WHEELING  (Cook  County) 

Addolorata  Villa— (AB-85) 

Hwy.  83,  McHenry  Rd. 

WILMETTE  (Cook  County) 

Baha’i  Home — (A-20) 

401  Greenleaf  Ave. 

Maryhaven,  Inc. — (AB-113) 

2228  Beechwood  Ave. 

WOODSTOCK  (McHenry  County) 

Sunset  Manor,  Inc. — (AB-54) 

920  Seminary  Ave. 


EXTENDED  CARE  FACILITIES 

The  facilities  listed  below  have  been  surveyed  by  the  Illinois  Department  of  Public  Health  and 
certified  by  the  U.S.  Department  of  Health,  Education,  and  Welfare  as  Extended  Care  Facilities  for 
Medicare  beneficiaries,  as  of  Aug.  1,  1968.  The  number  of  certified  beds  within  the  facility  is 
indicated. 


ABINGDON 

Abingdon  Nursing  Home  (74) 

ALTON 

Eunice  E.  Smith  Home  (64) 
ANNA 

Union  County  Hospital  (19) 

ARTHUR 

The  Arthur  Home  (41) 

AUBURN 
Parks  Memorial  Home  (22) 

AURORA 

Borealis  Nursing  Home  (112) 
St.  Charles  Hospital  (26) 


AVON 

Avon  Nursing  Home  (48) 

BELLEVILLE 
Memorial  Nursing  Home  (111) 

St.  Elizabeth’s  Home  (54) 

BENTON 

Franklin  Hospital  Skilled  Nursing  (81) 
BERWYN 

Fairfax  Ger.  & Conv.  Center  (31) 

R N Convalescent  Home  (20) 
BLOOMINGTON 
Heritage  Manor  (47) 


for  October,  1968 


509 


CARBONDALE 

Styrest  Nursing  Home  (54) 

CARLINVILLE 
Lake  View  Nursing  Home  (74) 

CASEY 

Casey  Nursing  Home  (92) 

CENTRALIA 

Centralia  Fireside  House,  Inc.  (46) 
CHARLESTON 
Hilltop  Nursing  Home  (25) 

CHESTER 

St.  Ann’s  Home  (45) 

CHICAGO 

All  American  Nursing  Home  (144) 
Augustana  Home  for  Aged  (28) 

Austin  Congress  Nursing  Home  (68) 
Balmoral  Home,  Inc.  (67) 

Bethany  Methodist  Hosp.  (87) 

Brittany  Terrace  (49) 

Bryn  Mawr  House,  Inc.  (183) 

Drexel  Home  (132) 

Elston  Home  (41) 

Fargo  Beach  Home  (149) 

Fountainebleau  Manor  (32) 

Fox  River  Rehab.  Center  (74) 

Garden  View  Home  (57) 

Jewish  Home  for  Aged  (232) 

Johnson  Rehab.  Nursing  Home  (76) 
Kostner  Manor  (119) 

Melbourne  Convalescent  Home  (41) 
Montgomery  Convalescent  Home  (80) 
Northwest  Home  for  Aged  (26) 

Park  View  Home  (31) 

Rosewood  Terrace  (70) 

South  Shore  Kosher  Rest  Home  (111) 
South  Shore  Pavilion  (113) 

Sovereign  Home  (29) 

Vincennes  Manor  (110) 

Wellington  Plaza  (91) 

Westwood  Manor  (115) 

Wrightwood  Nursing  Home  (90) 

CHICAGO  HEIGHTS 
Riviera  Manor  (55) 

Suburban  Convalescent  Home  (49) 
CHILLICOTHE 
ParkHill  Nursing  Home  (66) 

COAL  VALLEY 
Oak  Glen  Nursing  Home  (286) 
COLCHESTER 
Colchester  Nursing  Home  (49) 

DANVILLE 
Colonial  Manor  (24) 

DECATUR 

Americana  Nursing  Center  of  Decatur  (65) 
Lakeshore  Manor  (28) 

DEKALB 

DeKalb  Public  Hospital  (15) 

Pine  Acres  Retirement  Center  (60) 

DESPLAINES 

Brookwood  Convalescent  Center,  Inc.  (Ill) 
Golf  Road  Pavilion  (142) 


DIXON 

Orchard  Glen  (54) 

DUQUOIN 

Fair  Acres  Nursing  Home  (29) 

ELMHURST 
Elmhurst  Nursing  Home  (42) 

ELGIN 

Simpson  House  (67) 

EVANSTON 

Dobson  Plaza  Nursing  Home,  Inc.  (52) 
Presbyterian  Home  (75) 

Three  Oaks  Nursing  Center  (124) 

EVERGREEN 

Evergreen  Gardens,  Inc.  (40) 

Peace  Memorial  Home  (60) 

FLORA 

Flora  Nursing  Center  (24) 

FULTON 

Harbor  Crest  Nursing  Home  (49) 
GALESBURG 
Americana  Nursing  Center  (34) 

GODFREY 

Blu-Fountain  Manor  Nursing  Home  (29) 
GENESEO 

Hammond  Henry  Dist.  Hospital  (48) 
GLENVIEW 

Golf  Mill  Nursing  Home  (166) 

HARVEY 

Heather  Manor  Convalescent  Center  (49) 

HIGHLAND  PARK 

Villa  St.  Cyril  (39) 

HIGHWOOD 

Pavilion  of  Highland  Park  (46) 

HILLSIDE 

Oakridge  Convalescent  Home  (24) 
HOPEDALE 
Hopedale  Nursing  Home  (86) 

JACKSONVILLE 

Modern  Care  Conv.  & Nsg.  Home  (40) 

JOLIET 

Americana  Nursing  Center  of  Joliet  (47) 

Our  Lady  of  Angels  Ret.  Home  (22) 

Salem  Home  for  Aged  (26) 

St.  Patricks  Residence  (20) 

KANKAKEE 

Americana  Nursing  Center  of  Kankakee  (92) 
Riverside  Hospital  (50) 

KEWANEE 

Spoon  River  Residence  (41) 

LACON 

St.  Joseph  Nursing  Home  (54) 

LAGRANGE 
LaGrange  Colonial  Manor  (49) 

LAWRENCEVILLE 
Methodist  Home  for  the  Aged  (40) 
LEWISTOWN 
Clarytona  Manor  (25) 

LIBERTYVILLE 

Lake  County  Nursing  Home  (83) 

LINCOLN 

Abraham  Lincoln  Mem.  ECF  (58) 

Christian  Nursing  Home  (25) 

Mary  Henry  Nursing  Home  (52) 


510 


Illinois  Medical  Journal 


LITCHFIELD 

Litchfield  Nursing  Home  (16) 

LOVES  PARK 
Fountain  Terrace  (49) 

MACOMB 

Americana  Nursing  Center  of  Macomb  (31) 
MARSHALL 
Burnside  Nursing  Home  (90) 

MATTOON 
Douglas  Nursing  Center  (49) 

MENDOTA 

Sunrise  Nursing  Home  (49) 

MOLINE 

Americana  Nursing  Center  (67) 

MORTON 

Restmor,  Inc.  (58) 

MT.  MORRIS 
Pinecrest  Manor  (50) 

MT.  VERNON 

Good  Samaritan  Hosp.  ECF  (20) 

Hickory  Grove  Manor  (54) 

MT.  ZION 

Woodland  Inc.  Nursing  Home  (70) 
MUNDELEIN 

North  Riverwood  Center,  Inc.  (65) 
NAPERVILLE 
Americana  Nursing  Center  (97) 

NEWTON 

Newton  Rest  Haven  (29) 

NILES 

Pleasantview  Conv.  Nursing  Ctr.  (91) 

NORMAL 

Americana  Nursing  Center  (51) 

Brokaw  Hospital  (50) 

NORTHBROOK 

Edenview  Convalescent  Home  (142) 
Northbrook  Nursing  Home  (71) 

OAK  FOREST 
Oak  Forest  Hospital  (1,429) 

OAK  LAWN 

Monticello  Convalescent  Ctr.  (50) 

Oak  Lawn  Convalescent  Home  (38) 

Parkside  Gardens  Nursing  Home  (77) 

O’FALLON 

Parkview  Colonial  Manor  (107) 

OLNEY 

Burgin  Manor  Nursing  Home  (26) 

OTTAWA 

Highland  San.  & Conv.  Home  (63) 

Pleasant  View  Luther  Home  (54) 

PALATINE 

Plum  Grove  Nursing  Home  (46) 

PARK  RIDGE 

St.  Matthew  Lutheran  Home  (29) 

PEKIN 

Pekin  Mem.  Hosp.  (34) 

PEORIA 

Americana  Nursing  Center  (65) 

High  View  Nursing  Home  (40) 

PEORIA  HEIGHTS 
Fireside  House,  Inc.  (54) 


PERU 

Heritage  Manor  (55) 

PETERSBURG 

Menard  Convalescent  Center  (18) 

PITTSFIELD 

Pittsfield  Nurs.  Home  (74) 

PONTIAC 

Evenglow  Lodge  (40) 

Humiston  Haven  (20) 

QUINCY 

Illinois  Soldiers  & Sailors  Home  (10) 

Methodist  Sunset  Home  (17) 

St.  Joseph  Hall  (72) 

ROCHELLE 

Americana  Nursing  Center  (49) 

ROCK  FALLS 
Colonial  Acres  Rest  Home  (55) 

ROCKFORD 

Alma  Nelson  Manor  (36) 

Americana  Nursing  Center  Rockford  (72) 
Riverside  Manor  (59) 

Wesley  Willows  (30) 

ROSICLARE 

Hardin  County  General  Hosp.  (4) 

SALEM 

Twin  Willows  Nursing  Center  (28) 

SHELBYVILLE 

Shelby  County  Mem.  Hospital  (20) 

Young’s  Shelbyville  Restorium  (22) 

SKOKIE 

Old  Orchard  Manor  (61) 

Village  Nursing  Home  (84) 

S.  CHICAGO  HEIGHTS 
Suburgan  Con.  Nursing  Home  (49) 
SPRINGFIELD 
Americana  Nursing  Center  (72) 

Everett  McKinley  Dirksen  Home  (109) 
Rutledge  Manor  Care  Home,  Inc.  (31) 
STERLING 

Colonial  Acres  Rest  Home  (70) 

STREATOR 
Heritage  Manor  (27) 

SULLIVAN 

East  View  Manor  (52) 

SUMNER 

Red  Hills  Rest  Haven  Nursing  Home  (44) 
SWANSEA 

Castle  Haven  Nursing  Home  (51) 
TAYLORVILLE 
Meadow  Manor  (36) 

TECHNY 

St.  Ann’s  Home  & Infirmary  (47) 

TUSCOLA 

Douglas  County  Jarman  Memorial  Hospital  (6) 
URBANA 

American  Nursing  Center  (50) 

Fontana  Nursing  Care  Center  (47) 

WATSEKA 
Iroquois  Resident  Home  (58) 

WASHINGTON 
Washington  Nursing  Center  (88) 


for  October,  1968 


511 


WATERLOO 

Monroe  County  Nursing  Home  (60) 
WAUKEGAN 

Terrace  Nursing  Home  (43) 

Waukegan  Pavilion  Nursing  Home  (96) 


WINFIELD 

Abbey -Winfield  Convalescent  Home  (49) 

WHEATON 

DuPage  County  Convalescent  Home  (53) 


INDEPENDENT  LABORATORIES 

The  Independent  Laboratories  listed  below  have  been  surveyed  by  the  Illinois  Department  of  Public 
Health  and  certified  by  the  U.S.  Department  of  Health,  Education  and  Welfare  as  providers  of 
service  for  Medicare  beneficiaries  as  of  August  2,  1968.  The  specific  tests  reimbursable  by  Medi- 
care are  indicated  in  parenthesis  following  the  name  of  each  laboratory: 


A.  Microbiology 

B.  Serology 

C.  Clinical  Chemistry 

D.  Hematology 

E.  Immunohematology 

F.  Tissue  Pathology 

G.  Exfoliative  Cytology 

H.  All  Clinical 


ARGO 

Argo  Clinical  Lab.  (BCD) 

6252  Archer  Road  60501 
ARLINGTON  HEIGHTS 
Arlington  Medical  Lab.  (F) 

1430  N.  Arlington  Heights  Rd.,  60004 
Village  Medical  Lab.,  (CDE) 

1009  S.  Evergreen,  60005 
AURORA 

Clinical  Lab.  (H) 

143  S.  Lincoln,  60505 
BARRINGTON 

Barrington  Medical  Lab.  (ABCD) 

606  S.  Northwest  Hwy.,  60010 
BELLEVILLE 

St.  Clair  Medical  Lab.  (ABCDFG) 

301  W.  Lincoln,  62220 
BERWYN 

Kenilworth  Lab.  (ABCDE) 

6905  W.  Cermak  Rd.,  60402 
Medica  Clinical  Lab.,  (ABD) 

3340  S.  Oak  Park  Ave.,  60403 
BLOOMINGTON 

Bloomington  Cornbelt  Biochmcl.  Lab.  (ABCD) 
705  North  East,  61701 
Hans  H.  Stroink,  M.D.  (H) 

214  Unity  Bldg.,  61701 
BROADVIEW 

Broadview  Physicians  Lab.  (ABCDE) 

220  W.  Roosevelt,  60155 
CHAMPAIGN 

Doctors  Bldg.  Lab.,  (BCD) 

301  E.  Springfield,  61820 
CHICAGO 

Avenue  Medical  Lab.  (ABCD) 

5959  N.  Washtenaw,  60645 
A & D Medical  Lab.  (ABCDE) 

3848  W.  63rd  St.,  60629 
A.  S.  Cahan,  M.D.  (BCDE) 

4010  W.  Madison  St.  , 60624 
Accurate  Medical  Lab  (ABCDE) 

5959  N.  Washtenaw  , 60645 


Almar  Clinical  Lab.  (ABCDE) 

2457  W.  Peterson  Ave.,  60645 
Anderson  Clinical  Lab.  (BCDE) 

811  W.  Wellington,  60657 
Apogee  Medical  Labs  Inc.  (ACD) 

5962  Lincoln  Ave.,  60645 
Aquinas  Medical  Lab.  (C) 

1 1 102  S.  Artesian  Ave.,  60655 
Arcade  Clinical  Lab.  (ACDE) 

6355  Broadway,  60626 
Associated  Medical  Lab.,  Inc.  (ABCDE) 
4753  Broadway,  60640 
Auburn  Clinical  Lab.  (BCD) 

946  W.  79th  St.  60620 
Austin  Clinical  Lab.  (BCDE) 

5679  W.  Madison  St.,  60644 
Avenue  Medical  Lab.  (ABCD) 

11318  S.  Michigan  Ave.,  60628 
Bel-Aire  Medical  Bldg.  Lab.  (ACDEG) 
8501  Cottage  Grove  60619 
Beverly-Sheridan  Labs.,  Inc.,  (ABCD) 
94491/2  S.  Ashland,  60620 
Brooks  Clinical  Lab.  (ABCDE) 

4006  Milwaukee  Ave.,  60641 
Central  Doctors’  Medical  Lab  (CD) 

2715  N.  Central  60639 
Central  X-Ray  & Clinical  Lab.  (H) 

111  N.  Wabash,  60602 
Chatham  Avalon  Clinical  Lab.  (BCDE) 
8222  Martin  Luther  King  Dr. 
Chemical  Consulting  Corp.  (C) 

6018  W.  Fullerton  60639 
Clearing  Clinic,  Inc.  (ABCDE) 

5548  W.  65th  St.,  60638 
Colonial  Medical  Lab.  (ABCD) 

2024  W.  79th  St.,  60620 
Doctors  Medical  Lab.,  Inc.  (ABD) 

11450  S.  Michigan  Ave.,  60628 
Drexal  Home  (CD) 

6140  S.  Drexel  60637 
Drs.  Mason  & Baron  (H) 

2056  N.  Clark  St.  60614 


512 


Illinois  Medical  Journal 


Foster-Western  Clinical  Lab.  (ABCDE) 
5214  N.  Western  Ave.,  60625 
Gerber  X-Ray  & Clinical  Lab.  (ABCDE) 
2400  W.  Devon,  60645 
Gerson  Clinical  Lab.  (ACD) 

1 N.  Pulaski  Rd.,  60624 
Highland  Medical  Labs.  (ABCDE) 

7922  S.  Ashland  Ave.,  60620 
Humboldt  Clinical  Lab.  (D) 

2018  S.  Ashland,  60608 
Hyde  Park  Medical  Lab.  (BCDG) 

5240  S.  Harper,  60615 
K & K Clinical  Lab.,  Inc.  (ABCD) 

5935  W.  Addison,  60634 
Kendon  Medical  Lab.,  Inc.  (ABCD) 

8625  S.  Cicero,  60652 
Letho  Clinical  Labs.  (H) 

1325  S.  Racine,  60608 
Marquette  Medical  Lab.  (ABCDE) 

6132  S.  Kedzie,  60629 
Mart  X-Ray  Lab.,  Co.  (ACD) 

7-110  Merchandise  Mart,  60654 
Maryhaven  Medical  Lab.,  Inc.  (CD) 

8700  S.  Dante,  60619 
Medic  Clinical  Lab.  (B) 

6317  S.  Western  Ave.  60636 
Medical  Associates  of  Chicago  (H) 

3233  Martin  Luther  King  Dr. 

Medical  Center  Clinical  Labs.  (CD) 

3528  N.  Ashland,  60657 
Metro  Lab.  (H) 

1737  W.  Howard,  60626 
Metro  Lab.  (H) 

30  N.  Michigan  Ave.,  60602 
Metro  Lab.  (H) 

2376  E.  71st  St.  60649 
Michael  Reese  Research  Foundation  (BDE) 
530  E.  31st  St.,  60616 
Midwest  Cytology  Lab.  (G) 

5707  N.  Ashland  Ave.,  60626 
Molay  Medical  Labs.  (ABCD) 

185  N.  Wabash,  60601 
Murphy — Uptown  Clinical  Lab  (CD) 

4763  Broadway  60640 
North  Beverly  Clinical  Lab.  (BCDE) 

1700  W.  87th  St.,  60620 
North-Kimball  Medical  Labs.  (BCDE) 

1579  N.  Milwaukee,  60622 
Ogden  Hill  Medical  Lab.  (B) 

3451  W.  63rd  St.  60629 
Omens  Medical  Bldg.  Lab.  (B) 

5720  W.  North  Ave.  60639 
P.  M.  D.  Clinical  Lab.  (CD) 

2017  W.  95th  St.  60643 
Parkview  Home  (ABCD) 

1401  N.  California,  60622 
Parkway  Labs.  (ABCDE) 

408  E.  Marquette  Rd.,  60637 
Pathology  Associates  (H) 

55  E.  Washington,  60602 
Peterson-Westem  X-Ray  Lab.  (ABCDE) 
2424  W.  Peterson  Ave.,  60645 


Physicians  & Surgeons  Clinical  Lab  (ABCDE) 
6710  W.  North  Ave.,  60635 
S (fe  S Medical  Lab.  (CD) 

532  E.  47th  St.,  60653 
Sarian  Medical  Labs.  (ABCDE) 

6257  S.  Archer,  60638 
Sauganash  Medical  & X-Ray  Lab.  (ABCD) 

4833  W.  Peterson,  60646 
South  East  Medical  Lab.  (CD) 

1832  E.  87th  St.,  60617 
South  Central  Medical  Lab.  (ABCDE) 

5050  S.  State  St.,  60609 
Thornburg  Clinical  Lab.  (ABCDE) 

720  N.  Michigan  60611 
Thornburg  Clinical  Lab  (CD) 

841  E.  63rd  St.  60637 
200  Clinical  Lab.  (BCDE) 

200  E.  75th  St.,  60619 
2011  Clinical  Lab.  (ABCD) 

2011  E.  75th  St.,  60649 
United  Medical  Lab.,  Inc.  (H) 

8 S.  Michigan  60603 
University  Lab.  (ABCDE) 

5 S.  Wabash,  60603 
West  Lawn  Medical  Lab.  (ABCD) 

4255  W.  63rd  St.,  60629 
Westerly  Medical  Lab.  (ABCDE) 

10404  S.  Western,  60643 
Westridge  Clinical  Lab.  (ABCD) 

6450  N.  California,  60645 
Westside  Clinical  Lab.  (CD) 

3808  W.  Roosevelt  Rd.,  60624 
Zeitlin  X-Ray  & Clinical  Lab.  (BCDE) 

2800  N.  Milwaukee,  60619 
63rd  Medical  Lab.  (ABCDE) 

749  W.  63rd  St.  60621 
95th  St.  X-Ray  & Clinical  Lab.  (ABCDE) 

243  W.  95th  St.  60628 
CICERO 

Suburban  Labs.,  Inc.  (ABCD) 

2137  S.  Lombard,  60650 
DECATUR 

Central  Clinical  Lab.  (ABCDE) 

1314  N.  Main,  62526 
DEERFIELD 

Colrad  Clinical  Labs.  (ABCD) 

747  Deerfield  Rd.,  60015 
DEKALB 

De  Graffenried  & Fisher  Clinical  Lab.  (H) 
1838  Sycamore  Rd.,  60115 
DES  PLAINES 

De  Ridge  Clinical  Lab.  (ABCDE) 

3200  Dempster,  60016 
DIXON 

Physicians  Medical  Lab.  (ABCD) 

101  First  St.,  61021 
EAST  ST.  LOUIS 
Appleton  Lab.  (BCD) 

234  Collinsville  Ave.  62201 
Clinical  Lab.  (ABCDE) 

4601  State  St.,  62201 


for  October,  1968 


513 


ELGIN 

Fox  Valley  Medical  Lab.  (H) 

860  E.  Summit,  60120 
ELMHURST 

Haven  Clinical  Lab.  (ABCD) 

103  Haven  Rd.,  60126 
Sandahl  Medical  Labs.  (ABCDE) 

135  S.  Kenilworth,  60126 
EVANSTON 
COS  Building  Lab.  (H) 

2500  Ridge  Ave.,  60201 
Gyne  Cytology  Lab.,  Inc  (G) 

636  Church  St.,  60201 
Pathology  Associates  (H) 

636  Church  St.,  60201 
EVERGREEN  PARK 
Anatomic  & Clinical  Pathology  Lab.  (G) 
P.  O.  Box  919,  60642 
FOREST  PARK 

Bowers  Lab.  (ABCDE) 

7450  Jackson  Blvd.,  60130 
FRANKLIN  PARK 

Franklin  Park  Medical  Lab.  (CDEFG) 

9711  Grand,  60131 
GALESBURG 

Galesburg  Clinic  Lab.  (ABCDE) 

320  N.  Kellogg,  61401 
Medical  Lab.  (H) 

628  Bondi  Bldg.,  61401 
GLENVIEW 

NW  Sub  X-Ray  & Clinical  Lab.  (ABCDE) 
924  Waukegan,  60025 
HARVEY 

Graham  Clinical  Lab.  (BC) 

468  E.  147th  St.,  60426 
HIGHLAND  PARK 

Highland  Park  Medical  Lab.  (ABCDE) 

1950  Sheridan  Rd.,  60035 
HINSDALE 

Pathology  Associates  (H) 

40  S.  Clay,  60521 
HOFFMAN  ESTATES 

Twinbrook  Medical  Lab.,  Inc.  (ABD) 

Golf  & Roselle  Rds.,  60172 
JOLIET 

Associated  Pathologists  (G) 

2112  W.  Jefferson  St.  60435 
Central  Lab.  (ABCDE) 

57  W.  Jefferson  St.,  6043 1 
Osier  Labs.,  Inc.  (CD) 

120  N.  Scott  St.,  60431 
Prescription  Shop  Lab.,  (ABCE) 

56  N.  Chicago,  60431 
Woodruff  Lab.,  Inc.  (ABCD) 

250  N.  Ottawa  St.,  60431 
KANKAKEE 

Medical  Center  Lab.  (ABCDE) 

1309  E.  Court,  60901 
LA  GRANGE 

La  Grange  Medical  Building  Lab.  (BCDE) 
47  S.  Sixth  Ave.,  60525 


LANSING 

De  Graff  Clinical  Lab.  (ABCDE) 

3341  Ridge  Rd.,  60438 
LA  SALLE 

Medical  Lab.  (ABCDE) 

555  2nd  St.,  61301 
MAYWOOD 

Josyln  Clinic  Lab.  (ABCDE) 

1908  St.  Charles  Rd.,  60153 
McHENRY 

McHenry  Medical  Group  (H) 

1110  N.  Green  St.,  60050 
MELROSE  PARK 

Delm  Clinical  Lab.  (ABCDE) 

1900  W.  Iowa  60160 
MOLINE 

Martin  Clinical  Lab.  (H) 

1520  7th  St.,  61265 
MORTON  GROVE 
Sommerfeld  Med.  Lab.  (ABCD) 

5818  Dempster  St.  60003 
MOUNT  PROSPECT 

Mt.  Prospect  Clinical  Lab.  (ACDE) 

321  W.  Prospect,  60056 
Prospect  Clinical  Lab.  (ABCD) 

1060  W.  Northwest  Hwy,  60056 
NORTHBROOK 

Northbrook  Cl.  & X-Ray  Labs.  (A^CD) 

1775  Walters,  60062 
OAK  BROOK 

Pathology  Associates  (H) 

120  Oak  Brook  Ctr.  ML,  60521 
OAK  PARK 

American  Medical  Lab.  (BCD) 

6441  W.  North  Ave.,  60302 
Arms  Medical  Lab.  (CD) 

414  S.  Oak  Park  Ave.  60302 
Hill  Clinical  Lab.  (H) 

1011  Lake  St.,  60301 
James  B.  Hartney,  M.D.  (FG) 

410  Lake  St.,  60302 
Mac  Gregor  Lab.  (BCDE) 

6144  W.  Roosevelt  Rd.  60304 
North  Riverside  Medical  Lab.,  Inc.  (ABCDE) 
1159  Westgate,  60301 
Twin  Oaks  Lab.  (ABCDE) 

101  W.  Madison  St.,  60304 
OGLESBY 

Physicians  Clinical  Lab.  (CD) 

338  E.  Walnut  St,  61348 
PALOS  HEIGHTS 

Palos  Medical  Lab.  (ABCDE) 

12150  S.  Harlem,  60463 
PEKIN 

The  Medical  Lab.  (ABCDE) 

519  Margaret,  61554 
PEORIA 

M B Clinical  Lab.  (ABCDE) 

818  Main  Street,  61606 
Medical  Center  Labs.  (H) 

416  St  Marks  Ct,  61603 


514 


Illinois  Medical  Journal 


Wm.  Schwarzendruber  Lab.  (ABCD) 

300  E.  War  Mem.  Dr.,  61614 
ROCKFORD 

Medical  Labs,  of  Pathology  (H) 

1221  E.  State  St.,  61108 
SKOKIE 

Dempster  Street  Pathology  Lab.  (BDFG) 
4240  Dempster,  60076 
Lincoln  Medical  Lab.  (CD) 

4535  Oakton,  60076 
North  Sub.  Clinical  Lab.  (ABCDE) 

4801  Church  St.,  60076 
Pasco  Medical  Lab.  (BCDG) 

64  Old  Orchard  60076 
SPRINGFIELD 

Capitol  Clinical  Labs.  (ABCDE) 

1104  S.  Second,  62704 
Physicians  Medical  Lab.  (ABCDE) 

501  N.  6th  St.,  62705 
Springfield  Clinical  Lab.  (ABCD) 

1025  S.  7th  St.  62703 


Ardmore  Pharmacy  Inc.  (BCD) 
317  S.  Ardmore  Ave.  60181 
WAUKEGAN 

Besley-Waukegan  Clinic  (ABCDE) 
215  N.  Sheridan  Rd.,  60085 

Physicians  & Surgeons  Lab.  (H) 
1616  W.  Grand,  60085 
WHEATON 

Drs.  Mason  & Barron  (H) 

200  E.  Willow  60187 
WILMETTE 

Wilmette  ClinicaJ  Lab.  (H) 

165  Green  Bay  Rd.,  60091 
WINNETKA 

Clini-Tech  Labs.,  Inc.  (ABCD) 
1048  Gage  St.,  60093 

Winnetka  Clinical  Lab.  (ABCDE) 
725  Elm  St.,  60093 
ZION 

Zion  Clinic  Lab  (CDE) 

2629  Sheridan  Rd.,  60099 


ARTIFICIAL  KIDNEY  CENTERS 

As  of  May  1,  1968,  these  centers  may  be  contacted  regarding  renal  dialysis. 


Children’s  Memorial  Hospital 
2300  Children’s  Plaza 
Chicago 

Phone:  348-4040 

Person  in  Charge: 
Location  in  Hosp: 

Alan  Siegel,  M.D. 
Nephrology 

Edgewater  Hospital 
5700  N.  Ashland  Avenue 
Chicago 

Phone:  UP  8-6000 
Person  in  Charge: 
Location  in  Hosp: 

Rogelio  Riera,  M.D. 
Surgery 

Michael  Reese  Hospital 
2929  South  Ellis  Avenue 
Chicago 

Phone:  225-5525 

Person  in  Charge: 
Location  in  Hosp: 

Dr.  Allan  Kanter 
Department  of  Medicine 
Division  of  Renal  Medicine 

Mt.  Sinai  Hospital 
California  Ave.  at  15th  Street 
Chicago 

Phone:  277-4000 

Person  in  Charge: 
Location  in  Hosp: 

Dr.  George  Dunea 
Department  of  Medicine 

Passavant  Memorial  Hospital 
303  E.  Superior  Street 
Chicago 

Phone:  WH  4-4200 
Person  in  Charge: 
Location  in  Hosp: 

Francesco  del  Greco,  M.D. 
Artificial  Kidney 

Presbyterian-St.  Lukes  Hospital 
1753  West  Congress  Parkway 
Chicago 

Phone:  738-4411 

Person  in  Charge: 
Location  in  Hosp: 

Robert  M.  Kark,  M.D. 
Division  of  Medicine 

University  of  Chicago  Hospital 

950  E.  59th  Street 

Chicago 

Phone:  MU  4-6100 
Person  in  Charge: 
Location  in  Hosp: 

Dr.  Marvin  Forland 
Department  of  Medicine 

University  of  Illiaois  Research 
and  Educational  Hospital 
840  South  Wood  Street 
Chicago 

Phone:  663-7591 

Person  in  Charge: 
Location  in  Hosp: 

Clarence  Gantt,  M.D. 
Clinical  Research  Center 

St.  Joseph  Hospital 
277  Jefferson  Avenue 
Elgin 

Phone:  741-5400 

Person  in  Charge: 
Location  in  Hosp: 

Charles  K.  Bobelis,  M.D. 
Artificial  Kidney  Dept. 

for  October^  1968 


Evanston  Hospital 
2650  Ridge  Avenue 
Evanston 

Riverside  Hospital 
350  N.  Wall 
Kankakee 


Phone:  492-2000 

Person  in  Charge: 
Location  in  Hosp: 

Phone:  933-1671 

Person  in  Charge: 
Location  in  Hosp: 


Dr.  Bernard  Adelson 
Kidney  Dialysis  Dept. 

Dr.  Eugene  Anderson 
Intensive  Care 


Pres  ently 

West  Suburban  Hospital 
518  North  Austin  Boulevard 
Oak  Park 

St.  Francis  Hospital 
530  N.E.  Glen  Oak 
Peoria 

Swedish-American  Hospital 
1316  Charles  Street 
Rockford 

Memorial  Hospital 
First  & Miller  Streets 
Springfield 

St.  John’s  Hospital 
701  E.  Mason  Street 
Springfield 


available  for  acute  poisoning  ( 

Phone:  EU  3-6200 
Person  in  Charge: 
Location  in  Hosp: 

Phone:  674-7731 

Person  in  Charge: 
Location  in  Hosp: 

Phone:  968-6898 

Person  in  Charge: 
Location  in  Hosp: 

Phone  528-2041 
Person  in  Charge: 
Location  in  Hosp: 

Phone:  544-4451 
Person  in  charge: 


only 


Robert  Muehrcke,  M.D. 
Kidney  Dialysis  Room-2nd  FI. 

Ext.  605 

Dr.  J.  D.  Myers 

Chronic  Dialysis  Unit 

Dr.  John  Berry 
Intensive  Care 

Antonio  Versaci,  M.D. 
Intensive  Care 


Sister  M.  Jane 


HOME  HEALTH  AGENCIES 
CERTIFIED  UNDER  TITLE  18  (MEDICARE) 
AUGUST  1,  1968 

In  addition  to  providing  skilled  nursing 
service,  Home  Health  Agencies  are  certified 
for  providing  the  following  specific  secondary 
services : 


M.S.S. — Medical  Social  Services 
SP.T. — Speech  Therapy 
P.T. — Physical  Therapy 
O.T. — Occupational  Therapy 
H.H.A. — Home  Health  Aide  Service 

ALEDO 

Mercer  County  Health  Department 
Court  House,  Aledo  61231 
P.O.— O.T.— Sp.T. 

ALTON 

Family  Service  and  Visiting  Nurse  Assn.  - 
211  E.  Broadway  Alton  62002 
M.S.S. 

AURORA 

Visiting  Nurse  Association  of  Aurora 
320  N.  Lake  St.  60506 
Sp.T. 

RELLWOOD 

Community  Nursing  Service  of  Proviso  Township 
233  Mannheim  Rd.,  Bellewood  60104 
P.T. 


CAIRO 

Tri  County  Health  Department 
1115  Cedar  St.,  Cairo  62914 
Sp.T. 

CAMBRIDGE 

Henry  County  Health  Department 
Court  House  Annex,  Cambridge  61238 

P.T. 

CANTON 

Fulton  County  Health  Department 
31  S.  Main  St.,  Canton  61520 

P.T. 

CHAMPAIGN 

Champaign-Urbana  Public  Health  District 
505  S.  Fifth  St,  Champ  ign  61820 

P.T. 


516 


Illinois  Medical  Journal 


CHARLESTON 

Charleston  Community  Memorial  Hospital 
Rt.  130,  Charleston  61920 
P.T. 

CHICAGO 
Alvema  Home  Nursing  Center 
1437  W.  51st  St.,  Chicago  60609 

P.T. 

Babette  & Emanuel  Mandel  Clinic 
508  E.  29th  St.,  Chicago  60616 
P.T.— O.T.— M.S.S. 

Cook  County  Dept,  of  Public  Health 
1425  S.  Racine  Ave.,  Chicago  60608 
P.T. 

Drexel  Home  Inc. 

6140  S.  Drexel  Ave.,  Chicago  60637 
P.T.— O.T.— M.S.S.— H.H.A. 

Jewish  Home  For  Aged 
1648  S.  Albany  Ave.,  Chicago  60623 
P.T.— O.T.— Sp.T.— M.S.S.— H.H.A. 

Mt.  Sinai  Hospital  Medical  Center 
Cahfomia  Ave  & 15th  St.,  Chicago  60608 
P.T.—O.T.— Sp.T.— M.S.S. 

Park  View  Home 

1401  CaUfornia  Ave.,  Chicago  60622 
P.T.—O.T.— Sp.T.— M.S.S.— H.H.A. 

V.  N.  A.  of  Chicago 
5 S.  Wabash  Ave.,  Chicago  60603 
P.T.— Sp.T.— M.S.S.— H.H.  A. 

CLINTON 

DeWitt-Piatt  Bi-County  Health  Unit 
122  E.  Main  St.,  Clinton  61727 
Sp.T. 

DANVILLE 

Child  Welfare  and  Visiting  Nurse  Association  Inc. 
402  N.  Hazel  St.,  Danville  61832 
M.S.S.— P.T. 

Vermilion  County  Health  Department 
808  N.  Logan  Ave.,  Danville  61832 
M.S.S. 

DECATUR 

Visiting  Nurse  Association  of  Macon  County 
1891  North  Water  St.,  Decatur  62523 
P.T.—O.T.— H.H.A. 

DeKALB 

DeKalb  County  Health  Department 
1731  Sycamore  Rd.,  DeKalb  60115 
P.T.— Sp.T. 

DES  PLAINES 

Des  Plaines  Dept,  of  PubHc  Health 
City  Hall,  Des  Plaines  60016 
P.T.— Sp.T. 

DIXON 

Lee  County  Health  Department 
316  W.  Third  St.,  Dixon  61021 
Sp.T. 

EAST  MOLINE 

East  Moline  Visiting  Nurse  Association 
915 — 16th  Ave.,  East  Moline  61244 
P.T. — Sp.T.— O.T. 


EAST  ST.  LOUIS 

Visiting  Nurse  Assoc,  of  St.  Clair  County 
4601  State  St.,  East  St.  Louis  62205 
P.T.—O.T.— Sp.T.— H.H.A. 

EFFINGHAM 

Effingham  County  Health  Department 
112  E.  Section  Ave.,  Effingham  62401 

P.T. 

ELDORADO 

Egyptian  Health  Department 
1333  Locust  St.,  Eldorado  62930 
Sp.T. 

ELGIN 

Elgin  Health  Center 

370  E.  Chicago  St.,  Elgin  60120 

P.T. 

EVANSTON 

Visiting  Nurse  Association  of  Evanston 
828  Davis  St.,  Evanston  60201 
P.T.— Sp.T.— H.H.A. 

FLORA 

Clay  County  Health  Dept. 

104Vi  W.  Second  St.,  Flora  62839 
M.S.S. 

FREEPORT 

Stephenson  County  Health  Dept. 

12  N.  Galena  Rd.,  Freeport  61032 
Sp.T. 

Visiting  Nurse  Assoc,  of  Amity  Societies 
7 N.  State  St.,  Freeport  61032 

P.T. 

GALENA 

Jo  Daviess  County  Health  Department 
311  S.  Main  St.,  Galena  61036 

P.T. 

GOLCONDA 

Quadri-County  Health  Department 
Golconda  62938 
P.T.—O.T.— Sp.T. 

GREENVILLE 
Bond  County  Health  Department 
100  N.  Locust  St.,  Greenville  62246 

P.T. 

HARDIN 

Calhoun  County  Health  Department 
Sweeney  Professional  Bldg.,  Hardin  62047 

P.T. 

HIGHLAND  PARK 

Visiting  Nurse  Association  of  Deerfield  Township 
718  Glenview  Ave.,  Highland  Park  60035 
P.T. 

JACKSONVILLE 

Morgan  County  Health  Dept.  & Visiting  Nurse 
Association 

23414  W.  State  St.,  Jacksonville  62650 

P.T. 


for  October,  1968 


517 


JERSEYVILLE 
Jersey  County  Health  Department 
Courthouse,  Jerseyville  62052 
P.T. 

JOHNSTON  CITY 

Franklin — Williamson  Bi-County  Health  Dept. 
217  E.  Broadway,  Johnston  City  62951 

P.T. 

JOLIET 

Public  Health  Council 
IO2V2  E.  Van  Buren  St.  Joilet  60432 
P.T. 

Will  County  Health  Department 
21  E.  Van  Buren,  Joilet  60435 
P.T. 

LaSALLE 

Hygienic  Institute 
151  Fifth  St.,  LaSalle  61301 
P.T. 

LAKE  FOREST 

Lake  Forest  Hospital  Home  Care  Patients 
660  N.  Westmoreland  Rd.,  Lake  Forest  60045 
P.T. 

LAWRENCEVILLE 
Lawrence  County  Health  Department 
Courthouse,  Lawrenceville  62439 
P.T. 

LINCOLN 

Abraham  Lincoln  Memorial  Home  Health  Serv. 
315  Eighth  St.,  Lincoln  62656 
P.T.— Sp.T. 

MARSEILLES 
Marseilles  Nursing  Service 
227  S.  Main  St.,  Marseilles  61341 
P.T. 

McHENRY 

McHenry  County  Health  Department 
605  N.  Green  St.,  Woodstock  60050 
P.T. 

MOLINE 

Moline  Visiting  Nurse  Association 
1409 — 7th  Ave.,  Moline  61265 
P.T.— O.T.— Sp.T. 

MORRIS 

Grundy  County  Health  Department 
Courthouse,  Morris  60450 
P.T. 

MOUNT  CARROLL 
Carroll  County  Health  Department 
Courthouse,  Mount  Carroll  61053 
P.T. 

MURPHYSBORO 

Jackson  County  Health  Department 
lOlSVz  Chestnut  St.,  Murphysboro  62966 
Sp.T. 

OAK  LAWN 

Stickney  Public  Health  District 
5636  State  Rd.,  Oak  Lawn  60459 
M.S.S. 


OAK  PARK 

Community  Nursing  Service  of  Oak  Park  & River 
Forest 

124  S.  Marion  St.,  Oak  Park  60302 
P.T.— Sp.T.— O.T.— H.H.A. 

OREGON 

Ogle  County  Health  Department 
106  S.  5th  St.,  Oregon  61061 
P.T. 

OTTAWA 

Ottawa  Public  Health  Nursing  Assn. 

417  W.  Madison  St.,  Ottawa  61350 
P.T. 

PARK  FOREST 

Park  Forest  Public  Health  Nursing  Service 
Village  Hall,  200  F B,  Park  Forest  60466 
H.H.A. 

PEKIN 

Home  Care  Program  Pekin  Memorial  Hospital 
Corner  of  Court  & 14th  St.,  Pekin  61554 
H.H.A. 

PEORIA 

Peoria  County  Health  Department 
2114  N.  Sheridan  Rd.,  Peoria  61604 
P.T.— Sp.T.— O.T.— M.S.S. 

Visiting  Nurse  Assn,  of  Peoria  and  Peoria  NPC 
510  W.  High  St.,  Peoria  61606 
H.H.A.—O.T.—P.T.— M.S.S. 

PETERSBURG 

Menard  County  Health  Department 
Courthouse,  Petersburg  62675 
Sp.T. 

PITTSFIELD 

Pike  County  Health  Department 
Courthouse,  Pittsfield  62363 
P.T. 

PONTIAC 

Livingston  County  Public  Health  Dept. 

419  Bank  of  Pontiac  Bldg.,  Pontiac  61764 
P.T. 

PRINCETON 

Bureau  County  Health  Department 
Hotel  Clark,  Princeton  61356 
Sp.  T. 

QUINCY 

Adams  County  Health  Department 
333  N.  Sixth  St.,  Quincy  62301 
P.T.— M.S.S. 

ROCK  FALLS 

Whiteside  County  Board  of  Health 
201  W.  First  St.,  Rock  Falls  61071 
P.T. 

ROCK  ISLAND 
Rock  Island  Co.  Dept,  of  Health 
County  Courthouse,  Rock  Island  61201 
P.T. — Sp.T.— O.T. 

Rock  Island  Visiting  Nurse  Association 
1019 — 27th  Ave.,  Rock  Island  61201 
P.T.— Sp.T.— O.T. 


518 


Illinois  Medical  Journal 


ROCKFORD 

Visiting  Nurses  Association  of  Rockford 
703  Grove  St.,  Rockford  61108 
P.T. 

SHELBYVILLE 
Shelby  County  Health  Department 
123  N.  Broadway,  Shelbyville  62565 
Sp.T.— P.T. 

SILVIS 

Silvis-Carbon  Cliff  Visiting  Nurse  Assn. 
1040  First  Ave.,  Silvis  61282 
P.T.— Sp.T.— O.T. 

SKOKIE 

Skokie  Health  Department 
5127  Oakton  St.,  Skokie  60076 

P.T. 

Visiting  Nurse  Assn.,  of  Skokie  Valley 
5255  Main  St.,  Skokie  60076 
P.T.— Sp.T.— H.H.A. 

SPARTA 

Randolph  County  Health  Department 
112  W.  Jackson  St.,  Sparta  62286 

P.T. 

SPRINGFIELD 

Visiting  Nurse  Assn,  of  Sangamon  County 
730  E.  Vine  St.,  Springfield  62703 

P.T. 


TUSCOLA 

Douglas  County  Health  Department 
705  N.  Main  St.,  Tuscola  61953 
P.T. 

WATSEKA 
The  Iroquois  Hospital 
200  Fairman  St.,  Watseka  60970 
P.T.— Sp.T. 

WAUKEGAN 

Community  Nursing  Service  of  Lake  County,  Inc. 
1515  Washington  St.  Waukegan  60085 
P.T. 

WHEATON 

DuPage  County  Health  Dept.  & Nursing  Service 
222  E.  Willow,  Wheaton  60188 
P.T.— H.H.A. 

WILMETTE 
Wilmette  Visiting  Nurse  Ass’n. 

905  Ridge  Rd.,  Wilmette  60091 
P.T.— H.H.A. 

WINNETKA 

North  Shore  Visiting  Nurse  Ass’n 
614  Lincoln  Ave.,  Winnetka  60093 
P.T. 

WOODSTOCK 

McHenry  County  Dept.,  Public  Health 
209  N.  Benton  St.,  Woodstock  60050 
P.T. 


TAYLORVILLE  YORKVILLE 

Christian  County  Health  Department  Kendall  County  Health  Department 

106  E.  Main  St.,  Taylorville  62568  County  Courthouse,  Yorkville  60560 

P.T.— Sp.T.  P.T. 


MEDICAL  SCHOOLS  IN  THE  STATE  OF  ILLINOIS 


Chicago  Medical  School 
2020  W.  Odgen  Ave. 

Chicago,  111.  60612 

Leroy  Levitt,  M.D.,  Dean 
226-4100 

University  of  Chicago  Pritzker  School  of  Medicine 
950  E.  59th  St. 

Chicago,  111.  60637 

Leon  Jacobson,  M.D.,  Dean 
MU  4-6100 
MU  3-0800 


Northwestern  University  Medical  School 
710  N.  Lake  Shore  Dr. 

Chicago,  111.  60611 

Richard  H.  Young,  M.D.,  Dean 
649-8649 

University  of  Illinois  College  of  Medicine 
1853  W.  Polk  St. 

P.O.  Box  6998 
Chicago,  111.  60680 
William  Grove,  M.D.,  Dean 
663-7000 


Stritch  School  of  Medicine — Loyola  University 
1400  S.  First  Ave.,  Hines,  El.  60141 
921-2610 

John  F.  Sheehan,  M.D.,  Dean 
706  S.  Wolcott  Ave. 

Chicago,  El.  60612 
SE  3-8040 


for  October,  1968 


519 


APPROVED  SCHOOLS  OF  X-RAY  TECHNOLOGY 


ARLINGTON  HTS. — Northwest  Community 
Hospital 

AURORA — Copley  Memorial  Hospital 
St.  Joseph  Mercy  Hospital 
BLOOMIN  GT  ON — Bloomington -N  ormal 
Hospital 

BLUE  ISLAND — St.  Francis  Hospital 
CENTRALIA — St.  Mary’s  Hospital 
CHAMPAIGN — Burnham  City  Hospital 
CHICAGO — Chicago  Wesley  Memorial  Hospital 
Cook  County  Graduate  School  of 
Medicine 

Edgewater  Hospital 
Englewood  Hospital 
Evangelical  Hospital 
Franklin  Boulevard  Community 
Hospital 
Grant  Hospital 
Henrotin  Hospital 
Illinois  Masonic  Hospital 
Louis  A.  Weiss  Memorial  Hospital 
Lutheran  Deaconess  Hospital 
Michael  Reese  Hospital 
Mt.  Sinai  Hospital 
Norwegian-American  Hospital 
Presbyteriaii-St.  Luke’s  Hospital 
Provident  Hospital 
Ravenswood- Hospital 
Roseland  Community  Hospital 
St.  Anne’s  Hospital 
St.  Bernard’s  Hospital 
St.  Elizabeth’s  Hospital 
St.  Joseph  Hospital 
St.  Mary  of  Nazareth  Hospital 
South  Chicago  Community  Hospital 
Woodlawn  Hospital 


DANVILLE — Lake  View  Memorial  Hospital 
DECATUR — Decatur  and  Macon  County  Hospital 
DIXON — Dixon  Public  Hospital 
EAST  ST.  LOUIS — Centreville  Township  Hos- 
pital 

ELMHURST — Memorial  Hospital  of  DuPage 
County 

EVANSTON — St.  Francis  Hospital 
EVERGREEN  PARK — Little  Company  of  Mary 
Hospital 

GREAT  LAKES— U.S.  Naval  Hospital 
HARVEY — Ingalls  Memorial  Hospital 
HINSDALE — Hinsdale  Sanitarium  and  Hospital 
JOLIET — Silver  Cross  Hospital 
KANKAKEE — St.  Mary’s  Hospital 
KEWANEE — Kewanee  Public  Hospital 
MOLINE — Luthem  Hospital 

Moline  Public  Hospital 
OAK  PARK — ^West  Suburban  Hospital 
PARK  RIDGE— Lutheran  General  Hospital 
PEORIA — Methodist  Hospital  of  Central  Illinois 
St.  Francis  Hospital 
QUINCY — Blessing  Hospital 
St.  Mary  Hospital 

ROCKFORD — Rockford  Memorial  Hospital 
St.  Anthony  Hospital 
Swedish-American  Hospital 
ROCK  ISLAND — St.  Anthony’s  Hospital 
SKOKIE — Skokie  Valley  Community  Hospital 
SPRINGFIELD — Memorial  Hospital 
St.  John’s  Hospital 
URBANA — Carle  Memorial  Hospital 
Mercy  Hospital* 


APPROVED  SCHOOLS  OF  CYTOTECHNOLOGY 


CHICAGO — Michael  Reese  Hospital  and 
Medical  Center 

Mount  Sinai  Hospital  Medical  Center 
University  of  Chicago  Hospitals  and 
Clinics 

EVANSTON — Evanston  Hospital 

St.  Francis  Hospital 

EVERGREEN  PARK— Little  Company,  of 

Mary  Hospital 

FREEPORT — Freeport  Memorial  Hospital 
GENEVA — Community  Hospital 
HARVEY — Ingalls  Memorial  Hospital 
HINSDALE — Hinsdale  Sanitarium  and  Hospital 
JOLIET — Silver  Cross  Hospital 
St.  Joseph  Hospital 
MOLINE — Moline  Public  Hospital 


OAK  LAWN — Christ  Community  Hospital 
OAK  PARK — ^West  Suburban  Hospital 
PEORIA — Methodist  Hospital,  Proctor  Com- 
munity Hospital  and  St.  Francis 
Hospital 

QUINCY— St.  Mary’s  Hospital 

ROCKFORD — Rockford  Memorial  Hospital,  St. 

Anthony  Hospital  and  Swedish- 
American  Hospital 

ROCK  ISLAND — St.  Anthony  Hospital 
SPRINGFIELD — Memorial  Hospital 
St.  John’s  Hospital 

URBANA — Carle  Foundation 
WAUKEGAN— St.  Therese’s  Hospital 
WINFIELD — Central  Dupage  Hospital 


520 


Illinois  Medical  Journal 


APPROVED  SCHOOLS  OF 
MEDICAL  TECHNOLOGY 

AURORA — Copley  Memorial  Hospital 
BLUE  ISLAND — St.  Francis  Hospital 
CHAMPAIGN — Burnham  City  Hospital 
CHICAGO — ^Alexian  Brothers  Hospital,  Augus- 
tana  Hospital,  Chicago  Wesley  Me- 
morial Hospital,  Edgewater  Hos- 
pital, Grant  Hospital  of  Chicago, 
Holy  Cross  Hospital,  Illinois  Ma- 
sonic Hospital,  Louis  A.  Weiss  Me- 
morial Hospital,  Michael  Reese  Hos- 
pital, Mount  Sinai  Hospital,  North- 
western University  Medical  School, 
(Passavant  Memorial  Hospital), 
Presbyterian-St.  Luke’s  Hospital,  St. 
Anne’s  Hospital,  St.  Anthony  de- 
Padua  Hospital,  St.  Bernard’s  Hos- 
pital, St.  Joseph  Hospital,  St.  Mary 
of  Nazareth  Hospital,  University  of 
Illinois  School  of  Associated  Medi- 
cal Sciences  and  Veterans  Admin- 
istration Research  Hospital. 
CHICAGO  HEIGHTS— St.  James  Hospital 
DANVILLE — Lake  View  Memorial  Hospital 
DECATUR — ^Decatur  and  Macon  County  Hos- 
pital and  St.  Mary’s  Hospital 


APPROVED  SCHOOLS  FOR  MEDICAL 
RECORD  LIBRARIANS 

CHICAGO — University  of  Illinois  at  the 
Medical  Center 


APPROVED  SCHOOLS  OF 
INHALATION  THERAPY 

CHICAGO — Cook  County  Hospital,  Edgewater 
Hospital,  University  of  Chicago  Hos- 
pitals 

MELROSE  PARK — Gottlieb  Memorial  Hospital 
MOLINE — Lutheran  Hospital 
SPRINGFIELD — Memorial  Hospital,  St.  John’s 
Hospital 

APPROVED  COURSE  IN 
OCCUPATIONAL  THERAPY 

CHICAGO — University  of  Ilhnois  College  of 
Medicine 

APPROVED  SCHOOL  OF 
PHYSICAL  THERAPY 

CHICAGO— Northwestern  University  Medical 
School 

APPROVED  SCHOOLS  OF 
CERTIFIED  LABORATORY  ASSISTANTS 

ALTON — ^Alton  Memorial  Hospital 
CHICAGO — St.  Elizabeth’s  Hospital,  Swedish 
Covenant  Hospital  and  Veterans  Ad- 
ministration West  Side  Hospital. 
DANVILLE — St.  Elizabeth  Hospital 
DIXON — Dixon  Pubhc  Hospital 
ELGIN — Sherman  Hospital 
EVERGREEN  PARK — Little  Company  of  Mary 
Hospital 

OAK  PARK — Oak  Park  Hospital 
QUINCY — Blessing  Hospital 


APPROVED  SCHOOLS  OF  NURSING 


Associate  Degree 
iVursing  Program 

A coeducational  nursing  program  under  the 
auspices  of  a junior  college,  two  years  in  length 
and  leading  to  an  Associate  Degree  in  Nursing. 
The  curriculum  consists  of  arts  and  sciences  at 
the  junior  college  level  and  nursing  theory  closely 
coordinated  with  nursing  practice,  under  direction 
and  supervision  of  the  college  faculty,  in  com- 
munity hospitals  and  health  facilities. 

Graduates,  both  men  and  women,  are  prepared 
to  give  patient-centered  care  in  staff  nurse  posi- 
tions in  hospitals,  nursing  homes  and  similar  situa- 
tions. They  are  prepared  to  cooperate  and  to  share 
responsibility  for  the  patient’s  welfare  with  other 
members  of  the  nursing  and  health  staff,  and  to 
develop  their  own  skills  through  experience  as 
practicing  nurses. 

BELLEVILLE 

Belleville  Junior  College 
Department  of  Nursing 
2250  West  Blvd.  62221 


General  Entrance  Reqnirements ; 

Good  health. 

High  school  graduation:  with  courses  in  biologi- 
cal and  physical  sciences  (1-2  units  of  chem- 
istry recommended)  and  mathematics  (1-2 
units  recommended). 

Qualification  for  admission  to  the  college  and 
the  nursing  curriculum. 

Cost:  tuition  in  public  supported  junior  col- 
leges is  low,  in  private  colleges  considerably 
higher.  Add  to  this:  fees,  books,  uniforms 
and  maintenance. 

Living  Arrangements:  students  Live  at  home,  in 
a coUege  dormitory  or  other  approved  resi- 
dence. 

Graduate  is  eligible  to  take  the  state  examina- 
tion for  licensure  as  a registered  nurse 
(“R.N.”). 

CHICAGO 

Amundsen-Ma}Tair  Junior  College 
Department  of  Nursing 
4626  N.  Knox  Ave.  60630 


for  October,  1968 


521 


Crane  College  School  of  Nursing 

2250  W.  VanBuren  60612 

Southeast  College  School  of  Nursing 

8600  South  Anthony  60617 

CHICAGO  HEIGHTS 

Prairie  State  College 

Department  of  Nursing 
10th  & Dixie  Highway  60411 

CHAMPAIGN 

Parkland  College  School  of  Nursing 

2 Main  Street  61820 

CICERO 

J.  Sterling  Morton  Junior  College 
Department  of  Nursing 
2423  S.  Austin  Blvd.  60650 

DIXON 

Sauk  Valley  College  School  of  Nursing 

River  Campus,  R.R.  #1  61021 

EAST  PEORIA 

Illinois  Central  College  School  of  Nursing 
Highview  Road, 

P.  O.  Box  2400  61611 

ELGIN 

Elgin  Community  College 
Department  of  Nursing 
373  E.  Chicago  St.  60120 


HARVEY 

Thornton  Junior  College 
Department  of  Nursing 
151st  St.  & Broadway  60164 

LaSALLE 

Illinois  Valley  Community  College 

Associate  Degree  Nursing  Program 
Fifth  and  Chartres  61301 

MOLINE 

Black  Hawk  College 

Department  of  Nursing 

1001  Sixteenth  St.  61265 

NORTHLAKE 

Triton  College 

Department  of  Nursing 

1000  Wolf  Rd.  60164 

PALATINE 

Harper  College  Associate  Degree 
Nursing  Program 

34  W.  Palatine  Rd.  60067 

ROCKFORD 

Rock  Valley  College 

Associate  Degree  Nursing  Program 
3301  N.  Mulford  Rd.  61111 


Baccalaureate  Degree 
Nursing  Program 

Usually  a coeducational  nursing  program  under 
the  auspices  of  a college  or  university,  this  is  gen- 
erally four  academic  or  calendar  years  in  length. 
The  curriculum  combines  general  education  with 
nursing  education,  leading  to  the  Bachelor  of  Sci- 
ence Degree  in  Nursing.  Liberal  education  courses, 
such  as  arts  and  sciences,  are  shared  with  all  col- 
lege students.  University  medical  centers  and  other 
related  hospital  and  community  health  agencies  are 
utilized  for  nursing  theory  and  practice. 

Graduates,  both  men  and  women,  are  prepared 
for  beginning  nursing  positions  in  hospitals,  nurs- 
ing homes  and  community  health  services,  and  for 
advancement  without  further  formal  education  to 
positions  such  as  “nursing  team”  leader  or  head 
nurse.  They  also  have  the  foundations  for  con- 
tinuing personal  and  professional  development 
and  for  graduate  study  and  specialization  in  nurs- 
ing. 

BLOOMINGTON 

Illinois  Wesleyan  University 

Brokaw  Collegiate  School  of 
Nursing  61701 

CHICAGO 

DePaul  University 

Department  of  Nursing 
25  E.  Jackson  Blvd.  60604 

Loyola  University 

School  of  Nursing 

6526  N.  Sheridan  Rd.  60626 


General  Entrance  Requirements: 

Good  health. 

High  school  graduation:  college  preparatory 
program  including  biology  and  physical  sci- 
ences (1-2  units  of  chemistry  recommended) 
and  mathematics  (1-2  units).  Two  years  of 
a foreign  language  may  be  required.  Meets 
college  or  university  admission  standards. 

Cost:  college  or  university  tuition  fees  for  nurs- 
ing programs  are  comparable  to  those  for 
other  majors.  Range  in  Illinois  is  from  ap- 
proximately $1,000  to  $7,000  for  tuition  and 
fees  for  total  program.  Other  expenses:  books, 
uniforms,  maintenance. 

Living  Arrangements:  students  live  at  home,  in 
a college  dormitory  or  other  approved  residence. 

Graduate  is  eligible  to  take  state  examination 
for  licensure  as  a registered  nurse  (“R.N.”). 


North  Park  College 

Department  of  Nursing 
5125  N.  Spaulding  Ave. 
St.  Xavier  College 

School  of  Nursing 
103rd  & Central  Park 
University  of  Illinois 
College  of  Nursing 
808  S.  Wood  St. 


60625 

60655 

60612 


522 


Illinois  Medical  Journal 


DEIC\LB 

Northern  Illinois  Uni  versin’ 
School  of  Nursing 


edwardsmlle 

Southern  Illinois  Universin^ 
60115  Department  of  Nursing 


K.\NK.\KEE 

Olivet  Nazarene  College 

Department  of  Nursing  60901 


62025 


Diploma  (Hospital) 

Nursing  Program 

A nursing  program  under  the  auspices  of  a 
hospital  or  independent  school  of  nursing,  two  to 
three  years  in  length,  and  leading  to  a Diploma 
in  Nursing.  A college  or  universin’  may  provide 
some  of  the  courses.  The  curriculum  consists  of 
theoiy  and  practice  focused  primarilv  on  instruc- 
tion and  related  clinical  experience  in  the  nursing 
care  of  patients  in  hospitals.  Some  liberal  arts 
courses  may  be  included. 

Graduates,  both  men  and  women,  have  the 
understanding  and  skills  necessarv  to  organize 
and  implement  a plan  of  nursing  that  will  meet 
the  immediate  needs  of  one  or  more  patients 
and  that  will  promote  the  restoration  of  health. 
They  are  also  able  to  plan  with  associated  health 
personnel  for  the  care  of  patients,  and  may  be 


x\LTON 

Alton  Memorial  Hospital 

Memorial  Drive  62004 

St.  Josephus  Hospital 

915  E.  Fifth  St.  62004 

AUROR.\ 

Copley  Memorial  Hospital 

Lincoln  & Weston  60507 

BLOOMINGTON 

Mennonite  Hospital 

804  N.  East  St.  61701 

C-ANTON 

Graham  Hospital 

210  W.  Walnut  St.  61520 

CH.\MPA1GN 

Julia  F.  Burnham — 

Burnham  Cits’  Hospital 
404  S.  Third  St.  61822 

CHIC.\GO 

Augustana  Hospital 

411  Dickens  Ase.  60614 

Chicago  Wesley  Memorial  Hospital 

250  E.  Superior  St.  60611 

Coliunbus  Hospital 

2520  Lakeview  Ave.  60614 

Cook  Counts’ 

1900  W.  Polk  St.  60612 

Hospital  of  St.  .\nthony  dePadua 

2875  W.  19th  St.  ' 60623 

Illinois  Masonic  Hospital 

836  Wellington  Ase.  60657 


for  October,  196S 


responsible  for  the  direction  of  other  members 
of  the  nursing  team. 

General  Entrance  Reqnirements : 

Good  health. 

High  school  graduation:  Usually  upper  half  of 
class,  with  courses  in  biological  and  physical 
sciences  ' 1-2  units,  one  of  which  should  be 
chemistrs’)  and  mathematics  (1-2  units). 

Satisfactory  results  on  entrance  tests  and  quali- 
fication for  admission  to  the  school. 

Cost;  S900  to  S3,500;  some  include  full  mainte- 
nance. 

Living  Arrangements;  Schools  have  residence  fa- 
cities:  many  permit  smdents  to  Uve  at  home 
if  preferred. 

Graduate  is  eligible  to  take  the  state  examina- 
tion for  licensure  as  a registered  nurse 
(•■R.N.-). 


James  Ward  Thome — 

Passavant  Memorial  Hospital 
244  East  Pearson  St.  60611 

Michael  Reese  Hospital  and  Medical  Center 
2816  S.  Ellis  Ave.  60616 

Mount  Sinai  Hospital  Medical  Center 

2730  W.  15th  Place  60608 

Ravenswood  Hospital 

1931  W.  Wilson  Ave.  60640 

Roseland  Communits’  Hospital 

45  W.  111th  AVe.  60628 

St.  Anne's  Hospital 

4980  W.  Thcmas  60651 

St.  Bernard's  Hospital 

6344  S.  Harvard  Ave.  60621 

St.  Elizabeth's  Hospital 

1431  N.  Claremont  .-\ve.  60622 

St.  Mar\’  of  Nazareth  Hospital 

1127  N.  Oakley  Blvd.  60622 

South  Chicago  Community  Hospital 

2320  E.  93rd  St.  60617 

D.ASATLLE 

Lake  View  Memorial  Hospital 

812  N.  Logan  Ave.  61833 

DECATUR 

Decatur  and  Macon  Counts  Hospital 

2300  N.  Edward  St.  62526 

EV.VNSTON 

Evanston  Hospital 

2645  Girard  .\ve.  60201 

St.  Francis  Hospital 

319  Ridge  .-\ve.  60202 


523 


EVERGREEN  PARK 

Little  Company  of  Mary  Hospital 

2800  W.  95th  St.  60642 

FREEPORT 

Freeport  Memorial  Hospital 

1335  W.  Stephenson  61032 

GALESBURG 

Galesburg  Cottage  Hospital 

674  N.  Seminary  Ave.  61401 

JACKSONVILLE 

Passavant  Memorial  Area  Hospital 

1600  W.  Walnut  St.  62650 

JOLIET 

St.  Joseph’s  Hospital 

333  N.  Madison  St.  60435 

Silver  Cross  Hospital 

600  Walnut  St.  60432 

MOLINE 

Lutheran  Hospital 

555  Sixth  St.  61265 

Moline  Public  Hospital 

622  Fifth  Ave.  61265 

OAK  LAWN 

Evangelical  (Christ  Community  Hospital) 
4540  S.  Morgan 
OAK  PARK 

Oak  Park  Hospital 

500  S.  Maple  Ave.  60304 

West  Suburban  Hospital 

518  N.  Austin  Blvd.  60302 


PARK  RIDGE 

Lutheran  General  and  Deaconness  Hospitals 


1700  Western  Ave.  60068 

PEORIA 

Methodist  Hospital  of  Central  Illinois 

221  N.E.  Glen  Oak  61603 

St.  Francis  Hospital 

211  Greenleaf  St.  61603 

QUINCY 

Blessing  Hospital 

1005  Broadway  62301 

ROCKFORD 

Rockford  Memorial  Hospital 

2400  N.  Rockton  Ave.  61101 

St.  Anthony’s  Hospital 

1411  E.  State  St.  61108 

Swedish-American  Hospital 

1316  Charles  St.  61101 

ROCK  ISLAND 

St.  Anthony’s  Hospital 

767  Thirtieth  St.  61201 

SPRINGFIELD 

Memorial  Hospital 

200  W.  Dodge  St.  62701 

St.  John’s  Hospital 

821  E.  Mason  St.  62701 

URBANA 

Mercy  Hospital 

1405  W.  Park  St.  61801 


Practical  Nursing  Program 

A coeducational  nursing  program  under  the 
auspices  of  public  vocational  education  systems, 
hospitals  or  community  agencies,  usually  one 
year  in  length.  The  curriculum  includes  nursing 
theory  coordinated  with  nursing  practice. 

Graduates,  both  men  and  women,  of  programs 
in  practical  nursing  are  prepared  for  two  roles : 
(1)  under  the  supervision  of  a professional  nurse 
or  physician,  they  give  nursing  care  to  patients 
in  situations  relatively  free  of  scientific  complex- 
ity; (2)  in  a close  working  relationship,  they 
assist  the  professional  nurse  in  giving  care  to  pa- 
tients requiring  a high  degree  of  nursing  skill 
and  judgment. 


ALTON 

F.  W.  Olin  School  of  Practical  Nursing 

2200  College  Ave.  62002 

BLOOMINGTON 

Bloomington  School  of  Practical  Nursing 
709  S.  Clinton  St.  61701 

CAIRO 

Cairo  School  of  Practical  Nursing 

1615  Commercial  Street  62914 


Entrance  Requirements: 

Good  health. 

High  school:  Two  years  minimum,  graduation 
desirable.  Junior  and  senior  students  who  are 
currently  enrolled  in  high  school  are  eligible 
to  enroll  in  the  practical  nursing  program  as 
part  of  their  credit  curriculum. 

Satisfactory  results  on  entrance  tests. 

References  and  personal  interview. 

Cost:  None  under  MDTA  programs,  to  approxi- 
mately $400  plus  maintenance. 

Living  Arrangements:  Students  usually  live  at 
home  or  in  housing  approved  by  school. 
Graduate  is  eligible  to  take  the  state  examina- 
tion for  licensure  as  a practical  nurse 
(“L.P.N.”). 


CARBONDALE 

Southern  Illinois  University  Vocational  Public 
Technical  Institute  of  Practical  Nursing, 
Manpower  Division  (MDTA)  62901 

CHAMPAIGN 

Champaign  School  of  Practical  Nursing 

103  N.  Prospect  Ave.  61820 


524 


Illinois  Medical  Journal 


CHICAGO 

Chicago  Public  Schools  Practical  Nursing 
Program,  Chicago  Board  of  Education 
1820  W.  Grenshaw  60612 

Practical  Nurses  Training  Program,  Chicago 
Board  of  Education,  Manpower  Division 
(MDTA) 

2913  N.  Commonwealth  60657 

St.  Frances  X.  Cabrini  School  of  Practical 
Nursing 

811  S.  Lytle  St.  60607 

DANVILLE 

Danville  Junior  College  School  of  Practical 
Nursing 

305  W.  Madison  St.  61833 

DECATUR 

Decatur  School  of  Practical  Nursing 

210  W.  North  St.  62523 

DIXON 

Sauk  Valley  College 

Rural  Route  No.  1 61021 

EAST  PEKIN 

Pekin  Practical  Nurse  Program 

Pekin  Community  High  School  61554 

EAST  ST.  LOUIS 

Board  of  Education  District  189 
School  of  Practical  Nursing 

332  N.  Ninth  62201 

GALESBURG 

Galesburg  Practical  Nurse  Program 

650  Locust  St.  61401 

HARRISBURG 

Southeastern  Illinois  College  School  of  Prac- 
tical Nursing 

333  W.  College  St.  62946 

HINSDALE 

Hinsdale  Sanitarium  and  Hospital  School  of 
Practical  Nursing 

120  N.  Oak  St.  60521 

JACKSONVILLE 

Jacksonville  Board  of  Education  School  of 
Practical  Nursing 

504  E.  Court  St.  62650 

JOLIET 

Joliet  Township  H.S.  School  of  Practical 

Nursing 

201  E.  Jefferson  St.  60432 

KANKAKEE 

Kankakee  School  of  Practical  Nursing 

293  E.  Court  St.  60901 


LASALLE 

St.  Mary’s  Hospital  School  of  Practical 
Nursing 

1015  O’Connor  St.  61301 

MATTOON 

Lakeland  Community  College 
School  of  Practical  Nursing 

1921  Richmond  61938 

MT.  CARMEL 

Wabash  Valley  College  Practical  Nursing 
Program 

2222  College  Dr.  62863 

MT.  VERNON 

Rend  Lake  College 
School  of  Practical  Nursing 

315  South  7th  62864 

NORTHLAKE 

Triton  Junior  College 
Practical  Nursing  Program 

1000  Wolf  Road  60164 

OAK  FOREST 

Oak  Forest  Hospital  School  of  Practical 
Nursing 

15900  S.  Cicero  60452 

PEORIA 

Peoria  School  of  Practical  Nursing 

609  W.  High  St.  61606 

QUINCY 

Quincy  School  of  Practical  Nursing 

1200  Main  St.  62301 

ROCK  ISLAND 

Blackhawk  College  School  of  Practical 
Nursing 

2122  Twenty -fifth  Ave.  61201 

ROCKFORD 

Rockford  School  of  Practical  Nursing 

201  S.  Madison  61101 

SKOKIE 

Niles  Township  H.S.  School  of  Practical 
Nursing 

Oakton  and  Edens  Expressway  60018 

SPRINGFIELD 

Springfield  School  of  Practical  Nursing 

1300  S.  Sixth  St.  62704 

STREATOR 

Streator  Township  High  School 
Practical  Nursing  Program 

600  N.  Jefferson  61364 

WAUKEGAN 

Waukegan  Township  High  School  Practical 
Nurse  Program 

1011  Washington  St.  60089 


for  October,  1968 


525 


DEPARTMENT  OF  REGISTRATION  AND  EDUCATION 


John  C.  Watson,  Director 

John  B.  Hayes,  Superintendent  of  Registration 
Ira  T.  Dawson,  Assistant  Director 
Joel  E.  Gimpel,  Technical  Advisor, 

Division  of  Professional  Supervision 
The  department  is  primarily  concerned  with 
the  registration,  licensing  and  enforcement  of 
31  laws  governing  the  different  professions,  trades 
and  occupations,  including  the  Medical  Practice 
Act.  Enforcement  of  the  Medical  Practice  Act 
is  in  the  newly  created  Division  of  Professional 
Supervision  headed  by  a coordinator.  Registra- 
tion and  licensing  is  under  the  jurisdiction  of  the 
Division  of  Registration  headed  by  the  Superin- 
tendent of  Registration. 

The  Medical  Examining  Committee  appointed 
by  the  director  of  the  department  operates  within 
the  framework  of  the  act  and  is  charged  with 
the  responsibility  of  giving  examinations  for 
licensure,  hearing  complaints  for  revocation  and 
suspension  of  licenses  and  promulgating  rules  and 
regulations  for  the  administration  of  the  act. 

Medical  Examining  Committee 

William  Johnson,  M.D.,  Galesburg 
Dale  E.  Richardson,  D.O.,  Pontiac 
Kenneth  H.  Schnepp,  M.D.,  Springfield 
Warren  D.  Tuttle,  M.D.,  Harrisburg 
Robert  R.  Walper,  D.C.,  Chicago 

Medical  Practice  Act 

Licensing  and  Enforcement  Procedures 
Illinois  statutes  provide  for  licensing  of  physi- 
cians to  practice  medicine  “(1)  in  all  of  its 

branches,  and  (2)  licensing  of  those  persons  to 

treat  human  ailments  without  the  use  of  drugs 
or  medicine  and  without  operative  surgery.” 

The  Medical  Practice  Act  states,  “no  persons 
shall  practice  medicine  or  any  of  its  branches  or 
midwifery,  or  any  system  or  method  of  treating 
human  ailments  without  the  use  of  drugs  or  medi- 
cines, or  without  operative  surgery,  without  a 

vahd  existing  license  so  to  do.”  Applicant  for 
license  must  pass  an  examination  of  his  qualifica- 
tions which  must  be  satisfactory  to  the  Depart- 
ment of  Registration  and  Education. 

Required  Education 

Minimum  standards  of  professional  education: 
2 years’  course  of  instruction  in  a college  of 

liberal  arts  or  its  equivalent,  or  in  such  medical 
college  in  a course  of  instruction  in  the  treat- 
ment of  human  ailments  which  course  shall  have 
been  not  less  than  132  weeks  in  duration  and 
shall  have  been  completed  within  a period  of 
not  less  than  35  months  and  in  addition,  a course 
of  clinical  training  of  not  less  than  12  months 
in  a hospital.  The  college  of  liberal  arts,  medical 
school,  and  hospital  must  be  reputable  and  in 
good  standing  in  the  judgment  of  the  Depart- 
ment of  Registration  and  Education. 


All  examinations  provided  by  the  Medical  Prac 
tice  Act  shall  be  conducted  by  the  Department  of 
R&E.  Examinations  of  applicants  who  seek  to 
practice  medicine  in  all  of  its  branches  which  shall 
embrace  the  subjects  of  which  knowledge  is  gen- 
erally required  of  candidates  for  the  degree  of 
Doctor  of  Medicine  by  reputable  medical  colleges 
in  the  U.S.,  and  shall  be  such  in  the  judgment 
of  the  Department  of  R&E  that  will  determine 
the  qualifications  of  applicants  to  practice  medicine 
in  all  of  its  branches. 

Every  license  issued  under  the  Act  expires  on 
July  1 of  each  even-numbered  year.  Every  licensee 
under  the  Act  may,  biennially  during  the  month 
of  June  of  each  even-numbered  year,  renew  his 
license  upon  paying  to  the  Department  a renewal 
fee  of  $10. 

Revocation  and  Suspension  of  License  or 
Certificate 

The  department  may  revoke  or  suspend  the 
license,  certificate,  or  state  hospital  permit  of 
any  person  licensed  under  the  act  upon  any  of 
the  following  grounds: 

“1.  Conviction  of  procuring  or  attempting  or  aid- 
ing to  procure  such  an  abortion  as  was  made 
unlawful  at  the  time  under  the  Criminal 
Code  of  this  State; 

2.  Conviction  in  this  or  another  state  of  any 
crime  which  is  a felony  under  the  laws  of 
this  state  or  conviction  of  a felony  in  a 
federal  court. 

3.  Gross  malpractice  resulting  in  permanent  in- 
jury or  death  of  a patient; 

4.  Engaging  in  dishonorable,  unethical  or  un- 
professional conduct  of  a character  likely 
to  deceive,  defraud,  or  harm  the  public; 

5.  Obtaining  a fee,  either  directly  or  indirectly, 
either  in  money  or  in  the  form  of  anything 
else  of  value  or  in  the  form  of  financial 
profit  as  personal  compensation,  or  as  com- 
pensation, charge,  profit  or  gain  for  an  em- 
ployer or  for  any  other  person  or  persons, 
on  the  fraudulent  representation  that  a mani- 
festly incurable  condition  of  sickness,  disease 
or  injury  of  any  person  can  be  permanently 
cured; 

6.  Habitual  intemperance  in  the  use  of  ardent 
spirits,  narcotics,  or  stimulants  to  such  an 
extent  as  to  incapacitate  for  performance 
of  professional  duties; 

7.  Holding  one’s  self  out  to  treat  human  ail- 
ments under  any  name  other  than  his  own, 
or  the  personation  of  any  other  physician; 

8.  Employment  of  fraud,  deception  or  any  un- 
lawful means  in  applying  for  or  securing  a 
license,  certificate,  or  state  hospital  permit 
to  practice  the  treatment  of  human  ailments 
in  any  manner,  or  to  practice  midwifery, 
or  in  passing  an  examination  therefor,  or 
willful  and  fraudulent  violation  of  the  rules 


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and  regulations  of  the  department  governing 
examinations; 

9.  Holding  one’s  self  out  to  treat  human  ail- 
ments by  making  false  statements,  or  by 
specifically  designating  any  disease,  or  group 
of  diseases  and  making  false  claims  of  one’s 
skill  or  the  efficacy  or  value  of  one’s  medi- 
cine, treatment  or  remedy  therefor; 

10.  Professional  connection  or  association  with, 
or  lending  one’s  name  to,  another  for  the 
illegal  practice  by  another  of  the  treatment 
of  human  ailments  as  a business,  or  profes- 
sional connection  or  association  with  any 
person,  firm,  or  corporation  holding  himself, 
themselves,  or  itself  out  in  any  manner  con- 
trary to  this  Act; 

11.  Revocation  or  suspension  of  a medical  li- 
cense in  a sister  state. 

12.  A violation  of  any  provision  of  this  Act  or 
of  the  rules  and  regulations  formulated  for 
the  administration  of  this  Act; 

13.  Except  as  otherwise  provided  in  Section 
16.01,  advertising  or  soliciting  by  himself  or 
through  another,  by  means  of  hand  bills,  pos- 
ters, circulars,  stereopticon  slides,  motion 
pictures,  radio,  newspapers  or  in  any  other 
manner  for  professional  business.” 

Section  16.01.  Any  person  licensed  under  this  Act 
may  list  his  name,  title,  office  hours,  address, 
telephone  number  and  any  specialty  in  profes- 
sional and  telephone  directories;  may  announce 
by  way  of  a professional  card  not  larger  than 
3V2  inches  by  2 inches,  only  his  name,  title,  de- 
gree, office  location,  office  hours,  phone  num- 
ber, residence  address  and  phone  number  and 
any  specialty;  may  list  his  name,  title,  address 
and  telephone  number  and  any  specialty  in  public 
print  limited  to  the  number  of  lines  necessary 
to  state  that  information;  may  announce  his 
change  of  place  of  business;  absence  from,  or 
return  to  business  in  the  same  manner;  or  may 
issue  appointment  cards  to  his  patients,  when 
information  thereon  is  limited  to  the  time  and 
place  of  appointment  and  that  information  per- 
mitted on  the  professional  card.  Listings  in  public 
print,  in  professional  and  telephone  directories, 
or  announcements  of  change  of  place  of  business, 
absence  from,  or  return  to  business,  may  not  be 
made  in  bold  faced  type. 

Rules  and  Regulations  Adopted  for  the 
Administration  of  the  Illinois  Medical 
Practice  Act,  Effective  March  18,  1955 

Rule  1 — Accredited  Colleges  of  Medicine  and 
Surgery 

Medical  colleges  having  rules  and  curricula 
commensurate  with  and  equivalent  to  the  rules 
and  curricula  of  the  College  of  Medicine  of  the 
University  of  Illinois,  will  be  considered  for  ac- 
creditation by  the  Department  of  Registration 
and  Education. 


Rule  II — ^Accredited  Colleges  Teaching  Sys- 
tems OF  Treating  Human  Ailments  With- 
out THE  Use  of  Drugs  or  Medicine  and 
Without  Operative  Surgery. 

A professional  college  or  institution  teaching  a 
system  of  treating  human  ailments  without  the 
use  of  drugs  or  medicine  and  without  operative 
surgery  shall  be  deemed  reputable  and  in  good 
standing  in  the  judgment  of  the  Department  upon 
submission  of  proof  of  the  following  requirements: 

(a)  That  a Dean  or  other  Executive  Officer, 
employed  on  a full-time  basis  supervises  the  stu- 
dents and  curriculum. 

(b)  That  the  faculty  is  comprised  of  gradu- 
ates in  their  specialty  from  recognized  professional 
colleges  or  institutions. 

(c)  That  the  faculty  is  organized  and  each  de- 
partment has  a director,  professors,  associate 
professors  and  assistant  professors,  each  respon- 
sible to  his  superior  for  his  instruction  in  the 
particular  subject  he  teaches. 

(d)  That,  annually,  a catalogue  or  brochure  is 
published  setting  forth  the  requisites  for  admis- 
sion to  the  college,  tuition  rates,  courses  offered, 
dates  of  sessions,  schedule  of  classes,  require- 
ments for  graduation,  a roster  of  the  undergradu- 
ate students  and  a roster  of  the  last  graduating 
class.  The  catalogue  or  brochure  shall  contain  a 
list  of  the  departments  of  the  school,  the  titles 
of  the  personnel  and  a brief  summary  of  each  per- 
son’s qualifications.  The  curriculum  shall  include, 
but  not  be  limited  to,  four  academic  years’  in- 
struction in  the  following  subjects: 

( 1 ) Anatomy 

(a)  Embryology 

(b)  Histology 

(c)  Neuro-anatomy 

(2)  Physiology  and  Chemistry 

(3)  Pathology  and  Bacteriology 

(4)  Diagnosis 

(a)  Physical 

(b)  Differential 

(c)  Laboratory 

(e)  That  suitable  buildings  provided  with  lab- 
oratories equipped  for  instruction  in  anatomy, 
chemistry,  physiology,  pathology,  bacteriology  and 
other  areas  of  learning  necessary  to  the  due  course 
of  study  prescribed  by  these  rules;  and  that  a 
laboratory  equipped  with  supplies,  models,  mani- 
kins, charts,  stereopticon,  roentgen-ray  and  other 
special  apparatus  used  in  teaching  the  system  to 
treat  human  ailments  without  the  use  of  medi- 
cine and  operative  surgery,  be  provided. 

(f)  That  a working  library,  easily  accessible  to 
students,  is  maintained  from  at  least  9 a.m.  to  5 
p.m.,  with  a librarian  in  constant  attendance.  The 
library  shall  contain  a standard  medical  diction- 
ary, the  modern  text  and  reference  books,  and 
the  files  of  leading  periodicals  dealing  with  the 
particular  system  of  treating  human  ailments  with- 
out the  use  of  medicine  and  operative  surgery. 

(g)  That  the  college  or  institution  requires  all 


for  October,  1968 


527 


students  to  furnish,  before  matriculation,  satisfac- 
tory proof  of  the  preliminary  education  required 
by  the  Medical  Practice  Act. 

(h)  That  full  and  complete  records  are  kept 
showing  the  credentials  for  admission,  attendance, 
grades  and  financial  accounts  of  each  student. 

(i)  That  admission  of  transfer  students  will  be 
limited  to  honorably  dismissed  students  from  an- 
other approved  college  or  institution  teaching  the 
same  system.  The  transcript  of  record  obtained 
directly  from  the  transferring  school  shall  be  kept 
on  file.  It  shall  be  the  duty  of  a college  or  insti- 
tution to  furnish  such  a transcript  for  the  benefit 
of  each  student  subject  to  honorable  dismissal.  No 
credit  shall  be  given  a transferred  student  for  final 
or  “senior  year”  work  or  for  any  courses  taken 
by  correspondence. 

(j)  That  students  shall  start  class  attendance 
within  one  week  of  the  start  of  each  session.  That 
credit  for  completion  of  a course  will  not  be 
granted  a student  who  failed  to  attend  80  per  cent 
of  the  complete  session  of  the  course. 

Rule  III — Hospitals  Approved  for  Internship. 

1.  A hospital  shall,  in  the  judgment  of  the  De- 
partment be  deemed  reputable  and  in  good  stand- 
ing for  training  interns  and  intern  services  when 
it  meets  the  following  standards: 

(a)  General  hospital  of  150  beds’  capacity, 
with  an  average  of  at  least  60  patients  daily, 
with  rotating  service. 

(b)  Shall  contain  at  least  the  departments  of 
internal  medicine,  surgery,  obstetrics  and  pedi- 
atrics; and  an  organized  departmentalized  staff, 
holding  meetings  monthly  for  case  reviews  and 
study. 

(c)  Laboratory  employing  a full-time  qualified 
technician  and  at  least  a part-time  qualified 
pathologist,  visiting  the  laboratory  at  least  two 
days  per  week. 

(d)  Radiological  department  employing  a qual- 
ified X-ray  technician  and  at  least  a part-time 
qualified  roentgenologist,  visiting  the  depart- 
ment at  least  two  days  per  week. 

(e)  Maintenance  of  an  up-to-date  medical  li- 
brary located  in  a suitable  study  room  available 
to  interns. 

(f)  Such  hospital  shall  provide  and  furnish  the 
Department  with  the  names  of  staff  members 
of  the  various  departments  of  the  hospital. 

(g)  The  hospital,  upon  the  completion  of  a 
course  of  training  therein  of  not  less  than 
twelve  months,  shall  issue  its  certificate  there- 
for to  any  such  intern  or  at  the  request  of  the 
Department,  such  certificate  shall  include 
therein,  by  date,  the  commencement  and  the 
conclusion  thereof. 

2.  An  approved  internship  shall  consist  of  twelve 
months  rotating  service  in  medicine,  surgery, 
obstetrics  and  pediatrics,  with  an  election  in 
medical  specialties. 


In  the  event  an  applicant  has  received  training 
in  excess  of  the  twelve  months’  period  specified 
by  the  Medical  Practice  Act,  and  if  this  be  in  an 
institution  approved  by  the  Department  as  ade- 
quate for  specialty  training;  and  if  the  applicant 
has  received  certification  by  a recognized  Medical 
Specialty  Board,  and  has  had  two  or  more  years’ 
specialty  practice  or  Military  Service;  such  train- 
ing and  practice  may  be  accepted  as  the  equi- 
valent of  a rotating  internship. 

Any  applicant  who  shall  have  completed  twelve 
months  of  clinical  training  in  a hospital,  as  re- 
quired by  Section  5-1  (b)  of  the  Medical  Practice 
Act,  and  who  has  been  accepted  for  further  train- 
ing in  a specialty  or  general  practice  residency 
program  by  a hospital  or  institution  approved  by 
the  Department  for  that  purpose,  shall  be  deemed 
to  have  complied  with  the  requirements  of  this 
rule  and  of  the  Medical  Practice  Act  in  this 
regard. 

Rule  IV — ^Application  for  Examination 

An  applicant  for  examination  for  licensure  to 
practice  medicine  in  all  of  its  branches,  or  any 
system  of  treating  human  ailments  without  the 
use  of  drugs  or  medicine  and  without  operative 
surgery,  must  make  application  on  forms  fur- 
nished by  the  Department  at  least  fifteen  days 
prior  to  the  examination  and  present,  in  addition: 

(a)  Recommendations  from  two  (2)  physicians 
duly  licensed  to  practice  in  some  state  in  the 
United  States. 

(b)  A recent  photograph,  passport  size,  signed 
by  applicant  and  the  two  persons  licensed  to 
practice  the  system  of  treatment  of  human  ail- 
ments for  which  the  applicant  is  seeking  a 
license.  A duplicate  photograph  must  be  pre- 
sented with  the  card  of  admission  at  the  exami- 
nation. 

(c)  The  original  diploma  of  graduation  from 
the  professional  college  in  which  the  applicant 
completed  his  course  of  training,  or,  in  lieu  of 
presenting  the  diploma  with  the  application, 
the  applicant  may  present  it  at  the  examination. 

(d)  A certified  copy  of  secondary  school  and 
professional  school  studies  to  be  mailed  direct 
to  the  Department  by  the  schools  attended  or 
by  the  professional  schools  where  the  applicant 
completed  the  required  course  of  study. 

(e)  Proof  of  completion  of  a rotating  intern- 
ship of  twelve  months  in  an  approved  hospital 
for  applicants  seeking  admission  to  examina- 
tion for  license  to  practice  medicine  in  all  of  its 
branches;  and,  in  the  case  of  graduates  of 
medical  colleges  in  countries  other  than  the 
United  States  and  Canada,  who  apply  for  ex- 
amination after  January  1,  1953,  proof  of  ro- 
tating internships  of  one  year  in  approved 
hospitals  in  the  United  States. 

A candidate  under  Section  5,  paragraph  Ib  or 
Section  13,  may  apply  for  the  examination  or 


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Illinois  Medical  Journal 


clinical  test  and  take  the  examination  given 
immediately  prior  to  completion  of  his  intern- 
ship provided  he  furnishes  a statement  from 
the  hospital  authorities  stating  his  internship 
has  been  satisfactory  to  date.  The  results  of 
the  examination  will  be  withheld  and  no  li- 
cense will  be  issued  until  the  Department  re- 
ceives proof  of  satisfactory  completion  of  the 
required  internship  in  an  approved  hospital 
training  program. 

(f)  Applicants  who  completed  their  medical 
courses  in  the  extramural  colleges  of  Ireland 
and  Scotland  shall  not  be  eligible  for  admission 
to  examinations  for  licensure  under  the  Illinois 
Medical  Practice  Act. 

(g)  Graduates  of  European  colleges  or  uni- 
versities after  January  1,  1943,  with  the  ex- 
ception of  certain  approved  colleges  in  the 
British  Isles,  Denmark,  Holland,  Norway, 
Sweden  and  Switzerland,  be  not  accepted  for 
admission  to  examinations  for  licensure  under 
the  Illinois  Medical  Practice  Act. 

Graduates  of  such  European  medical  colleges 
after  January  1,  1943  may  be  considered  for 
admission  to  Illinois  examinations  provided 
they  present  diplomas  of  graduation  from  ap- 
proved medical  colleges  in  the  United  States 
after  attendance  in  such  colleges  for  at  least 
one  year;  and  in  addition,  have  served  rotating 
interships  of  one  year  in  approved  hospitals 
in  the  United  States. 

(h)  An  applicant  who  presented  a diploma  of 
graduation  from  an  approved  school  will  not 
be  accepted,  if  he  was  accorded  advanced  stand- 
ing in  such  school  based  upon  his  prior  edu- 
cation in  an  unapproved  school. 

Rule  V — Examinations 

1.  Examinations  for  licensure  to  practice  medi- 
cine in  aU  of  its  branches  shall  be  conducted  in 
the  English  language  and  shall  be  in  the  following 
theoretical  and  practical  areas  of  medicine: 

Theoretical 

Chemistry 

Physiology 

Anatomy 

Pharmacology 

Pathology 

Bacteriology 

Medicine 

Public  Health  & Preventive  Medicine 

Obstetrics  & Gynecology 

Surgery 

Pediatrics 

Psychiatry 

Clinical 

General  Practice  of  Medicine 

2.  Examinations  for  licensure  to  practice  the 
treatment  of  human  ailments  without  the  use  of 
drugs  or  medicine  and  without  operative  surgery 
shall  be  conducted  in  the  English  language  and 
shall  be  in  the  following  theoretical  and  practical 
subjects: 


Theoretical 
Chemistry  & Physiology 
Anatomy  & Histology 
Pathology  & Bacteriology 
Diagnosis 

Hygiene  & Medical  Jurisprudence 
Eye,  Ear,  Nose,  & Throat 
Dermatology,  Pediatrics  & Neurology 
System  of  Practice 

Obstetrics  (of  graduates  of  approved  osteo- 
pathic colleges) 

Practical 

System  of  Practice 

3.  To  be  successful,  applicants  must  receive  gen- 
eral averages  of  75%  with  no  grade  below  60  in 
the  written  examination,  and  a general  average 
of  75%  in  the  clinical  or  practical  test. 

Applicants  applying  for  registration  under  Sec- 
tions 12  and  12a  of  the  Medical  Practice  Act  shall 
be  required  to  make  general  averages  of  75%  in 
the  three  subjects  required  for  license  to  practice 
medicine  and  surgery  in  Illinois. 

4.  In  case  of  failure  in  the  first  and  second  ex- 
aminations applicants  will  be  allowed  credit  on 
the  following  examination  for  aU  grades  of  75  or 
more;  but  in  case  of  failure  in  the  third  examina- 
tion they  must  retake  all  written  subjects  at  each 
subsequent  examination.  It  is  not  required  that 
the  clinical  or  practical  part  of  the  examination 
be  repeated  after  a passing  grade  of  75  has  been 
received  in  that  part  of  the  examination. 

5.  Applicants  who  take  the  regular  examina- 
tion conducted  by  the  Department  for  licenses  as 
Physicians  and  Surgeons  shall  be  excused  from 
taking  the  clinical  test. 

6.  An  applicant  for  registration  as  Physician 
and  Surgeon  who  has  been  unsuccessful  in  five 
examinations  will  be  deemed  to  be  eligible  for  fur- 
ther examination  upon  receipt  of  proof  that  he 
has  completed  one  year  of  residency  training  in  an 
approved  hospital  training  program  in  the  United 
States  received  subsequent  to  the  applicant’s  fifth 
failure. 

7.  An  applicant  who  has  been  unsuccessful  in 
five  examinations  for  registration  as  a drugless 
practitioner  will  be  eligible  for  reexamination  upon 
receipt  of  proof  that  he  has  completed  a course 
of  study  of  960  hours  in  a school  which  is  ac- 
credited under  the  Medical  Practice  Act.  This 
course  must  be  received  subsequent  to  the  appli- 
cant’s fifth  failure. 

8.  An  applicant  who  furnished  proof  of  a 
course  of  study  of  240  hours  in  a school  of  chiro- 
practic recognized  by  the  Department  in  order 
to  be  eligible  for  further  examination  under  Sec- 
tion 9a  of  the  Medical  Practice  Act  will  be  con- 
sidered as  a new  applicant  and  his  grades  of  75 
per  cent  or  more  will  be  carried  over  to  the  sec- 
ond and  third  examinations. 


for  October,  1968 


529 


Rule  VI — Reciprocity 

1.  Each  applicant  for  registration  through  reci- 
procity, either  for  the  practice  of  medicine  in  all 
of  its  branches  or  for  the  treatment  of  human  ail- 
ments without  the  use  of  drugs  or  medicine  and 
without  operative  surgery,  filed  on  forms  provided 
by  the  Department,  will  be  considered  on  its  in- 
dividual merits,  provided  the  state  or  territory  of 
original  licensure  grants  a like  privilege  to  persons 
licensed  in  Illinois. 

2.  If  the  application  is  not  endorsed  by  offi- 
cers of  a state  or  county  society  it  must  be  en- 
dorsed by  two  (2)  physicians  duly  licensed  to 
practice  in  some  state  in  the  United  States. 

3.  Applicants  for  licensure  through  reciprocity 
or  upon  the  basis  of  having  passed  the  National 
Board  Examination  prior  to  January  1,  1964,  must 
pass  the  clinical  test  conducted  by  this  Depart- 
ment. Applicants  upon  the  basis  of  the  National 
Board  Examination  who  completed  Part  III  after 
January  1,  1964,  are  required  to  report  for  an 
interview  with  the  Medical  Examining  Committee. 
The  clinical  test  shall  be  such  in  the  judgment  of 
the  Committee  as  will  determine  the  qualifications 
of  the  applicant  to  practice  medicine  in  all  of  its 
branches,  taking  into  consideration  the  quality  of 
medical  education  and  clinical  training  or  practi- 
cal experience  which  the  applicant  has  had,  special 
honors  or  awards,  publications  in  recognized  and 
reputable  journals,  authorship  of  textbooks  in 
medicine,  and  any  other  circumstance  or  attribute 
that  the  Committee  accepts  as  evidence  of  an 
outstanding  and  proven  ability  in  any  branch  of 
the  field  of  medicine. 

4.  Graduates  of  Chiropractic  colleges  whose  ap- 
plications for  registration  in  Illinois  by  reciprocity 
are  approved,  shall  be  required  to  pass  a written 
examination  in  theory  in  addition  to  a practical 
test  before  the  chiropractic  examiner. 

Rule  VII — Licensure 

1.  An  examinate  who  successfully  completes  his 
medical  examination  must  secure  his  certificate  of 
licensure  within  one  year  from  the  date  of  his 
examination. 

2.  The  Department  will  not  issue  a duplicate 
certificate  of  registration  to  practice  medicine  in  all 
of  its  branches,  or  to  treat  human  ailments  without 
the  use  of  drugs  or  medicine  and  without  opera- 
tive surgery,  unless  proof  satisfactory  to  the  De- 
partment and  the  Committee  is  presented  that  the 
original  certificate  was  destroyed;  or  in  case  of 
change  of  name  when  the  original  certificate  is 
returned  for  cancellation,  together  with  satisfac- 
tory legal  proof  of  such  change  of  name. 

3.  A license  to  practice  medicine  in  Illinois 
shall  be  a requisite  for  a residency  in  an  Illinois 
hospital. 

Rule  VIII — Tempory  Certificates  of 
Registration 

1.  Any  person  not  licensed  to  practice  medicine 


in  all  of  its  branches  in  the  State  of  Illinois  who 
wishes  to  pursue  a program  of  graduate  or  spe- 
cialty or  residency  training  in  this  State,  must 
be  the  holder  of  a Temporary  Certificate  of 
Registration  issued  by  the  Department  under  the 
provisions  of  Section  11a  of  the  Medical  Practice 
Act  of  Illinois  and  in  accordance  with  the  provi- 
sions of  the  within  Rules. 

2.  Application  for  a Temporary  Certificate 
must  be  made  on  blank  forms  prepared  and  fur- 
nished by  the  Department.  It  must  be  submitted 
to  the  Department  together  with  evidence  satis- 
factory to  the  Department  that  applicant  meets 
the  requirements  of  Section  11a  of  the  Illinois 
Medical  Practice  Act  and  that  if  his  application 
is  approved  he  will  be  accepted  or  appointed  for 
the  residency  training  in  the  hospital  designated 
in  such  application. 

3.  A Temporary  Certificate  of  Registration  will 
be  issued  on  behalf  of  an  otherwise  qualified  appli- 
cant only  for  residency  or  specialty  training  in 
a hospital  situated  in  this  State  which  is  approved 
by  the  Department  for  the  purpose  of  such  train- 
ing. An  approved  hospital  is  one  which  in  the 
judgment  of  the  Department  is  qualified  to  offer 
such  training,  and  which  shall  comply  with  the 
within  Rules. 

4.  Written  notice  of  the  Department’s  final 
action  on  every  application  for  a Temporary 
Certificate  of  Registration  shall  be  given  to  the 
applicant  and  the  hospital  designated  therein; 
when  such  application  is  approved  the  Temporary 
Certificate  of  Registration  shall  be  delivered  or 
mailed  to  the  hospital  designated  therein  and  shall 
be  kept  in  the  care  and  custody  of  such  hospital. 
The  applicant  shall  not  commence  such  specialty 
or  residency  training  before  he  or  the  hospital 
receives  written  notification  of  approval  of  his 
application. 

5.  A Temporary  Certificate  of  Registration 
shall  not  be  valid  for  longer  than  one  year  after 
issuance  thereof  and  may  be  renewed  from  time 
to  time,  in  the  discretion  of  the  Department,  for 
a period  of  not  more  than  one  year  each  time. 
Application  for  renewal  must  be  made  on  forms 
prepared  and  furnished  by  the  Department  and 
the  Temporary  Certificate  of  Registration  sought 
to  be  renewed  must  be  submitted  therewith  to 
the  Department. 

6.  When  any  person  in  whose  behalf  a Tem- 
porary Certificate  of  Registration  has  been  issued 
shall  be  discharged  or  shall  terminate  his  specialty 
or  residency  training  in  the  hospital  designated 
therein,  such  hospital  shall  immediately  deliver 
or  mail  by  registered  mail  to  the  Department  his 
Temporary  Certificate  of  Registration  and  writ- 
ten notice  of  the  reason  for  return  of  same. 

7.  A Temporary  Certificate  of  Registration  is 
not  transferable  without  prior  notice  to  and  ap- 
proval by  the  Department.  If  the  holder  of  a 
Temporary  Certificate  of  Registration  wishes  to 
change  to  another  training  program  in  the  ap- 


530 


lUinois  Medical  Journal 


proved  hospital  designated  therein,  or  he  wishes 
to  enter  a training  program  in  another  approved 
hospital,  he  must  make  application  on  Forms  fur- 
nished by  the  Department.  His  current  Tempor- 
ary Certificate  of  Registration  must  accompany 
such  application  and  he  cannot  thereafter  continue 
in  the  training  program  designated  on  such  cur- 
rent Certificate,  and  he  may  not  commence  such 
other  training  program  until  a Temporary  Certi- 
ficate of  Registration  has  been  issued  therefor. 

8.  Not  more  than  one  Temporary  Certificate 
of  Registration  shall  be  issued  to  any  person  for 
the  same  period  of  time.  A person  on  whose  be- 
half a Temporary  Certificate  of  Registration  has 
been  issued  is  limited  in  the  practice  of  medicine 
to  the  performing  of  such  acts  as  may  be  pre- 
scribed by  and  incidental  to  his  program  of  resi- 
dency training  in  the  hospital  designated  in  his 
Temporary  Certificate  of  Registration,  and  he 
cannot  otherwise  engage  in  the  practice  of  medi- 
cine in  the  State  of  Illinois. 

9.  Whenever,  under  the  within  Rules,  a hospital 
is  required  to  deliver  or  return  a Temporary  Cer- 
tificate of  Registration  to  the  Department,  in 
case,  because  of  the  loss  or  destruction  of  such 
Certificate,  or  for  any  other  reason,  such  hospital 
shall  be  unable  immediately  so  to  deliver  or  mail 
such  Certificate,  such  hospital  shall  immediately 
mail  or  deliver  to  the  Department  a written  ex- 
planation in  detail  of  such  inability. 

10.  The  Department  shall  not  accept  any  ap- 
plication for  a Temporary  Certificate  of  Registra- 
tion on  behalf  of  an  applicant  who  has  a pend- 
ing application  on  file  to  take  the  Department 
examination  for  a license  to  practice  medicine 
in  all  its  branches  in  the  State  of  Illinois,  or  an 
applicant  who  has  previously  taken  and  failed  such 
Department  examination. 

11.  The  holder  of  a Temporary  Certificate  of 
Registration  is  not  barred  thereby  from  becoming 
eligible  for  admission  to  the  Department  examina- 
tion for  a license  to  practice  medicine  in  Illinois 
if  he  otherwise  meets  the  requirements  for  ad- 
mission to  such  examination  and  if  such  person 
should  fail  to  pass  such  examination  such  failure 
shall  not  bar  him  from  completing  his  training 
program. 

Rule  IX — Limited  Licenses  to  Practice  in 
State  Hospitals 

1.  Each  application  made  on  forms  provided  by 
the  Department  will  be  considered  on  its  own 
merits. 

2.  The  State  Hospital  at  which  the  applicant 
will  practice  under  the  supervision  of  a medical 
officer,  shall  signify  to  the  Department  that  the 
hospital  will  appoint  the  applicant  in  the  event 
he  receives  a Limited  License. 

3.  Any  applicant  for  a Limited  License  who  has 
failed  in  more  than  three  examinations  for  licen- 
sure under  the  Illinois  Medical  Practice  Act  shall 
not  be  eligible  for  a Limited  License. 


ECFMG  REQUIREMENTS 

The  Education  Council  for  Foreign  Medical 
Graduates  (ECFMG)  commenced  operations  in 
October,  1957.  Sponsors  of  this  agency  are  the 
American  Hospital  Association,  American  Medical 
Association,  Association  of  American  Medical 
Colleges,  and  Federation  of  State  Medical  Boards 
of  the  United  States.  ECFMG  gives  two  examina- 
tions a year  to  foreign  medical  graduates.  The 
examinations  test  the  graduate’s  general  knowl- 
edge of  medicine  and  command  of  English. 

Persons  successfully  passing  this  examination 
are  granted  an  ECFMG  certificate.  This  certificate 
in  the  State  of  Illinois  is  not  a substitute  for 
nor  is  it  the  equivalent  of  licensure  to  practice 
medicine.  It  simply  indicates  that  the  holder’s 
command  of  English  has  been  tested  and  found 
adequate  for  assuming  an  internship  in  an  Ameri- 
can hospital.  The  holder  of  such  a certificate  may 
not  practice  medicine  in  any  degree  in  a hospital 
in  Illinois  unless  he  is  within  one  of  the  categories 
outlined  above. 

Offenses  Listed 

An  unlicensed  person  who  commits  any  of  the 
following  acts  regardless  of  whether  the  same  be 
committed  within  or  without  a hospital  is  guilty 
of  practicing  medicine  without  a license — a crimi- 
nal offense: 

1.  Hold  himself  out  to  the  public  as  being  en- 
gaged in  the  diagnosis  or  treatment  of  ail- 
ments of  human  beings. 

2.  Suggest,  recommend  or  prescribe  any  form  of 
treatment  for  the  palliation,  relief  or  cure 
of  any  physical  or  mental  ailment  of  a per- 
son with  the  intention  of  receiving  therefor, 
either  directly  or  indirectly,  any  fee,  gift,  or 
compensation  whatsoever. 

3.  Diagnosticate  or  attempt  to  diagnosticate  any 
ailment  or  supposed  ailment  of  another. 

4.  Operate  upon,  profess  to  heal,  prescribe  for, 
or  otherwise  treat  any  ailment,  or  supposed 
ailment  of  another. 

5.  Maintain  an  office  for  examination  or  treat- 
ment of  persons  afflicted,  or  alleged  or  sup- 
posed to  be  afflicted,  by  any  ailment. 

6.  Attach  the  title  Doctor,  Physician,  Surgeon, 
M.D.,  or  any  other  word  or  abbreviation  to 
his  name,  indicative  that  he  is  engaged  in 
the  treatment  of  human  ailments  as  a busi- 
ness. 

(Section  24  Medical  Practice  Act.  [Chp.  91, 

Sec.  16i,  1967  Rev.  Stat.\) 

Manifestly,  the  enforcement  of  the  Medical 
Practice  Act  with  respect  to  the  elimination  of 
unlicensed  persons  practicing  medicine  in  a hos- 
pital is  dependent  upon  co-operation  by  respon- 
sible persons  within  the  hospital.  It  should  be 
noted  that  lack  of  co-operation  or  failure  to  meet 
responsibilities  can  in  a proper  case  be  translated 
into  criminal  liability  and  disciplinary  action  re- 


/or  October,  1968 


531 


suiting  in  revocation  or  suspenson  of  a license  to 
practice  medicine  as  follows: 

1.  The  unlicensed  person  practicing  medicine 
is  committing  a criminal  offense. 

2.  A hospital  administrator  who  assigns  an  un- 
licensed person  to  duties  which  involve  his 
practicing  medicine  may  subject  himself  to 
the  criminal  offense  of  aiding  and  abetting 
such  unlicensed  person  to  illegally  practice 
medicine,  and  the  same  may  be  true  of  a hos- 
pital chief  of  staff  or  department  head  if 
in  the  nature  of  his  duties  he  is  directly  re- 
sponsible for  assigning  such  duties  to  the  un- 
licensed person. 

3.  A licensed  doctor  may  have  his  license  sus- 
pended or  revoked  if  he  has  professional 
connection  or  association  with  another  who  is 
illegally  practicing  medicine.  A chief  of  staff 
who  knowingly  allows  such  person  to  illegally 
practice  medicine,  or  in  a proper  case,  any 
member  of  the  medical  staff  of  a hospital 
may  subject  himself  to  disciplinary  action 
against  his  license. 

4.  A licensed  doctor  may  have  his  license  sus- 
pended or  revoked  for  unethical  or  unpro- 
fessional conduct  of  a character  likely  to 
deceive,  defraud  or  harm  the  public. 

A member  of  the  medical  staff  of  a hospi- 
tal may  place  himself  within  such  conduct 
if  he  neglects,  fails  or  refuses  to  fulfill  his 
responsibilities  while  on  emergency  room 
call. 

Other  Examining  Boards 

Other  examining  boards  operating  under  the 
jurisdiction  of  the  Department  of  Registration  and 
Education  are: 

Chiropody -Podiatry  Examining  Committee 
Dr.  Charles  H.  Delano 
Dr.  Theodore  S.  Hollingsworth 


Dental  Examining  Committee 
Dr.  Eugene  E.  Ausbrook 
Dr.  Hugh  D.  Burke 
Dr.  Ralph  H.  Council 
Dr.  Herbert  C.  Gustavson 
Dr.  Peyton  Sidney  Neuwirth 
Dr.  Adrian  L.  Swanson 
Dr.  William  O.  Vopata 

Committee  of  Nurse  Examiners 
Eleanor  Maria  Carlson 
Sister  M.  Francis,  O.S.F. 

Dona  Herbst 

Dr,  Annette  Lefkowitz 

Marion  Lennan 

Optometry  Examining  Committee 
Wayne  B.  Cox,  O.D. 

Stanley  Engelhardt,  O.D. 

James  K.  Finley,  O.D. 

Thomas  M.  McGuire,  O.D, 

Clarence  J.  Strobel,  O.D. 

Pharmacy  Examining  Committee 
Milton  G.  Christy 
Joseph  Davidson 
Dr.  James  E.  Gearien 
Aloysius  J.  Niezgodski 
Harold  W.  Pratt 
Benjamin  B.  Rosen 
David  W.  Watt 

Physical  Therapy  Examining  Committee 
James  Mason  Gray 
Mildred  F.  Andrews 
Vilma  Evans 

Psychologist  Examining  Committee 
Dr.  Philip  Ash 
Dr.  Roy  Brener 
Dr.  Carl  Duncan 
Dr.  Leroy  A.  Wauk 


532 


Illinois  Medical  Journal 


Medical  Legal  Information 


LEGAL  SERVICES  OF  ISMS 

The  lUinois  State  Medical  Society  retains  a 
General  counsel  and  occasionally  uses  the  services 
of  special  counsel  in  implementing  its  various  pro- 
grams. Legal  advice  is  given  to  the  state  society 
and  its  components  as  organizations,  but  is  not 
available  to  individual  members. 

It  is  intended  that  this  article  give  general  in- 
formation only;  for  any  specific  problem  consul- 
tation should  be  had  with  the  physician’s  in- 
dividual attorney. 

HOW  TO  SET  YOUR 

A physician’s  death,  expected  or  not,  often 
creates  burdensome  tasks  for  survivors.  Natural 
grief  is  complicated  by  the  necessity  for  rapid 
decisions  and  hurried  searches  for  required  in- 
formation. Signifiicant  papers  may  be  so  well  put 
away  that  prolonged  seeking  in  various  places  may 
be  required,  with  added  pain  for  the  bereaved. 

It  is  therefore  suggested  that  the  physician,  dur- 
ing his  lifetime,  ease  the  situation  by  compiling 
in  one  place  needed  information  about  the  location 
of  important  records  and  papers.  In  addition,  the 
Illinois  State  Medical  Society  urges  each  member 
to  have  a will  prepared  by  a competent  attorney 
and  to  have  the  said  will  re-evaluated  by  an  at- 
torney whenever  there  is  a material  change  in 
any  of  his  circumstances  or  in  the  law  of  his  state. 

The  executor  named  in  the  wiU  can  handle  the 
doctor’s  estate  most  efficiently  if  he  has  access  to 
specific  information. 

The  physician  should,  of  course,  leave  informa- 
tion about  insurance,  real  estate,  and  bank  ac- 
counts just  as  everyone  else  does,  but  he  has 
additional  responsibilities  peculiar  to  his  profes- 
sion. He  should  leave  instructions  for: 


The  legal  department  of  the  Society  can  answer 
specific  questions  propounded  by  officers  of  county 
medical  societies  in  Illinois,  which  are  part  of  and 
make  up  the  state  society,  if  the  questions  are  of 
interest  to  the  membership  as  a whole. 

Although  the  Society  and  its  counsel  cannot 
provide  personal  advice  to  ISMS  members,  it  is  to 
every  physician’s  advantage  to  acquaint  himself 
with  as  much  general  medical-legal  knowledge 
as  possible.  The  following  section,  therefore,  is 
devoted  to  this  kind  of  information. 

AFFAIRS  IN  ORDER 

1.  Temporary  coverage  of  his  practice.  Some 
arrangement  with  a colleague  should  be  made  im- 
mediately for  hospitalized  patients,  and  others 
should  be  notified  of  the  doctor’s  death. 

2.  Patient  records,  which  should  be  carefully 
preserved  for  a minimum  of  10  years  and  for  25 
years,  if  possible.  Contents  of  the  records  should 
be  turned  over  to  another  physician  upon  written 
request. 

3.  Return  of  unused  narcotics  to  the  Treasury 
Department,  the  narcotics  tax  stamp  and  order 
book  to  the  Internal  Revenue  Service,  and  reten- 
tion of  the  narcotics  ledger  for  two  years. 

4.  Disposal  of  his  practice.  If  it  is  to  be  sold, 
rapid  action  is  advised  as  value  is  lost  quickly. 
Equipment  is  best  disposed  of  with  the  sale  of  the 
practice. 

5.  Benefits  that  may  be  due  survivors  from  un- 
used insurance  premiums.  Blue  Cross-Blue  Shield, 
Veterans  Administration,  or  Social  Security. 

As  soon  as  practical  after  death,  the  attorney 
who  will  handle  the  estate  should  be  contacted 
and  his  advice  followed  thereafter. 


for  October^  1968 


533 


LEGAL  LIABILITY  OF  PHYSICIANS 

The  legal  liability  of  physicians  is  a question 
on  which  much  has  been  written.  It  has  also  been 
the  topic  of  discussion  at  many  meetings  of  medi- 
cal and  medical-legal  groups.  However,  because  of 
the  grave  nature  of  the  problem,  the  Illinois  State 
Medical  Society’s  legal  counsel  believes  that  the 
subject  cannot  be  overemphasized. 

Statistics  prove  that  the  number  of  malpractice 
and  general  liability  suits  against  physicians  is  on 
the  increase.  This  does  not  mean  that  physicians 
are  becoming  less  skillful  or  more  careless  in  their 
diagnosis  and  treatment;  it  probably  means  that 
physicians  are  being  affected  by  the  tremendous 
growth  there  has  been  recently  in  all  types  of 
personal  injury  litigation. 

More  people  than  ever  before  are  receiving 
medical  attention  and  more  are  starting  lawsuits 
against  physicians  when  recovery  is  less  than 
complete. 

Liability  Insurance 

For  this  reason,  it  is  essential  that  every 
physician  carry  liability  insurance  to  protect 
him  against  all  possible  claims.  The  physician 
should  be  aware,  however,  that  there  are  some 
inadequate  policies  on  the  market  today  and  an 
attorney  should  be  consulted  before  contracting 
for  insurance  that  may  not  cover  the  doctor’s  par- 
ticular circumstance.  Additional  coverage  insofar 
as  limits  are  concerned  is  relatively  inexpensive 
and  should  be  carried  in  sufficient  amount  to 
cover  all  possibilities. 

Prior  to  the  1967  Session  of  the  General  As- 
sembly of  Illinois,  the  greatest  recovery  that 
could  be  had  for  wrongful  death  was  $30,000  but 
this  limitation  has  now  been  removed  and  there 
is  no  limit  in  the  amount  which  may  be  recovered 
in  the  case  of  wrongful  death.  This  means  that 
in  malpractice  cases  resulting  in  death,  the  ver- 
dict could  be  extremely  high.  It  is.  therefore  recom- 
mended that  all  physicians  take  a look  at  their 
malpractice  insurance  policies  to  determine  that 
they  are  properly  covered  and  in  adequate  limits. 
The  cost  of  this  insurance  does  not  materially 
increase  with  the  increase  in  limits  and  therefore 
extremely  high  limits  are  suggested. 

A physician  today  is  a “sitting  duck”  for  a 
lawsuit  even  though  he  may  in  no  way  be  guilty 
of  negligence.  And  lawsuits  to  defend,  no  matter 
how  meritorious,  require  the  expenditure  of  time 
and  money. 

Legal  implications  in  this  field  are  wide,  but 
basically  the  physician  is  liable  for  his  own 
negligent  acts  and  the  negligent  acts  of  all  his 
employees.  In  the  case  of  a partnership,  he  is 
also  liable  for  the  negligent  acts  of  his  partners. 

While  the  right  kind  of  insurance  in  sufficient 
amount  will  protect  the  physician  financially,  steps 
should  be  taken  by  all  doctors  to  help  minimize 
the  filing  of  lawsuits  of  this  kind  and  to  work  for 


reduction  in  the  number  of  guilty  verdicts  being 
obtained. 

The  American  Medical  Association  has  pre- 
pared, and  has  available  for  distribution,  several 
interesting  pamphlets  and  papers  on  this  subject. 
The  pamphlet  entitled,  “Professional  Liability  and 
the  Physician,”  reprinted  from  the  February  1963 
issue  of  the  Journal  of  the  American  Medical 
Association,  contains  this  statement: 

Physician’s  Responsibility 

“In  the  final  analysis,  the  physician  himself 
must  share  the  responsibility  for  the  continuing 
existence  of  the  unpleasant  professional  liability 
situation.  Many  physicians  have  been  satisfied  to 
pay  their  professional  liability  insurance  premiums 
and  thereafter  to  sit  back  complacently,  doing 
nothing  until  they  become  a target.  Every  phy- 
sician must  be  brought  to  realize  that  this  money 
payment  is  only  part  of  his  insurance  program; 
a much  more  important  part  is  his  contribution 
of  time,  study,  and  attention  to  put  into  effect 
all  possible  measures  to  safeguard  the  patient, 
himself,  and  his  colleagues.  Professional  liability 
is  in  no  sense  merely  an  insurance  problem.  It 
is  a medical  problem  and  must  be  combatted  by 
members  of  the  medical  profession.” 

The  AMA  phamphlet  goes  on  to  say  that  “pre- 
vention is  the  best  possible  defense  against  claims 
and  suits”  and  lists  these  20  prevention  “com- 
mandments”: 

1.  The  physician  must  care  for  every  patient 
with  scrupulous  attention  given  to  the  require- 
ments of  good  medical  practice. 

2.  The  physician  must  know  and  exercise  his 
legal  duty  to  the  patient. 

3.  The  physician  must  avoid  destructive  and 
unethical  criticism  of  the  work  of  other  physicians. 

4.  The  physician  must  keep  records  which 
clearly  show  what  was  done  and  when  it  was 
done,  which  clearly  indicate  that  nothing  was  ne- 
glected, and  which  demonstrate  that  the  care  given 
met  fully  the  standards  demanded  by  the  law. 
If  any  patient  discontinues  treatment  before  he 
should,  or  fails  to  follow  instructions,  the  records 
should  show  it;  a good  method  is  to  preserve  a 
carbon  copy  of  the  physician’s  letter  advising  the 
patient  against  the  unwise  course. 

5.  The  physician  must  avoid  making  any  state- 
ment which  constitutes,  or  might  be  construed 
as  constituting  an  admission  of  fault  on  his  part. 
He  should  instruct  employees  to  make  no  such 
statements. 

6.  The  physician  must  exercise  tact  as  well  as 
professional  ability  in  handling  his  patients,  and 
should  insist  on  a professional  consultation  if  the 
patient  is  not  doing  well,  if  the  patient  is  unhappy 
and  complaining,  or  if  the  family’s  attitude  in- 
dicates dissatisfaction. 

7.  The  physician  must  refrain  from  over-opti- 
mistic prognoses. 

8.  The  physician  must  advise  his  patients  of 


534 


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any  intended  absences  from  practice  and  recom- 
mend, or  make  available,  a qualified  substitute. 
The  patient  must  not  be  abandoned. 

9.  The  physician  must  unfailingly  secure  an 
“informed”  consent  (preferably  in  writing)  for 
medical  and  surgical  procedures  and  for  autopsy. 

10.  The  physician  must  carefully  select  and 
supervise  assistants  and  employees  and  take  great 
care  in  delegating  duties  to  them. 

11.  The  Physician  should  limit  his  practice  to 
those  fields  which  are  well  within  his  qualifica- 
tions. 

12.  The  physician  must  frequently  check  the 
condition  of  his  equipment  and  make  use  of 
every  available  safety  installation. 

13.  The  physician  should  make  every  effort 
to  reach  an  understanding  with  his  patient  in  the 
matter  of  fees,  preferably  in  advance  of  treat- 
ment. 

14.  The  physician  must  realize  that  it  is  dan- 
gerous to  diagnose  or  prescribe  by  telephone. 

15.  The  physician  should  not  sterilize  a patient 
solely  for  the  patient’s  convenience  except  after  a 
reasonably  complete  explanation  of  the  procedure 
and  its  risks  and  possible  complications  and  after 
obtaining  a signed  consent  from  the  patient  and 
from  the  patient’s  spouse  if  the  patient  is  married. 
Such  sterilization  is  a crime  in  Connecticut,  Kan- 
sas, and  Utah  and  should  not  be  performed  in 
those  states.  Eugenic  sterilization  should  be  per- 
formed only  in  conformity  with  the  law  of  the 
state,  if  any.  Sterilization  for  therapeutic  purposes 
may  lawfully  be  performed  with  the  informed 
consent  of  the  patient  and  preferably  with  the  in- 
formed consent  of  the  patient’s  spouse,  if  the 
patient  is  married. 

16.  Except  in  an  actual  emergency  situation 
which  makes  it  impossible  to  avoid  doing  so,  a 
male  physician  should  not  examine  a female 
patient  unless  an  assistant  or  nurse,  or  a member 
of  the  patient’s  family  is  present. 

17.  The  physician  should  exhaust  all  reasonable 
methods  of  securing  diagnosis  before  embarking 
upon  a therapeutic  course. 

18.  The  physician  should  use  conservative  and 
less  dangerous  methods  of  diagnosis  and  treatment 
wherever  possible,  in  preference  to  highly  toxic 
agents  or  dangerous  surgical  procedures. 

19.  The  physician  should  read  the  manufac- 
turer’s brochure  accompanying  a toxic  agent  to 
be  used  for  diagnostic  or  therapeutic  purposes, 
and,  in  addition,  should  ascertain  the  customary 
dosage  or  usage  in  his  area. 

20.  The  physician  should  be  aware  of  all  the 
known  toxic  reactions  to  any  drug  he  uses,  to- 
gether with  the  proper  methods  for  treating  such 
reactions. 

The  general  counsel  for  the  Illinois  State  Medi- 
cal Society  has  given  the  following  suggestions 
on  how  to  avoid  and  defeat  malpractice  suits: 

1.  Physicians  should  conduct  their  practice  in 
hospitals  so  that  they  comply  with  and  live  up 
to  the  standards  for  hospital  accreditation  of  the 
American  Hospital  Association,  the  hospital  regu- 


lations adopted  by  the  State  Department  of  Pub- 
lic Health  under  the  Hospital  Licensing  Act  and 
the  by-laws  of  the  hospital  in  which  they  are 
practicing. 

2.  Physicians  should  keep  up  on  modern  medi- 
cine in  the  fields  in  which  they  practice  so  they 
are  conversant  with  and  use  the  latest  proven 
developments. 

3.  Physicians  should  call  in  specialists  when- 
ever the  need  arises. 

4.  Physicians  should  provide  for  automatic  con- 
sultation in  all  serious  cases — it  cannot  be  dis- 
puted that  any  physician  being  called  on  to  de- 
fend his  treatment  in  court  is  in  a much  better 
position  if  he  can  also  bring  forth  as  a witness 
the  physician  who  reviewed  the  case  and  con- 
sulted with  him,  or  the  specialist  in  a given  field 
called  in  by  him. 

5.  Hospital  records  and  those  of  the  physician 
should  be  kept  in  such  manner  and  in  such  de- 
tail as  will  be  meaningful  and  show  that  adequate 
medical  procedures  were  followed.  It  should  be 
remembered  that  frequently  cases  are  not  filed 
until  some  time  after  the  alleged  injury  took  place 
and  sometimes  do  not  come  to  trial  for  several 
years  thereafter. 

6.  All  cases  should  be  treated  in  such  a man- 
ner and  records  kept  as  if  the  case  would  result 
in  a malpractice  suit  and  would  not  come  to 
trial  for  a considerable  period  of  time  after  the 
alleged  injury  had  taken  place. 

7.  Physicians  should  carry  adequate  malprac- 
tice insurance. 

Physician  and  Hospital  Liens 

Paragraph  101.1  of  Chapter  82,  Illinois  Re- 
vised Statutes  1967,  provides  that  every  licensed 
physician  practicing  in  the  State  of  Illinois  who 
renders  service  to  an  injured  person,  except  serv- 
ices rendered  under  the  provisions  of  the  Work- 
men’s Compensation  Act  and  Workmen’s  Occupa- 
tional Diseases  Act,  shall  have  a lien  upon 
all  claims  and  causes  of  action  for  the  amount 
of  his  reasonable  charges  up  to  one-third  of  the 
sum  recovered  by  the  injured  person.  In  order 
to  effectuate  this  lien,  notice  in  writing  must  be 
given  to  the  injured  person  and  also  to  the  per- 
son or  persons  against  whom  such  claim  or  right 
of  action  exists. 

Under  paragraph  97  of  Chapter  82,  Illinois  Re- 
vised Statutes  1967,  not-for-profit  hospitals  and 
those  hospitals  maintained  by  a county  shall 
have  a lien  on  all  claims  or  causes  of  action  for 
the  amount  of  reasonable  charges  at  ward  rates 
up  to  one-third  of  the  amount  recovered.  Again, 
in  order  to  perfect  the  lien,  it  must  be  filed  in 
the  same  manner  as  the  physician’s  lien  described 
above. 

While  the  language  is  substantially  the  same  un- 
der both  liens,  they  are  entirely  separate  en- 
actments, neither  is  subservient  to  the  other 
and,  therefore,  both  the  hospitals  and  the  phy- 
sicians can  recover  up  to  one-third  of  the  amount 
received  by  the  patient. 


for  October,  1968 


535 


A suggested  form  of  physician’s  lien  notice  is 
as  follows: 

Notice  of  Lien 

In  favor  of  John  M.  Jones,  M.D. 

1424  Chestnut  Street 
Springfield,  Illinois 

Dated  this day 

of 19 

TO:  


I am  advised  that  , 

whose  address  is,  

has  a claim,  right,  or  cause  of  action  against  you 
for  injuries  received,  resulting  from  an  accident  on 
or  about  

You  are  notified  that  I claim  a lien  upon  such 
claim,  right,  or  cause  of  action  for  reasonable 
charges  for  medical  services  rendered  said 

on  account 

of  said  injuries,  the  total  amount  of  such  lien  not 
to  exceed  one-third  (}A)  of  any  sums  due  or  paid 
to  such  injured  person  by  compromise,  settlement, 
or  satisfaction  after  the  satisfaction  of  any  attor- 
ney’s lien,  if  any. 

This  lien  is  claimed  pursuant  to  an  Act  provid- 
ing for  a lien  for  physicians  rendering  treatment 
to  injured  persons  approved  July  23,  1959  (Chap. 
82,  Sec.  101.1  through  101.6,  111.  Rev.  Stats., 
1967). 

Money  paid  in  settlement  of  this  claim  or  in 
settlement  or  payment  of  any  judgment  or  decree 
on  this  claim  is  subject  to  this  lien,  and  before 
making  settlement,  you  should  consult  with  me 
and  see  that  this  lien  is  satisfied. 


Signature 

(This  notice  to  be  served  on  both  the  injured 
person  and  the  parties  against  whom  such  claim  or 
right  of  action  exists,  by  certified  mail  or  in  per- 
son.) 

Suggested  form  of  authorization  to  be  used  by 
lawyer: 

(Place)  (Date) 

“I,  , hereby 

authorize  and  direct  , 

my  attorney,  or  attorneys  to  pay  from  the  proceeds 

of  any  recovery  in  my  case  to  Dr 

the  reasonable  amount 

for  professional  services  in  the  treatment  of  in- 
juries sustained  by  me  and/or  my  wife  and 
/or  child  or  children,  as  the  case  may  be,  in  an 

accident  which  occurred  on , 19 , 

said  payment  to  include  professional  services  here- 
tofore rendered  and  those  rendered  to  the  time  of 
the  settlement  or  other  disposition  of  my  case  for 
the  treatment  of  said  injuries,  and  fees  for  testify- 
ing in  court.” 

“I  further  authorize  said  Doctor  to  furnish  said 
Attorney  with  any  reports  he  may  request  in  ref- 
erence to  my  injury.  I understand  that  this  in  no 
way  relieves  me  of  my  personal  responsibility  to 
pay  all  such  medical  charges.” 

Witness  

Signed  


Admissibility  in  Evidence  of 
Deliberations  of  Tissue  Committees 

In  1961  the  Illinois  legislature  passed  an  act  in 
which  one  of  the  purposes  was  to  prevent  the 
admissibility  in  evidence  and  making  public  the 
deliberations  and  findings  of  tissue  committees. 
The  act  is  set  out  at  paragraphs  101-105  of 
Chapter  51,  Illinois  Revised  Statutes  1967,  and 
is  as  follows: 

“101.  All  information,  interviews,  reports, 
statements,  memoranda  or  other  data  of  the  Illi- 
nois Department  of  Public  Health,  Illinois  State 
Medical  Society,  allied  medical  societies,  or  in- 
hospital  staff  committees  or  accredited  hospitals, 
but  not  the  original  medical  records  pertaining 
to  the  patient,  used  in  the  course  of  medical 
study  of  the  purpose  of  reducing  morbidity  or 
mortality  shall  be  strictly  confidential  and  shall 
be  used  only  for  medical  research. 

102.  Such  information,  records,  reports,  state- 
ments, notes,  memoranda,  or  other  data,  shall  not 
be  admissible  as  evidence  in  any  action  of  any 
kind  in  any  court  or  before  any  tribunal,  board, 
agency  or  person. 

103.  The  furnishings  of  such  information  in  the 
course  of  a research  project  to  the  Illinois  De- 
partment of  Public  Health,  Illinois  State  Medical 
Society,  allied  medical  societies,  or  to  in-hospital 
staff  committees  or  their  authorized  representa- 
tives, shall  not  subject  any  person,  hospital,  sani- 
tarium, nursing  or  rest  home  or  any  such  agency 
to  any  action  for  damages  or  other  relief. 

104.  No  patient,  patient’s  relatives,  or  patient’s 
friends  named  in  any  medical  study,  shall  be  in- 
terviewed for  the  purpose  of  such  study,  unless 
consent  of  the  attending  physician  and  surgeon 
is  first  obtained. 

105.  The  disclosure  of  any  information,  records, 
reports,  statements,  notes,  memoranda  or  other 
data  obtained  in  any  such  medical  study  except 
that  necessary  for  the  purpose  of  the  specific 
study  is  unlawful,  and  any  person  convicted  of 
violating  any  of  the  provisions  of  this  Act  is 
guilty  of  a misdemeanor.” 

While  there  have  been  no  decisions  under  the 
act  quoted  by  any  of  the  Illinois  appellate  courts 
or  the  Supreme  Court,  it  would  appear  that  a 
tissue  committee  would  come  within  the  meaning 
of  “inhospital  staff  committees  of  accredited  hos- 
pitals,” and,  therefore,  would  be  inadmissible  in 
evidence  and  considered  private  and  confidential. 
Unfortunately,  the  act  does  not  define  accredited 
hospitals,  but  this  would  probably  mean  either 
licensed  hospitals  or  those  accredited  by  the  medi- 
cal professions.  (There  are  only  10  licensed  hos- 
pitals in  Illinois  which  have  not  been  accredited 
by  the  medical  professions.) 

In  addition  to  the  above  statute,  the  fact  that 
tissue  committees  are  not  required  by  Illinois 
law,  but  are  established  through  the  voluntary 
co-operation  of  the  hospitals  and  the  medical  pro- 
fession for  the  betterment  of  medicine  through 
research  of  prior  cases,  would  be  a powerful  argu- 
ment against  admissibility. 

Another  legal  argument  against  the  introduc- 


536 


Illinois  Medical  Journal 


tion  in  evidence  of  such  records  would  be  the  fact 
that  the  results  would  be  the  deliberations  of  a 
committee  and  there  would  be  no  way  to  cross- 
examine  a committee,  which  would  mean  that  a 
fundamental  right  was  being  lost  by  one  or  more 
of  the  litigants  in  the  case. 

As  stated  above,  there  are  no  decisions  in 
Illinois  which  can  be  relied  upon,  but  it  is  the 
opinion  of  the  ISMS  general  counsel  that  such 
records  cannot  legally  be  used  in  any  legal  action. 

It  should  be  pointed  out  that  in  most  instances 
subpoenas  and  subpoenas  duces  tecum  (produce 
the  records)  are  issued  by  the  clerk  of  the  court 
on  application  of  one  of  the  parties  litigant 
and  no  determination  is  made  as  to  the  ad- 
missibility of  the  testimony  or  records  until  the 
witnesses  and  records  are  produced  in  court.  It  is 
suggested  that  if  a subponea  or  court  order 
is  ever  received  involving  the  records  and  de- 
liberations of  the  tissue  committee,  your  at- 
torney be  contacted  immediately  in  order  to 
file  appropriate  motions  to  suppress  the  produc- 
tion of  the  records.  If  the  trial  court  should  hold 
that  such  records  are  admissible,  it  is  then  sug- 
gested that  an  appeal  be  made  to  the  Supreme 
Court  of  Illinois  on  this  question,  for  if  such 
records  are  produced,  it  could  conceivably  have 
the  result  of  diminishing  the  efficiency  or  the  ulti- 
mate abandonment  of  such  committees,  with  the 
result  that  research  and  advancement  in  the  art 
of  medicine  would  be  retarded. 

Consent  by  Minors  to  Medical 
Treatment  and  Operations 

The  general  law  in  Illinois  is  that  a minor 
carmot  give  legal  consent  or  waive  any  rights 
which  he  has  under  the  law.  In  the  year  1961, 
the  lUinois  legislature  made  an  exception  to  this 
rule  by  specifically  providing  that  consent  to 
the  performance  of  medical  or  surgical  treat- 
ment by  a licensed  physician  could  be  executed 
by  a married  person  who  is  a minor  or  a preg- 
nant woman  who  is  a minor  and  shall  not  be 
voidable  because  of  such  minority.  This  act 
further  provides  that  any  parent  who  is  a minor 
may  consent  to  the  performance  upon  his  or  her 
child  of  medical  or  surgical  procedures  by  a li- 
censed physician  and  that  the  consent  shall  not 
be  voidable  because  of  such  minority. 

The  act  referred  to  above  is  set  out  at  para- 
graphs 18.1  and  18.2  of  Chapter  91,  Illinois 
Revised  Statutes  1967. 

Employment  Contract  Between 
Physician  and  Patient 

The  relationship  between  a physician  and  a 
patient  is  one  of  contractual  relationship  and, 
therefore,  a physician  is  under  no  legal  require- 
ment to  accept  anyone  as  a patient  unless  he  so 
desires.  This  rule  is  true  in  the  case  of  an 
emergency  even  though  no  other  physician  is 
available. 

Legally,  a physician  has  the  right  to  refuse 


treatment  in  the  case  of  an  accident  or  other 
emergency  and  could  not  in  any  way  be  held 
fiable  for  refusing  to  administer  aid.  {This  is 
strictly  the  legal  answer  and  does  not  involve 
the  moral  or  ethical  question.)  The  rendering  of 
such  services  as  may  be  necessary  in  the  case 
of  an  emergency  does  not  of  itself  give  rise  to 
the  relationship  of  physician  and  patient  and  the 
physician  is  under  no  obligation  to  continue 
treatment  beyond  the  emergency. 

The  physician  in  rendering  emergency  treat- 
ment, however,  must  use  the  same  degree  of  skill 
and  care  as  required  in  other  cases,  taking  into 
consideration  conditions  at  the  scene  of  the  ac- 
cident. 

Continuation  of  Treatment 

A physician  or  surgeon,  on  undertaking  an 
operation  or  treatment,  is  under  the  duty,  in 
the  absence  of  an  agreement  limiting  the  serv- 
ice, of  continuing  his  attendance,  after  the  oper- 
ation or  first  treatments,  as  long  as  the  case 
requires  attention;  and  a surgeon,  in  his  treat- 
ment subsequent  to  an  operation,  is  required  to 
exercise  reasonable  and  ordinary  sldll  and  care. 

The  failure  to  give  needed  continued  care 
under  an  obligation  to  do  so  constitutes  negligence 
or  malpractice.  The  obligation  of  continuing  at- 
tention can  be  terminated  only  by  the  cessation 
of  the  necessity  which  gave  rise  to  the  relation- 
ship of  physician  and  patient,  by  mutual  con- 
sent of  the  parties,  by  the  discharge  of  the 
physician  by  the  patient,  or  by  the  physician’s 
withdrawing  from  the  case  after  giving  the  pa- 
tient reasonable  notice  so  as  to  enable  him 
to  secure  other  medical  attendance. 

A physician  has  the  legal  right  to  withdraw 
from  a case  if  the  patient  breaks  the  contract 
by  failure  to  foUow  the  medical  advice  or  treat- 
ment and  direction  of  the  physician,  but  the 
relationship  cannot  be  terminated  until  the  phy- 
sician has  advised  the  patient  of  his  withdrawal 
from  the  case  and  has  allowed  the  patient  a 
reasonable  length  of  time  to  procure  another 
doctor. 

Written  Notice 

What  is  reasonable  notice  to  the  patient  de- 
pends upon  the  circumstances  of  each  case. 
Factors  which  must  be  taken  into  consideration 
are  the  condition  of  the  patient,  the  size  of  the 
community,  and  the  availability  of  other  phy- 
sicians. In  order  to  be  completely  safe,  prior  to 
withdrawal  from  the  case,  the  physician  should 
advise  the  patient  in  writing  of  his  intent  to  with- 
draw, his  reasons  therefor,  and  the  fact  that  he  wiU 
make  available  the  patient’s  case  history  and  in- 
formation regarding  diagnosis  and  treatment  to 
the  new  physician  when  selected  by  the  patient. 
Should  the  patient  return  to  the  original  phy- 
sician stating  that  he  has  been  unable  to  procure 
other  medical  aid,  treatment  should  not  be  re- 
fused until  a replacement  has  been  obtained. 


for  October,  1968 


537 


A physician  has  the  right  to  leave  his  prac- 
tice temporarily  if  he  makes  provisions  for  the 
attendance  of  a competent  physician  during  his 
absence.  This  notice,  which  again  preferably 
should  be  in  writing,  should  be  in  sufficient  time 
so  that  patients  can  obtain  replacements  of  their 
own  choice  if  they  do  not  desire  to  consult  the 
physician  temporarily  handling  the  practice  of  the 
absent  physician. 

GOOD  SAMARITAN  BILL 

The  1965  Legislature  passed  and  the  Gov- 
ernor signed  Senate  Bill  395,  the  so-called  “Good 
Samaritan  Bill.”  This  bill  provides  that  any  phy- 
sician who,  in  good  faith,  provides  emergency 
care  without  a fee  at  the  scene  of  a motor  ve- 
hicle accident  or  in  case  of  nuclear  attack  shall 
not  as  a result  of  his  acts  or  omissions,  except  in 
the  case  of  gross  willful  or  wanton  negligence, 
be  liable  for  damages.  Paragraph  2a  of  Chapter 
91,  Illinois  Revised  Statutes,  1967. 

The  physician  in  rendering  emergency  treat- 
ment other  than  that  necessitated  by  motor  ve- 
hicle accidents  or  nuclear  explosions  must  use 
the  same  degree  of  skill  and  care  as  required  in 
other  cases,  taking  into  consideration  conditions 
at  the  scene  of  the  accident. 

CONSUMER  FRAUD  ACT 

This  act  is  designed  to  protect  the  consumer. 
In  part  it  reads, — “The  act,  use  or  employment 
by  any  person  of  any  deception,  fraud,  false  pre- 
tense, false  promise,  misrepresentation,  or  the 
concealment,  suppression,  or  omission  of  any  ma- 
terial fact  with  intent  that  others  rely  upon  such 
concealment,  suppression  or  omission,  in  connec- 
tion with  the  sale  or  advertisement  of  any  mer- 
chandise, whether  or  not  any  person  has  in  fact 
been  misled,  deceived  or  damaged  thereby,  is  de- 
clared to  be  an  unlawful  practice.”  The  term  mer- 
chandise includes  any  objects,  wares,  goods,  com- 
modities, intangibles,  real  estate,  or  services. 

COMMITMENT  OF  PATIENTS  TO 
MENTAL  HOSPITALS 

The  State  of  Illinois  adopted  in  1963  a 
Mental  Health  Act  which  went  into  effect  July 
1,  1964,  which  Act  is  set  out  under  Chapter  911^, 
Illinois  Revised  Statutes,  1967. 

Under  the  provisions  of  this  Act  and  the 
Youth  Commission  Act,  there  are  seven  ways  in 
which  an  individual  may  be  admitted  to  a mental 
hospital. 

1.  Informal  admission 

2.  Voluntary  application  for  admission 

3.  Admission  on  certificate  of  one  physician 

4.  Admission  on  certificate  of  two  physicians 

5.  Hospitalization  upon  court  order 

6.  Emergency  admission,  except  for  mentally 
retarded  persons 

7.  Special  procedures  by  the  Youth  Commission 


Informal  admission: 

Any  person,  as  to  admission  for  mental  illness 
to  a state  hospital,  may  be  admitted  without 
formal  application  if  the  superintendent,  after 
examination,  deems  the  person  suitable.  Such  pa- 
tient is  to  be  released  on  his  request  at  any  time 
between  the  hours  of  9 a.m.  and  5 p.m.  and  he 
is  to  be  advised  of  such  right  when  he  is  ad- 
mitted. This  section  does  not  apply  to  the  per- 
son who  is  a patient  of  a physician  and  is  ad- 
mitted to  a licensed  private  hospital  or  the 
psychiatric  unit  of  a general  hospital  under  the 
supervision  of  such  physician. 

Voluntary  application  for  admission: 

Any  person  who  is  mentally  retarded  or  in 
need  of  mental  treatment  or  is  alleged  to  be  in 
need  of  mental  treatment  or  being  mentally  re- 
tarded may  be  admitted  to  a hospital  if,  in  the 
judgment  of  the  superintendent,  such  person  is 
a proper  subject  for  voluntary  admission  after 
application  has  been  filed,  with  the  application 
being  presented  by  the  person  himself  or  his  at- 
torney or  relative  with  his  consent  or  if  a 
minor,  by  his  parent  or  guardian.  Upon  this 
type  of  admission,  the  patient  has  the  right  to 
leave  the  hospital  15  days  after  having  given 
notice  in  writing  of  his  desire  to  leave  and  upon 
admission  the  patient  shall  be  advised  both  orally 
and  in  writing  of  this  right  of  release.  The  ad- 
vice so  given  is  given  to  the  patient  and  his 
relatives,  parents,  guardian  or  attorney  if  any 
such  accompany  the  patient  to  the  hospital.  How- 
ever, this  release  in  15  days  may  not  take  place 
in  such  period  if  a petition  for  hospitalization  up- 
on court  order  is  filed  within  such  15  days  period. 

The  patient  also  may  be  discharged  by  act 
of  the  superintendent. 

While  the  voluntary  patient  and  those  admitted 
on  certificate  of  one  physician  or  upon  certificate 
of  two  physicians  may  be  restrained  and  given 
such  standard  treatment  as  fits  the  patient’s  wel- 
fare, no  surgery  may  be  performed  except  by 
consent  of  the  patient  or  the  parent  or  guardian. 
Admission  on  certificate  of  one  physician : 

The  superintendent  of  a mental  hospital  may 
receive  and  detain  as  a patient  any  person  alleged 
to  be  in  need  of  mental  treatment  who  does  not 
object  thereto  upon  the  application  signed  by  a 
proper  relative  of  the  patient  or  peace  or  health 
officer  or  an  officer  of  any  proper  charitable  or 
proper  welfare  institution  or  by  the  superintendent 
of  a hospital  operated  by  the  state  or  a political 
subdivision  thereof,  or  by  a friend  of  the  pa- 
tient together  with  the  certificate  of  one  examin- 
ing physician  executed  within  10  days  prior  to 
such  admission.  Prior  to  admission  the  super- 
intendent of  the  mental  hospital  shall  cause  the 
patient  to  be  again  examined  in  order  to  confirm 
the  need  for  hospitalization.  If  the  hospital  de- 
termines within  15  days  after  admission  that  the 
patient  should  be  detained  for  further  care  and 
treatment  and  the  patient  does  not  agree  to  re- 


538 


Illinois  Medical  Journal 


main  in  the  hospital  as  a voluntary  patient,  the 
certificate  of  another  examining  physician  sup- 
porting the  application  is  required. 

Admission  on  certificate  of  two  physicians: 

The  same  general  procedure  is  followed  here  as 
in  the  case  of  one  physician,  except  that  the 
consent  of  the  patient  is  not  required,  but  within 
five  days  after  his  admission  he  shall  consult  at  the 
hospital  with  a magistrate  or  other  judicial  officer, 
at  which  time  he  shall  be  advised  of  his  right  to 
hearing,  at  which  hearing  he  must  be  represented 
by  counsel  and  may  present  evidence.  After  ad- 
mission the  patient  is  forthwith  to  be  examined 
by  some  other  physician  than  said  two  physicians 
and  must  be  found  to  be  in  need  of  treatment. 
The  patient  also  has  a right  to  further  hearing 
any  time  prior  to  expiration  of  60  days  from  his 
admission.  If  this  is  not  asked,  the  superintendent 
must  arrange  in  said  period  to  have  a hearing. 
Other  provisions  also  provide  for  further  period- 
ical review  of  need  for  hospitalization. 

Hospitalization  upon  court  order: 

Whenever  any  person  shall  be,  or  supposed  to 
be,  mentally  retarded  or  in  need  of  mental  treat- 
ment, any  reputable  citizen  of  this  state  may  file 
in  the  Circuit  Court  the  verified  petition  alleg- 
ing that  the  individual  is  in  need  of  mental 
treatment  and  that  he  be  admitted  to,  and  con- 
fined to,  a hospital  for  the  mentally  ill.  Upon  the 
filing  of  the  petition  the  court  shall  have  power 
to  make  necessary  temporary  orders  of  restraint 
and  a hearing  shall  be  had  after  an  examination 
has  been  made  by  a physician  or  psychologist  ap- 
pointed by  the  court.  At  the  hearing  the  patient 
may  be  represented  by  counsel  and  has  the  right 
to  a trial  by  a jury  of  six.  When  the  patient  de- 
mands a jury,  one  of  the  six  members  shall  be 
a physician  or  a psychiatrist  dependent  upon 
question  of  mental  treatment  or  mental  retarda- 
tion. 

Emergency  admission,  detention : 

Whenever  a petition  is  filed  in  the  Circuit  Court 
by  a reputable  citizen  alleging  that  the  condition 
of  an  individual  is  such  that  immediate  restraint 
is  necessary,  which  petition  is  accompanied  by 
a certificate  of  a physician,  the  individual  may 
be  confined  in  a mental  hospital  for  a period  not 
exceeding  15  days. 

This  new  Mental  Health  Act  not  only  appears 
to  contain  adequate  provisions  for  the  confinement 
of  mental  cases,  but  also  provides  sufficient  safe- 
guards so  that  an  individual  cannot  be  wrong- 
fully restrained  for  an  undue  period  of  time.  In 
fact,  it  would  seem  remote  that  abuses  would 
happen  under  the  numerous  safeguards  provided. 
As  an  example,  any  advice  as  to  the  rights  of  the 
patient  must  be  given  in  a language  with  which 
the  patient  is  familiar. 

The  State’s  Attorney  of  each  county  is  charged 
with  the  responsibility  of  the  enforcement  and 


operation  of  this  Act  and  this  is  the  office  which 
should  be  contacted  by  the  physician  when  deal- 
ing with  mental  patients.  The  clerks  of  the  courts 
concerned  have  been  furnished  forms  to  be  em- 
ployed under  the  Act  and  it  is  provided  that  all 
forms  shall  comply  substantially  with  those  so 
furnished  so  that  it  is  obvious  that  one  should 
employ  the  same. 

INTERNAL  REVENUE  CODE 

It  should  be  evident  to  the  busy  physician  that 
it  is  just  as  unwise  for  him  to  be  his  own  tax  con- 
sultant as  it  is  for  every  man  to  be  his  own 
doctor.  The  physician  is  well  aware  that  in  seek- 
ing to  keep  abreast  of  all  of  the  ramifications  and 
developments  of  modern  medicine,  he  has  a bur- 
den that  is  becoming  increasingly  difficult  to  sus- 
tain and  that  he  has  very  little  time  to  devote  to 
subjects  as  complex  as  taxation,  which  is  right- 
fully the  province  of  his  accountant  and  lawyer. 

Taxation  in  the  United  States  is  complex  and 
many  tax  matters  have  no  particular  application  to 
the  medical  profession  as  such.  However,  the 
doctor  as  a citizen  should  be  aware  that  he  is 
greatly  affected  by  a subject  so  varied  and  so 
complicated  that  the  statutes  themselves  require 
seme  1,500  pages  to  be  set  forth.  And  he  should 
know  that  sections  1(a)  through  8023(b)  are 
printed  in  a size  of  type  that  should  be  of  some 
benefit  in  fees  to  practitioners  who  concern  them- 
selves with  the  human  eye.  Surely  the  point  that 
physicians  are  well  advised  to  place  their  prob- 
lems with  accounting  and  legal  advisors  is  fur- 
ther exemplified  by  such  facts  as  the  following: 

Regulations  implementing  the  Internal  Revenue 
Act  require  some  9,700  pages  for  them  to  be 
spelled  out  and  that,  in  order  to  designate  the  dif- 
ferent regulations,  the  government  needs  to  entitle 
the  regulations  as  Regulation  Section  1.0-1  through 
Regulation  Section  301.770-11. 

Just  as  the  patient  would  be  so  much  better 
served  if  he  saw  his  doctor  regularly  before  dif- 
ficulties become  advanced,  so  the  physician’s  inter- 
ests would  be  better  served  if  he  would  seek  ad- 
vice on  income  and  estate  tax  problems  before  the 
fact,  rather  than  after  problems  have  arisen. 

PROCEDURES  AND  REPORTS  IN 
CONTROL  OF  NARCOTIC  DRUGS 

Physicians  are  subject  to  control  by  both  the 
state  of  Illinois  and  the  federal  government  in 
relation  to  narcotic  drugs.  The  numerous  pro- 
visions of  the  federal  regulations  are  set  forth  in 
a fairly  lengthy  pamphlet  entitled,  “Regulations 
No.  5 Relating  to  the  Importation,  Manufacture, 
Production,  Sale,  etc.,  of  Opium,  Coca  Leaves, 
Isonipecaine  or  Opiates,”  which  was  reprinted 
April  1,  1957,  and  is  available  at  a cost  of  45 
cents  through  the  Superintendent  of  Documents, 
U.  S.  Government  Printing  Office,  Washington, 
D.  C.  This  is  published  by  the  Bureau  of  Nar- 
cotics of  the  U.  S.  Treasury  Department. 


for  October,  1968 


539 


The  state  of  Illinois’  “Uniform  Narcotic  Drug 
Act”  has  been  in  effect  since  Jan.  1,  1958.  It  is 
found  in  paragraphs  22-1  through  22-49,  inclusive, 
Chapter  38  of  Illinois  Revised  Statutes,  1967.  The 
Division  of  Narcotic  Control’s  current  rules  and 
regulations  to  implement  the  Act  have  been  in 
effect  since  Apr.  1,  1960.  They  cover  such  matters 
as  prescriptions  and  official  forms  therefor, 
emergencies  excusing  use  of  other  than  official 
prescription  forms,  reporting  of  loss  or  theft  of 
such  prescription  blanks,  records  to  be  kept  by 
the  physician,  dispensing  of  hypodermic  syringes 
and  needles,  prescribing  procedures  in  hospitals, 
and  other  subjects  related  to  narcotic  drugs.  The 
Act  and  the  rules  and  regulations  are  available  at 
no  cost  through  the  Division  of  Narcotic  Control, 
623  E.  Adams  St.,  Springfield. 

Further,  the  state  of  Illinois  has  had  in  effect 
since  Jan.  1,  1960,  a “Uniform  Drug,  Device  and 
Cosmetic  Act.”  Its  rules  and  regulations  control 
such  things  as  the  keeping  of  adequate  rec- 
ords, for  a period  of  two  years,  of  all  purchases 
and  dispositions  of  dangerous  drugs  as  such  drugs 
are  defined  by  the  Act.  A publication  containing 
the  Act  and  the  pursuant  rules  and  regulations 
is  also  available  through  the  Division  of  Nar- 
cotic Control  in  Springfield. 

All  physicians  are  urged  to  have  in  their  posses- 
sion copies  of  both  the  state  and  federal  narcotic 
control  acts  and  the  rules  and  regulations  imple- 
menting them.  As  these  laws  and  regulations  are 
changed  from  time  to  time,  every  effort  should  be 
made  to  have  the  current  rules. 

PROCEDURES  AND  REPORTS  AS  TO 
COMMUNICABLE  DISEASES 

In  order  to  be  conversant  with  the  presently 
governing  rules  and  regulations  as  to  the  control 
of  communicable  diseases  and  the  physician’s 
duties  as  to  reports  and  procedures  in  relation 
to  these  afflictions,  it  is  suggested  that  the  phy- 
sician apply  to  the  Department  of  Public  Health 
of  the  State  of  Illinois  at  Room  500,  State  Office 
Building,  Springfield,  for  the  publication  entitled, 
“Rules  and  Regulations  for  the  Control  of  Com- 
municable Diseases,”  which  was  revised  July  1, 
1959. 

HOW  TO  WILL  YOUR  BODY  OR  ANY 
PORTION  THEREOF  TO  SCIENCE 

The  law  in  the  State  of  Illinois  as  to  the  right 
of  an  individual  to  leave  his  body  or  particular 
parts  thereof  to  science  by  will  or  agreement  is 
not  at  all  clear.  While  there  are  instances  of 
medical  science  receiving  dead  bodies  or  parts 
thereof  under  provisions  in  wills  and  agreements 
made  prior  to  death,  such  disposition  has  never 
been  passed  upon  by  the  Illinois  courts  of  last 
resort.  There  is  no  statutory  authority  in  Illinois 
specifically  providing  for  such  disposition. 

Illinois  does  have  an  Act  covering  deceased 


bodies  which  are  to  be  buried  at  public  expense. 
These  bodies  may,  under  certain  conditions,  be 
used  for  advancement  of  medical  science.  The  Act 
is  set  forth  in  paragraph  19,  Chapter  91,  Illinois 
Revised  Statutes  1967,  and  is  as  follows: 

“Superintendents  of  penitentiaries,  houses  of 
correction  and  bridewells,  hospitals,  state  charit- 
able institutions  and  county  homes,  coroners, 
sheriffs,  jailors,  funeral  directors  and  all  other 
state,  county,  town  and  city  officers,  in  whose 
custody  the  body  of  any  deceased  person  re- 
quired to  be  buried  at  public  expense,  shall,  in 
the  absence  of  disposition  of  such  body,  or  any 
part  thereof  by  will  or  other  written  instrument, 
give  permission  to  any  physician  or  surgeon 
licensed  in  Illinois,  or  to  any  medical  college 
or  school,  or  other  institution  of  higher  science, 
education  or  school  of  mortuary  science,  public 
or  private,  of  any  city,  town  or  county,  upon  his 
or  their  receipt  in  writing  of  request  therefor, 
to  receive  and  remove  free  of  public  charge  or 
expense,  after  having  given  proper  notice  to 
relatives  or  guardians  of  the  deceased,  the  bodies 
of  such  deceased  persons  about  to  be  buried 
at  public  expense,  to  be  by  him  or  them  used 
within  the  state,  for  advancement  of  medical, 
anatomical,  biological  or  mortuary  science.  Pref- 
erence shall  be  given  to  medical  colleges  or 
schools,  public  or  private  and  such  bodies  to  be 
distributed  to  and  among  the  same,  equitably, 
the  number  assigned  to  each,  being  in  proportion 
to  the  students  of  each  college  or  school:  except, 
if  any  person  claiming  to  be,  and  satisfying  the 
proper  authorities  that  he  is  of  kindred  of  the  de- 
ceased asks  to  have  the  body  for  burial,  it  shall, 
in  the  absence  of  other  disposition  of  such  body, 
or  any  part  thereof  by  will,  court  order,  or  other 
written  instrument,  be  surrendered  for  interment. 
Any  medical  college  or  school,  or  other  institution 
of  higher  science  education  or  school  of  mortuary 
science,  public  and  private,  or  any  officers  of  the 
same,  that  receive  the  bodies  of  deceased  persons 
for  the  purposes  of  scientific  study,  under  the  pro- 
visions of  this  Act,  shall  furnish  the  same  to  stu- 
dents of  medicine,  surgery,  and  biological  or  mor- 
tuary sciences,  who  are  under  their  instruction,  at 
a price  not  exceeding  the  sum  of  $5.00  for  each 
and  every  such  deceased  body  so  furnished.” 

It  should  be  noted  that  in  the  above  law  it  is 
provided  that  disposition  shall  be  made  only  in 
case  the  deceased  has  not  specifically  made  dis- 
position by  his  will  or  other  written  instrument. 
This  would  tend  to  support  an  argument  that  the 
deceased  does  have  the  right  to  dispose  of  his 
body  as  he  sees  fit,  but  to  make  it  completely  clear 
a new  act  specifically  giving  this  power  should,  if 
possible,  be  adopted  by  the  legislature. 

The  rather  recent  discovery  that  certain  parts 
may  be  removed  from  a dead  body  and  used  in  a 
living  person  has  greatly  increased  the  need  for 
cadavers  and  parts  thereof.  Any  one  wishing  to 
make  a donation  should  so  provide  by  his  will 
and  notify  the  institution  to  receive  the  body,  or 


540 


Illinois  Medical  Journal 


any  part  thereof,  of  this  provision  in  his  will  and 
aLo  notify  the  executor  of  the  will  and  his  next 
of  kin,  or  whoever  is  the  most  likely  to  be  notified 
immediately  of  his  death,  for  time  is  of  the  essence 
in  the  case  of  transplants, 

AUTOPSY 

In  Illinois,  the  heirs  and  next  of  kin  can  bring 
an  action  for  mutilation  of  the  body  in  those  cases 
where  an  autopsy  is  performed  without  authority 
or  permission.  In  order  to  avoid  the  possibiUty  of 
liability,  autopsies  should  only  be  performed,  in 
Illinois,  when  ordered  by  the  coroner  or  upon  writ- 
ten consent  given  by  the  next  of  kin.  The  coroner 
may  order  an  autopsy  directly  against  the  wishes 
of  the  next  of  kin. 

THE  MEDICAL  WITNESS 

It  is  difficult  to  find  a field  of  law  in  which 
expert  evidence  is  of  greater  importance  than  the 
testimony  of  the  physician  in  accident  cases.  The 
carnage  and  mutilation  on  highways  alone  result 
in  many  thousands  of  lawsuits  a year  and  the  busy 
physician  finds  that  attending  court  is  a burden 
that  often  cannot  be  avoided. 

There  may  be  hope  that  the  growing  use  of 
depositions  will  reduce  some  of  the  load  from  both 
physicians  and  attorneys  as  disclosure  of  evidence 
through  deposition  is  likely  to  result  in  settlement 
before  a case  is  brought  to  trial.  Nevertheless,  all 
signs  indicate  that  the  average  practitioner  can 
expect  an  increase  in  the  number  of  times  he  will 
be  called  upon  as  an  expert  witness  in  the  coming 
years. 

It  is  suggested  that,  if  the  physician  wishes  to 
better  prepare  himself  as  to  medical  jurisprudence, 
there  are  a number  of  sources  which  can  give  him 
an  insight  into  what  he  may  expect  in  the  forum 
and  give  him  greater  confidence  as  to  this  aspect 
of  his  practice.  Such  sources,  without  even  the 
suggestion  that  the  following  begin  to  exhaust  a 
listing  are: 

1 . Doctor  and  Patient  and  the  Law,  by  Attorney 
C.  Joseph  Stetler  and  Alan  R.  Moritz,  M.D.,  Di- 
rector of  the  Institute  of  Pathology  at  Western  Re- 
serve University,  Fourth  Edition,  published  in 
1962  by  The  C.  V.  Mosby  Company  of  St.  Louis. 

2.  Chapter  III  on  Evidence  in  Law  in  Medical 
and  Dental  Practice  by  Lott  and  Gray,  published 
in  1942  by  The  Foundation  Press  of  Chicago. 

3.  Medical  Trial  Technique  by  Attorney  Irving 
Goldstein  and  Willard  Shabat,  M.D.,  published  in 
1942  by  Callaghan  and  Company  of  Chicago. 

4.  Lawyers  Medical  Cyclopedia  of  Personal  In- 
juries and  Allied  Specialties,  which  consists  of 
seven  volumes  and  is  an  elaborate  treatment  of  the 
subject;  published  in  1962  by  The  Allen  Smith 
Company  of  Indianapolis. 

5.  The  Rights  and  Rewards  of  the  Medical  Wit- 
ness by  Nordstrom,  published  in  1962  by  Thomas 
Publishing  Company  of  Springfield. 


MEDICAL  CORPORATIONS 

In  1963  the  Illinois  Legislature  for  the  first 
time  authorized  the  formation  of  medical  cor- 
porations (Paragraph  631  through  647  Chapter 
32  Illinois  Revised  Statutes,  1967).  Under  this  act 
one  or  more  physicians  licensed  to  practice  medi- 
cine may  organize  as  an  Illinois  business  cor- 
poration. All  officers,  directors  and  shareholders 
of  the  corporation  must  be  licensed  under  the 
Medical  Practice  Act. 

The  formation  of  such  a corporation  has  the 
advantage  of  giving  the  physicians  in  such  a cor- 
poration limited  liability  and  has  the  possibility 
of  some  tax  advantages. 

INTERPROFESSIONAL  CODE  FOR 
PHYSICIANS  AND  LAWYERS 
OF  ILLINOIS 

The  following  Interprofessional  Code  for  Physi- 
cians and  Lawyers  of  Illinois  was  drafted  by  a 
Special  Committee  on  Medical-Legal  Cooperation 
of  the  Illinois  State  Bar  Association  and  the  Liai- 
son Committee  of  the  Illinois  State  Medical  So- 
ciety to  serve  as  a guide  to  physicians  and  lawyers. 
It  has  been  approved  by  the  governing  board  of 
both  the  Illinois  State  Bar  Association  and  the 
Illinois  State  Medical  Society. 

Preamble 

The  purposes  of  this  Code  are  to  establish  stand- 
ards of  practice  and  of  ethical  conduct  for  physi- 
cians and  lawyers  in  those  areas  in  civil  cases 
where  there  is  and  will  continue  to  be  an  inter- 
relationship of  medicine  and  law,  and  thereby  to 
improve  the  practical  working  relationships  of  the 
two  professions,  to  protect  the  legitimate  interests 
and  the  rights  of  the  patient-client,  of  the  phy- 
sician, the  lawyer,  and  of  society,  and  thereby  to 
help  advance  the  more  effective  administration  of 
justice. 

The  provisions  of  the  Code  constitute  recogni- 
tion that  the  members  of  each  profession  have  an 
obligation  not  only  to  the  individual  who  obtains 
their  advice  and  assistance  but  also  to  the  com- 
munity and  society  as  a whole,  and  to  all  other 
members  of  their  own  professions.  The  objectives 
of  the  Code  can  be  achieved  only  if  the  members 
of  both  professions  acquaint  themselves  with  these 
standards  of  practice  and  follow  them,  subject  to 
rules  of  law  and  principles  of  medical  and  legal 
ethics. 

ARTICLE  I 

Attending  Physician’s  Medical  Reports 
AND  Conferences 

Purpose  of  Physician’s  Report 

1.  Information  relative  to  an  attending  physi- 
cian’s treatment  of  a patient  whose  physical  or 
mental  condition  is  an  issue  in  litigation  is  of 
prime  importance  to  the  parties  involved  in  litiga- 
tion. To  properly  prepare  his  client’s  case  for  trial 


for  October,  1968 


541 


and  to  be  in  a position  to  properly  represent  his 
client  in  settlement  negotiations,  the  patient’s  law- 
yer has  the  duty  of  acquiring  pertinent  information 
from  the  attending  physician.  During  the  course 
of  litigation,  it  becames  necessary  for  the  lawyer 
to  correspond  with  and  confer  with  his  client’s 
physician  and  to  obtain  written  reports  from  the 
physician. 

Keep  Complete  Records 

2.  The  attending  physician  should  prepare,  keep 
and  preserve  full  and  complete  records  of  his  ex- 
amination, diagnostic  findings  (laboratory),  and 
treatment  of  the  patient. 

Request  for  Report 

3.  When  a medical  report  is  desired  by  the  law- 
yer, he  should  make  a written  request  for  it  from 
the  attending  physician,  and  this  request  should 
be  accompanied  by  a written  authorization  from 
the  client  for  the  release  of  the  information  sought 
from  the  client’s  physician.  The  request  should 
ask  the  physician  to  give  the  following  specific  in- 
formation; 

(a)  History  of  the  occurrence  leading  to  the  in- 
jury or  condition,  as  given  by  the  patient  to 
the  physician. 

(b)  Pertinent  subjective  complaints  elicited 
from  the  patient. 

(c)  Pertinent  objective  findings  made  by  the 
physician  throughout  the  course  of  treat- 
ment. 

(d)  The  physician’s  diagnosis. 

(e)  Interpretation  of  x-rays,  electroencephalo- 
grams, electromyograms,  and  any  and  all 
other  pertinent  data  used  in  the  treatment 
and  diagnosis  (source  and  interpretation 
should  be  stated). 

(f)  Treatment  rendered  by  the  physician  to  the 
patient. 

(g)  The  physician’s  opinion  as  to  whether  there 
is  permanent  residual  from  the  injury  or 
condition  and  the  extent  thereof. 

(h)  The  prognosis. 

(i)  The  physician’s  opinion  as  to  the  necessity 
of  further  medical  or  surgical  treatment. 

The  request  for  a report  should  be  accompanied 
by  a statement  that  the  lawyer  will  endeavor  to 
provide  for  the  payment  of  the  physician’s  fees  out 
of  any  settlement  or  satisfaction  of  judgment. 

The  Physician’s  Report 

4.  The  physician  has  the  obligation  to  cooperate 
with  his  patient’s  lawyer  and  should  as  soon  as 
practicable  after  receiving  the  request  for  it  sup- 
ply the  patient’s  lawyer  with  a written  report.  This 
report  should  be  clear  and  concise  and  should  con- 
tain specific  responses  to  the  elements  enumerated 
in  the  lawyer’s  request  for  a report.  In  preparing 
the  report,  the  physician  should  examine  his  own 
records  and  where  practicable,  the  records  of  any 
hospital  he  deems  necessary  pertaining  to  the  treat- 
ment of  the  patient. 


The  attending  physician  should  not  give  written 
or  oral  reports  concerning  his  patient  to  attorneys, 
adjusters,  or  investigators  representing  parties 
whose  interests  are  adverse  to  those  of  the 
patient  without  express  written  authorization  from 
the  patient. 

Report  Should  Be  Complete 

5.  The  report  to  the  lawyer  should  be  objective, 
impartial  and  complete.  The  attending  physician 
should  not  give,  and  should  not  be  asked  to  give 
a report  that  does  not  comply  with  these  standards. 

Conference  Between  Physician  and  Lawyer 

6.  Prior  to  the  submission  of  a medical  report  by 
the  attending  physician  to  the  patient’s  lawyer,  con- 
ferences may  be  required  between  the  patient’s 
physician  and  lawyer.  Conferences  at  the  request 
of  either  the  physician  or  the  lawyer  should  be  ar- 
ranged at  the  mutual  convenience  of  each.  At  the 
conference  there  should  be  candid  discussion  of 
the  medical  aspects  of  the  litigation  to  promote 
complete  understanding  between  the  patient’s 
physician  and  lawyer. 

ARTICLE  II 

Examining  Physician’s  Medical  Reports 

The  “examining  physician,”  as  the  term  is  used 
in  the  Code,  differs  from  the  “attending  physician” 
and  the  “expert”  in  that  he  does  not  prescribe 
treatment  and  is  not  necessarily  expected  to  testi- 
fy at  the  trial.  His  examination  is  made  at  the 
request  of  the  lawyer  for  one  or  both  of  the 
parties  or  at  the  request  of  the  court.  Should  he 
later  testify  at  the  trial  he  testifies  as  an  expert. 

Request  for  Examination  and  Report 

1.  Where  the  examination  is  made  at  the  behest 
of  either  party,  a written  request  for  examination 
should  be  sent  to  the  physician  by  the  lawyer 
asking  for  the  examination  stating  the  nature  of 
the  examination  desired. 

The  request  should  be  specific  and  request  the 
physician  to  give  the  following  information: 

(a)  Pertinent  subjective  complaints  elicited  from 
the  patient. 

(b)  Pertinent  objective  findings  made  by  the 
physician. 

(c)  The  physician’s  diagnosis  as  of  the  time  of 
the  examination. 

(d)  Interpretation  of  x-rays,  electroencephalo- 
grams, electhomyograms  and  any  and  all 
other  pertinent  data  used  in  the  diagnosis 
(source  of  interpretation  should  be  stated). 

(e)  The  physician’s  opinion  as  to  whether  there 
is  a permanent  residual  from  the  injury, 
and  the  extent  thereof. 

(f)  The  prognosis. 

(g)  The  physician’s  opinion  as  to  the  necessity 
of  further  medical  or  surgical  treatment. 

Report  of  Examination 

2.  The  examining  physician  should  send  the  re- 
port of  the  examination  to  the  lawyer  requesting 
the  examination  as  soon  as  practicable  after  the 


542 


Illinois  Medical  Journal 


examination.  The  report  should  be  clear  and  con- 
cise and  should  contain  specific  responses  to  the 
elements  enumerated  in  the  lawyer’s  request. 

Report  is  Confidential 

3.  The  examining  physician  shall  not  give  medi- 
cal information  to  the  opposing  lawyer  without 
the  authorization  of  the  lawyer  who  requested  the 
examination,  unless  the  examination  is  pursuant  to 
order  of  court. 


take  all  reasonable  steps  to  see  that  his  client  pays 
the  said  fee. 

(5)  The  attending  physician  shall  not  charge  his 
patient  a higher  fee  because  the  patient  may  re- 
cover the  amount  of  these  charges  as  the  result  of 
a claim  or  litigation. 

(6)  The  lawyer  should  not  pay  the  attending 
physician’s  fee  except  with  the  client’s  funds. 

(7)  The  physician’s  fee  shall  not  be  contingent 
upon  the  outcome  of  the  litigation. 


Keep  Complete  Records 

4.  The  examining  physician  should  prepare,  keep 
and  preserve  full  and  complete  records  of  his  ex- 
amination and  diagnostic  findings  (laboratory). 

Report  Should  Be  Complete 

5.  The  report  to  the  lawyer  should  be  objective, 
impartial,  and  complete.  The  examining  physician 
should  not  give,  and  should  not  be  asked  to  give 
a report  that  does  not  comply  with  these  standards. 

Examination  at  the  Request  of  the  Court 

6.  Provisions  for  examination  at  the  request  of 
the  court,  and  the  procedure  to  be  followed,  are 
covered  by  rule  of  court  or  by  statute. 

Copy  of  Report  to  Employee  in 
Workmen’s  Compensation  Cases 

7.  In  Workmen’s  Compensation  cases,  the  exam- 
ining physician  selected  by  the  employer  is  re- 
quired to  deliver  a copy  of  his  report  to  the  in- 
jured employee  or  his  lawyer,  unless  the  employee 
has  a physician  of  his  own  selection  present  during 
the  examination. 


ARTICLE  III 
Medical  Fees 

A-ttending  Physician 

(1)  The  attending  physician  of  a patient  whose 
physical  or  mental  condition  is  the  subject  matter 
in  litigation  may,  in  the  manner  provided  by  the 
Statutes  of  the  State  of  Illinois,  perfect  his  lien  for 
medical  fees  for  his  sed/ices  rendered  to  the 
patient. 

(2)  The  physician  shou  i also  notify  the  lawyer 
for  the  patient  of  his  lien^^by  sending  him  a copy 
of  the  Notice  of  Lien. 

(3)  The  lawyer  for  the  j^ktient  should  explain  to 
his  client  the  nature  of  the  lien  and  necessity  for 
satisfying  it  out  of  any  recovery.  The  lawyer 
should  take  all  reasonable  steps  to  assure  payment 
for  the  physician’s  services  out  of  any  recovery 
made  for  the  client.  If  the  lawyer  finds  that  he 
cannot  accomplish  this,  he  should  notify  the  phy- 
sician immediately  so  that  he  may  take  steps  to  en- 
force his  lien. 

(4)  In  the  event  that  the  attending  physician 
expends  time  in  preparing  a report,  in  appearing 
at  a deposition  or  in  court,  or  in  any  other  manner 
for  his  patient,  the  physician  shall  be  entitled  to  a 
reasonable  fee  from  his  patient.  The  lawyer  shall 


Examining  Physician 

(1)  A physician  who  makes  an  examination  at 
the  request  of  a lawyer  shall  charge  the  reasonable 
value  of  his  services  so  rendered  on  the  same  basis 
as  if  his  services  were  not  rendered  to  patient  in 
connection  with  litigation.  The  physician’s  charge 
for  reports,  conferences  with  the  lawyer,  and  ap- 
pearances at  depositions  and  in  court  shall  also  be 
based  upon  the  reasonable  value  of  those  services. 

(2)  The  said  charges  shall  be  the  obligation  of 
the  client  and  not  of  his  lawyer.  The  lawyer  shall 
make  every  reasonable  effort  to  see  to  it  that  his 
client  pays  the  fee  of  the  examining  physician  for 
all  services  rendered  by  the  physician  to  or  in 
behalf  of  said  patient. 

(3)  The  examining  physician’s  fee  shall  not  be 
contingent  upon  the  outcome  of  the  litigation. 
Experts 

(1)  The  physician  whose  services  may  be  ren- 
dered as  an  expert  in  connection  with  any  phase 
of  litigation,  shall  not  charge  more  than  the  rea- 
sonable value  of  his  services.  The  fee  shall  be  the 
obligation  of  the  patient-client  and  not  of  his 
lawyer. 

(2)  The  lawyer  shall  make  every  reasonable  ef- 
fort to  see  that  his  client  pays  the  fee  of  the  expert. 

(3)  The  expert’s  fee  shall  not  be  contingent  up- 
on the  outcome  of  the  litigation. 

ARTICLE  IV 

The  Physician  At  The  Trial  Or  Hearing 
On  Deposition 

Conferences  Prior  to  Trial 

( 1 ) The  lawyer  and  the  physician  should  arrange 
to  confer  with  each  other  before  the  physician  tes- 
tifies at  any  hearing,  and  if  possible,  before  the 
trial  commences.  At  the  conference  the  common 
problems  involved  in  the  case  should  be  discussed. 
The  lawyer  has  the  responsibility  of  acquainting 
the  physician  with  any  particular  legal  problems 
which  might  involve  the  physician,  and  with  the 
assistance  of  the  physician  should  determine  the 
areas  in  which  the  physician  will  be  called  to 
testify.  The  lawyer  should  familiarize  the  physician 
with  the  contents  of  any  proposed  hypothetical 
questions. 

(2)  The  physician  should  make  every  effort  to 
cooperate  with  the  lawyer  in  regard  to  this  con- 
ference. Each  should  be  mindful  of  the  demands 
on  the  other’s  time  in  making  appointments  for 
conferences,  in  the  time  spent  on  conferences,  and 


for  October,  1968 


543 


in  notifying  the  other  promptly  if,  for  any  reason, 
either  is  unable  to  attend  the  appointed  conference. 
While  the  physician  should  recognize  that  he  is 
not  an  advocate  and  the  lawyer  is,  he  should  at 
the  conference  familiarize  the  lawyer  with  the 
medical  problems  involved,  the  areas  in  which  he 
(the  physician)  feels  qualified  to  testify,  and  the 
facts  and  opinions  about  which  he  is  prepared  to 
testify. 

Court  Arrangements 

(1)  The  lawyer  should  make  every  effort  to  be 
economical  in  his  use  of  the  physician’s  time.  He 
should  give  the  physician  reasonable  advance 
notice  of  when  and  how  long  he  shall  be  needed 
in  court,  advise  the  physician  promptly  of  any 
changes  in  the  time  of  his  needed  appearance  and 
should  call  the  physician  as  a witness  upon  his 
arrival  at  court,  with  as  little  delay  as  possible. 

(2)  The  physician  has  an  obligation  to  be  in 
court  at  the  time  requested.  He  should  recognize 
that  only  a true  emergency  will  excuse  his  nonat- 
tendance. In  the  event  that  such  an  emergency 
does  arise,  he  should,  as  soon  as  possible,  notify 
the  lawyer  who  requested  his  appearance  in  court 
of  his  inability  to  be  in  court  at  the  appointed 
time  and  also  advise  as  to  the  earliest  time  he  will 
be  available  to  testify. 

Subpoenas 

(1)  The  lawyer  should  determine  whether  or 
not  the  physician  should  be  served  with  a sub- 
poena. If  the  physician  is  to  be  served  with  a sub- 
poena, the  lawyer  should  advise  the  physician  of 
the  reason  for  serving  him;  for  example,  that  serv- 
ice of  a subpoena  is  necessary  to  lay  the  founda- 
tion for  a continuance  if  the  physician  is  unable 
to  attend  the  trial  due  to  an  emergency  or  other 
cause.  If  service  of  a subpoena  is  to  be  had,  the 
lawyer  should  advise  the  physician  in  advance,  and 


if  possible,  arrange  for  the  service  of  the  subpoena 
at  a time  and  place  satisfactory  to  the  physician. 

(2)  The  physician  should  recognize  that  a law- 
yer may  deem  it  necessary  to  subpoena  the  physi- 
cian, and  that  the  physician  is  obliged  to  answer 
the  subpoena  as  any  other  citizen.  He  should  co- 
operate with  the  lawyer  with  regard  to  the  time 
and  place  of  service. 

Conduct  as  a Witness 

(1)  It  is  improper  for  a lawyer  to  attempt  to 
color  or  otherwise  influence  the  professional  opin- 
ion of  a physician. 

(2)  The  physician’s  testimony  should  be  un- 
biased and  given  in  terms  understandable  to  the 
jury.  He  should  be  prepared  to  testify  in  detail  as 
to  his  qualifications,  the  medical  facts  in  the  case, 
and  to  give  his  frank  and  honest  medical  opinion 
in  regard  thereto.  Technical  or  medical  terms,  if 
used,  should  be  carefully  and  fully  explained.  The 
physician  should  remember  that  he  is  not  an  ad- 
vocate trying  a lawsuit,  nor  should  he  feel  that  he 
is  taking  sides  on  any  particular  medical  issue  or 
fact. 

Conclusion 

If  the  above  interprofessional  code  for  physi- 
cians and  attorneys  of  Illinois  was  followed  by  all 
parties,  the  following  results  might  well  be 
attained; 

1.  A greatly  improved  understanding  of  each 
others  problems  by  the  members  of  both  profes- 
sions. 

2.  A considerable  savings  of  time  by  all  partici- 
pants. 

3.  Better  public  relations  for  both  groups. 

4.  Better  and  easier  collections  of  fees. 

5.  Better  and  more  efficient  administration  of 
justice. 


ia 

A Philosophy  ^ 

I would  liken  our  current  condition  to  that  of  the  atomic  physicists  of 
twenty  years  ago.  Following  the  creation  of  the  atomic  bomb,  these  men 
claimed  that  since  they  had  made  the  bomb,  someone  else  must  determine 
its  use.  The  political,  international,  and  military  philosophy  regarding  its  use 
and  by  whom,  was  a problem  to  be  argued  and  determined  by  the  military 
politicians  and  the  public  at  large.  History  shows  that  the  physicists  were 
unable  to  hide  behind  their  particular  premise.  They  were  forced  to  engage 
in  a public  dialogue  and  through  multiple  conversations,  partly  of  their  mak- 
ing, the  code  of  mores  relating  to  the  dropping  of  the  bomb  became  of  them 
and  by  them.  So  must  you  and  I,  as  physicians,  participate  in  the  creation  of 

solutions  to  current  ethical  and  moral  problems (C.  Barber  Mueller, 

'To  Practice  Solely  For  Cure,"  Rocky  Mountain  Med.  Jl.  [Mar.]  1968;  pg.  39.) 


544 


Illinois  Medical  Journal 


INDEX  TO  REFERENCE  SECTION 


Administration,  Division  of 444 

Aging,  Committee  on  423 

Alcoholism,  Committee  on  424 

American  Medical  Association 

Delegates  and  Alternates  to 419 

Officers  of  the  407 

Approved  Schools 520 

Archives  Committee  424 

Artificial  Kidney  Centers 515 

Autopsy  540 

Benevolence,  Sub-Committee  on 429 

Board  of  Trustees 407 

Business  Services,  Division  of 444 

Cancer  Control,  Committee  on  424 

Child  Health,  Committee  on  425 

Certified  Laboratory  Assistants, 

Approved  Schools  of 521 

Comb-1  Insurance  Form  447 

Commitment  of  Patients  to  Mental  Hospitals  ..538 
Committees 

Committee  to  Study 425 

Trustee  District 417 

Illinois  State  Medical  Society  423 

Index  442 

Communicable  Diseases,  Procedures  and 

Reports  as  to 540 

Constitution  and  Bylaws  385 

Committee  on  425 

Index  to  399 

Consumer  Fraud  Act  538 

Continuing  Education,  Committee  on 426 

Councils  of  the  Illinois  State  Medical 

Society  421 

County  Medical  Societies,  Officers  of 410 

Cytotechnology,  Approved  Schools  of  520 

Delegates  and  Alternates 

to  the  American  Medical  Association 419 

to  the  Illinois  State  Medical  Society  407 

Disaster  Hospital  Manual  448 

Disaster  Medical  Care,  Committee  on  426 

District  Committees  417 

Doctor’s  Responsibility  to  the  Press  453 

Drugs  and  Therapeutics,  Sub-Committee  on  ....432 

Editorial  Board  430 

Educational  & Scientific  Foundation  447 

Committee  on  426 

Educational  and  Scientific  Services, 

Division  of 446 

Ethical  Relations  Committee  427 

Ethics,  Principles  of  Medical  384 


Executive  Committee  428 

Extended  Care  Facilities  509 

Eye  Committee  428 

Films  447 

Finance  Committee  428 

Good  Samaritan  Bill  538 

Group  Disability  Program  451 

Group  Major  Medical  Expense  Plan  451 

History  of  Founding  and  Expansion 

of  ISMS  381 

Home  Health  Agencies,  Certified 

(Medicare)  516 

Homes,  Directory  of  Licensed 

for  the  Aged  506 

Nursing  489 

Sheltered  Care 501 

Hospital  Relations,  Committee  on 429 

Hospitals 

General  481 

Pre-Positioned  Packaged  Disaster  475 

Private  Mental  488 

with  Special  Type  of  Service  487 

State  Mental  487 

State  Schools  for  Mentally  Defective 488 

House  of  Delegates,  ISMS  407 

Chicago  Medical  Society  Delegates  408 

Downstate  Delegates  and  Alternates  409 

Ex-Officio  Members  of  407 

How  to  Set  Your  Affairs  in  Order 533 

How  to  Will  Your  Body  or  Any  Portion 
Thereof  to  Science 540 

Illinois  Association  of  the  Professions 458 

Illinois  Department  of  Public  Aid, 

Medical  Advisory  Committee  to  432 

Illinois  Medical  Assistants  Association  457 

Illinois  Medical  Journal 

Editorial  Board  430 

Journal  (Publications)  Committee  430 

Illinois  Medical  Political  Action 

Committee  (IMPAC)  457 

Illinois  State  Government  459 

Executive  Branch  460 

Legislative  Branch 460 

Department  of  Children  and  Family 

Services  468 

Advisory  Committees  47 1 

Comprehensive  Mental  Health 

Services,  Division  of 461 

General  Services,  Division  of  462 

Medical  Center  Complex 462 


for  October,  1968 


545 


Mental  Retardation  Services, 

Division  of  461 

Personnel  Services,  Division  of  462 

Planning  and  Evaluation  Services, 

Division  of 461 

Professional  Services,  Division  of  461 

Research  Services,  Division  of 462 

Statutory  Boards  462 

Department  of  Children  & 

Family  Services  468 

Administrative  Services,  Division  of  468 

Child  Welfare,  Division  of  468 

Children’s  Schools,  Division  of  468 

Personnel  Administration,  Division  of  ....468 
Planning,  Research  & Statistics 

Division  of  468 

Rehabilitation  Services,  Division  of  468 

Institutions  469 

Visually  Handicapped  Services  469 

Department  of  Public  Aid 469 

Medical  Advisory  Committee  to  432 

Department  of  Public  Health  464 

County  and  Multiple-County 

Health  Departments  466 

Dental  Health,  Division  of  464 

Foods  and  Drugs,  Division  of 464 

General  Administration,  Division  of  464 

Hospitals  481 

With  Special  Type  of  Service  486 

Mental  487 

Chronic  Illness,  Division  of 464 

Laboratories,  Division  of 464 

Legislative  Commissions  474 

Local  Health  Services,  Division  of 465 

Milk  Control,  Division  of 465 

Non  Statutory  Boards  472 

Nursing  Homes,  Directory  of  Licensed 489 

Packaged  Disaster  Hospitals  475 

PKU  Fluorometric  Test, 

Approved  Laboratories  478 

Poison  Control  Centers  478 

Preventive  Medicine,  Division  of 465 

Regional  Offices  466 

Revised  Vital  Records,  1968  454 

Sanitary  Engineering,  Division  of  465 

Statutory  Boards  and  Commissions 47 1 

Tuberculosis  Control,  Division  of  465 

Urban  Health  Departments  467 

Department  of  Registration  and 

Education  526 

Medical  Examining  Committee 526 

Medical  Practice  Act  526 

Division  of  Vocational  Rehabilitation  470 

State  Officers 460 


Impartial  Medical  Testimony  449 

Committee  on  429 

Independent  Laboratories  512 

Index  to  Constitution  and  Bylaws  442 

Index  to  I.  S.  M.  S.  Policy  Manual 406 

Inhalation  Therapy,  Approved  Schools  of 521 

Insurance  Form,  Comb-1  447 

Insurance  Programs  450 

Internal  Revenue  Code 539 

Interprofessional  Code  for 

Physicians  and  Lawyers  541 

Interprofessional  Groups, 

Advisory  Committee  to  515- 

Journal  Committee  430 

Laboratory  Evaluation,  Committee  on  431 

Legal  Liability  of  Physicians  534 

Legislation  and  Public  Affairs,  Council  on 421 

Legislation  and  Public  Affairs,  Division  of  ....445 

Map  of  Trustee  Districts  416 

Maternal  Welfare,  Committee  on  431 

Medical  Benevolence,  Sub-Committee  on  429 

Medical  Career  Recruitment  Programs  448 

Medical  Corporations  541 

Medical  Economics  and  Insurance, 

Committee  on  433 

Medical  Education,  Committee  on 433 

Medical  Education,  Council  on  422 

Medical  Ethics,  Principles  of  384 

Medical  Examining  Committee  526 

Medical  Legal  Council 421 

Medical -Legal  Information  533 

Admissibility  in  Evidence  of  Deliberations 

of  Tissue  Committees  535 

Autopsy  540 

Consent  by  Minors  to  Medical  Treatment 

and  Operations  537 

Consumer  Fraud  Act  538 

Commitment  of  Patients  to  Mental 

Hospitals  538 

Employment  Contract  Between  Physician 

and  Patient  537 

Good  Samaritan  Bill 538 

How  to  Set  Your  Affairs  in  Order 533 

How  to  Will  Your  Body  or  Any  Portion 

Thereof  to  Science  540 

Internal  Revenue  Code 539 

Legal  Liability  of  Physicians  534 

Liability  Insurance  534 

Medical  Corporations  541 

Medical  Witness,  the 541 

Physician  and  Hospital  Liens  536 

Procedures  and  Reports  as  to 

Communicable  Diseases  540 


546 


Illinois  Medical  Journal 


Procedures  and  Reports  in  Control 

of  Narcotic  Drugs 539 

Medical  Practice  Act  526 

Medical  Practice  and  Quackery,  Committee  on  434 
Medical  Record  Librarians,  Approved 

Schools  of  521 

Medical  Schools  in  the  State  of  Illinois  519 

Medical  Self-Help  Training  Program  453 

Medical  Service,  Council  on  422 

Medical  Technology,  Approved  Schools  of  ....521 

Medical  Witness,  The  541 

Membership  Committee  434 

Mental  Health 

Committee  on  434 

Illinois  Department  of  461 

Modem  Management  of  Multiple  Births  Film  447 

Narcotics 


and  Hazardous  Substances,  Committee  on  435 


Procedures  and  Reports  in  Control  of  539 

Nursing 

Approved  Schools  of  521 

Committee  on  435 

Homes,  Directory  of  Licensed  489 

Nutrition,  Committee  on  ....435 

Occupational  Therapy,  Approved  Course  in  ....521 
Officers 

of  County  Medical  Societies 410 

Illinois  State  Medical  Society  407 

and  Places  of  Meeting  Since 

Organization  of  the  Society 382 

State  of  Illinois  460 

Osteopathic  Problems,  Committee  to  Study  ....436 

Paramedical  Groups,  Advisory  Committee  to  ..436 

Past  Presidents  407 

Physical  Therapy,  Approved  School  of 521 

Physicians’  Placement  and  Student  Loan 

Fund  Program  448 

PKU  Fluorometic  Test,  Approved 

Laboratories  478 

Poison  Control  Centers  478 

Policy  Committee  436 

Policy  Manual,  ISMS  400 

Index  406 

Prepayment  Plans,  Committee  on  437 

Principles  of  Medical  Ethics  384 

Professional  Liability  Program  452 

Public  Affairs,  Committee  on  437 

Public  Aid,  Medical  Advisory  Committee 

to  the  Illinois  Department  of  432 

Public  Health  Committee  on  438 

Public  Health,  Illinois  Department  of 464 

Public  Relations 

Committee  438 


Council  on =..., 422 

and  Economics,  Division  of 446 

Public  Safety,  Committee  on  438 

Publications,  Division  of  446 

Pulse  447 

Radiation,  Committee  on 439 

Radio-Television 

Public  Service  Materials  452 

Registration  an  Education,  Illinois 

Department  of  ...526 

Rehabilitation  Services,  Committee  on  439 

Renal  Dialysis  Centers  515 

Religion  and  Medicine,  Committee  on  439 

Retirement  Investment  Program  450 

Rural  Health  and  Student  Loan, 

Committee  on  440 

Schools,  Approved 

Certified  Laboratory  Assistants  521 

Cytotechnology  520 

Inhalation  Therapy  521 

Medical  519 

Medical  Record  Librarians  521 

Medical  Technology  521 

Nursing 

Associate  Degree  Programs  521 

Baccalaureate  Degree  Programs  522 

Diploma  Programs  523 

Practical  524 

Occupational  Therapy  521 

Physical  Therapy  521 

X-Ray  Technology  520 

Scientific  Assembly,  Committee  on  440 

Scientific  Section  Chairman  441 

Scientific  Services,  Council  on 423 

Services,  ISMS  443 

Sheltered  Care  Homes  501 

Speakers  Bureau 

Scientific  448 

Special  Publications  447 

Stroke — Early  Restorative  Measures 

in  Your  Hospital  Film  447 

Student  Loan  Fund  Program 449 

Tax  Qualified  Retirement  Program  452 

Trustee  District  Committees  417 

Trustees,  Board  of  407 

Usual  and  Customary  Fees,  Committee  on  ....441 

Vocational  Rehabilitation,  Division  of  470 

What  Goes  on  in  Illinois  447 

Woman’s  Auxiliary 

Advisory  Committee  to  the  441 

Chairman  of  Committees  456 

District  Councilors  456 

Officers  and  Board  455 

X-Ray  Technology,  Approved  Schools  of  520 


for  October,  1968 


547 


An  anorectic  will  help  her  lose  weight- 
hut  can  she  keep  it  off? 

You  need  more  than  a pill 
(even  ours)  to  do  that! 


k 


That’s  why  Abbott  offers 
you  a pill  plus  a program. 


The  Product 


For  smooth  appetite 
control  plus  mood 
elevatio7i 


DESOXYN'Gradumef  @ © t 

Methamphetamine  Hydrochloride  5 mg.  10  mg.  15  mg. 

in  Long-Release  Dose  Form 


0 _ 

Forpatwits  who  can’t  DESBUTAL  10  Gradumet 

take  plain  amphetamine  10  mg.  Methamphetamine  Hydrochloride, 

60  mg.  Sodium  Pentobarbital 

DESBUTAL  15  Gradumet 

15  mg.  Methamphetamine  Hydrochloride, 

90  mg.  Sodium  Pentobarbital 


FRONT  SIDE 


The  Program 


Weight  Control  Booklet 


Specifically  written  to  help  your  patients  under- 
stand why  they  are  overweight,  and  what  they  can 
do  about  it.  The  booklet  stresses  the  importance  of 
changing  lifelong  eating  habits  and  explains  how  this 
can  be  done,  sensibly,  comfortably — and  perma- 
nently. There  is,  also,  a comprehensive  list  of  foods 
showing  their  caloric  content. 


f " 

; [turret  | 

Ilf 

fnntrnllinfi 

tfMir 


I 


Food  Diary 


Designed  to  help  the  overweight  patient  follow 
your  eating  instructions.  Space  is  provided  for 
breakfast,  lunch,  supper,  and  even  snacks.  By  writ- 
ing down  everything  that’s  eaten  each  day,  the 
patient  is  constantly  reminded  that  she’s  trying  to 
change  her  eating  habits.  And  you  are  furnished 
with  a written  record  of  how  well  she’s  doing. 


Picture  Menu  Booklet 


Please  see  Brief  Summary 
on  next  page. 


A large  (10"  x 10")  booklet  which  features  appetiz- 
ing lunch  and  dinner  menus  for  every  day  of  the 
week.  The  meals  are  depicted  in  full  color  and  the 
correct  portion  size  so  that  the  dieter  can  see  the 
amount  of  food  that’s  recommended.  Patients  are 
pleasantly  surprised  to  learn  that  each  day’s  meals 
add  up  to  only  1,000  calories.  soi444 


Ask  Your  Abbott  Man  For  Free  Supplies 


Brief  Summary 
DESOXYN®Gradumet® 

Methamptietamine  Hydrochloride 
in  Long-Release  Dose  Form 

DESBUTAC 10  Gradumet 

10  mg.  Methamphetamine  Hydrochloride, 

60  mg.  Sodium  Pentobarbital 

DESBUTAL  15  Gradumet 

15  mg.  Methamphetamine  Hydrochloride, 

90  mg.  Sodium  Pentobarbital 

Indications:  Desoxyn  and  Desbutal 
are  used  orally  as  appetite  suppres- 
sants, for  reduction  of  mild  mental 
depression,  and  to  help  in  manage- 
ment of  psychosomatic  complaints 
or  neuroses.  Desoxyn,  when  ad- 
ministered parenterally,  may  be 
used  as  a vasopressor  agent  or  ana- 
leptic. 

Contraindications : Methampheta- 
mine (in  Desoxyn  and  Desbutal) 
is  contraindicated  in  patients  tak- 
ing a monoamine  oxidase  inhibitor. 
Do  not  use  pentobarbital  (in 
Desbutal)  in  persons  hypersensi- 
tive to  barbiturates. 

Precautions,  Side  Effects:  Observe 
caution  in  patients  with  hyperten- 
sion, cardiovascular  disease,  hyper- 
thyroidism, old  age,  or  those 
sensitive  to  sympathomimetic 
drugs.  Prolonged  usage  may  lead 
to  tolerance  or  psychic  dependence. 
Careful  supervision  is  necessary  to 
avoid  chronic  intoxication  and 
drug  dependence. 

Amphetamine  side  effects  such 
as  headache,  excitement,  agitation, 
palpitation  or  cardiac  arrhythmia 
usually  may  be  controlled  by  re- 
ducing the  dose.  Paradoxically- 
induced  depression  is  an  indication 
to  withdraw  the  drug.  Pentobarbi- 
tal (in  Desbutal)  may  cause  skin 
rash.  Nervousness  or  ex- 
cessive sedation  with 
Desbutal  is  often  transient. 


801444 


NEW 

PHARMACEUTICAL 

SPECIALTIES 

by  Paul  deHaen 


New  Pharmaceutical  Specialties 

For  detailed  information  regarding  indications, 
dosage,  contraindications,  and  adverse  reactions, 
refer  to  the  manufacturer’s  package  insert  or 
brochure. 

Single  Chemicals:  Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products:  Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products:  Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms:  Of  a previously  introduced 
product. 


NEW  SINGLE  CHEMICALS 

DESFERAL  Mesylate  Iron  Chelating  Agent  R 

Manufacturer:  Ciba  Pharmaceutical  Co. 

Nonproprietary  Name:  Deferoxamine  mesylate 

Indications:  Adjunctive  use  in  acute  iron  intox- 
ication. 

Contraindications:  Severe  renal  disease  or  anuria. 

Dosage:  Intramuscular  or  intravenous  adminis- 
tration as  described  in  the  package  insert. 

Supplied:  Ampuls  - 500  mg.  lyophUized  deferox- 
amine mesylate. 

COMBINATION  PRODUCTS 


DONNASEP-MP  Urinary  Antiseptic  R 

Manufacturer:  A.  H.  Robins  Co. 

Composition: 

Methenamine  mandelate  500  mg. 

Hyoscyamine  sulfate  0.0519  mg. 

Atropine  sulfate  0.0097  mg. 

Hyoscine  hydrobromide  0.0033  mg. 

Phenobarbital  8.1  mg. 

Indications:  Urinary  tract  infections 


Contraindications:  Severe  renal  and  hepatic  dys- 
function, narrow  angle  glaucoma,  obstruction 
of  the  GI  and  uringary  tract,  cardiospasm. 
Dosage:  Two  tablets  3 or  4 times  daily. 
Supplied:  Capsules;  bottles  of  100  and  500. 

FILIBON  Forte  Hematinic  R 


Manufacturer:  Lederle  Laboratories 
Composition: 

Vitamin  A Acetate  6,000  USP  Units 

Vitamin  D 400  USP  Units 

Vitamin  E (Tocopheryl  Acid 


Succinate)  30 

Ascorbic  Acid 
Niacinamide 
Pyridoxine  HCl  (Bg) 

Pantothenic  Acid 
Thiamine  Mononitrate  (B,) 
Riboflavin  (Bg) 

Folic  Acid 
Vitamin  B,2 

Ferrous  Fumarate  (elemental  iron) 
Indications:  Anemias  of  pregnancy. 
Contraindications:  None  stated. 
Dosage:  One  tablet  daily. 

Supplied:  Capsules;  bottles  of  100. 

(Continued  on  page  559) 


Int.  Units 
100  mg. 
21  mg. 
10  mg. 
5 mg. 
3 mg. 
3 mg. 
1 mg. 
5 meg. 
45  mg. 


550 


IlUnois  Medical  Journal 


The  first  nationwide  medical 
television  service,  NCME— The 
Network  for  Continuing  Medical 
Education— brings  you  visually  the 
important  achievements  of  leading 
medical  authorities.  By  means  of 
closed-circuit  television,  this  inde- 
pendent network  provides  your 
hospital  or  medical  school  with  a 
complete  videotape  service  that 
helps  shorten  the  gap  between  new 
medical  knowledge  and  its  availabil- 
ity for  clinical  or  teaching  purposes. 

The  Network 
for  Continuing 
Medical 
Education 


NCME  TV  Offers  These  Practical 
Benefits: 

□ Every  two  weeks  a new  60-minute 
videotape  dealing  with  three  separate 
medical  subjects  is  sent  to  participat- 
ing institutions. 

□ Content  and  format  of  NCME  tele- 
casts fulfill  criteria  for  postgraduate 
medical  education,  permitting  Ameri- 
can Academy  of  General  Practice 
course  credits  under  specified  condi- 
tions, 

□ To  help  your  institution  make 
effective  use  of  closed-circuit  televi- 
sion, NCME  offers  a wide  range  of 
services  and  utilization  aids,  including: 
Technical  consultation  in  setting  up  a 
closed- circuit  system;  advance  pro- 
gram information  on  the  contents  of 
each  telecast;  display  units  to  help 
publicize  programs;  expense-paid 
seminars  to  improve  utilization  of 
medical  television. 

□ NCME  programs  are  brief  and  may 
be  shown  as  often  as  desired;  you  can 
view  the  telecasts  at  times  that  are 
most  convenient,  without  disrupting 
your  normal  schedule. 


A recent  NCME  hospital  telecast 
presented  Philip  N.  Sawyer,  M.D., 
Professor  of  Surgery  and  Head  of  the 
Vascular  Surgical  Service  at  Down- 
state  Medical  Center,  Brooklyn,  N.  Y, 
in  a demonstration  and  evaluation  of 
“Gas  Endarterectomy.” 

In  this  program,  Dr.  Sawyer  performs 
the  operation  on  a patient  with  gross 
occlusion  of  the  right  iliac,  femoral 
and  popliteal  arteries. 

In  Dr.  Sawyer’s  view,  gas  endarterec- 
tomy has  several  advantages  over 
mechanical  methods:  the  operation 
can  be  completed  faster,  causes  less 
damage  to  the  arteries  and  offers  a 
more  successful  outcome. 

NCME  is  an  independent  network 
supported  by  Roche  Laboratories  to 
increase  the  use  of  closed-circuit  TV 
for  medical  education  under  direct 
hospital  and  school  control. 

If  your  hospital  or  school  does  not 
participate  in  the  biweekly  NCME 
program,  information  on  the  cost-free 
service  may  be  obtained  by  writing  to 
NCME,  342  Madison  Avenue 
New  York,  N.Y.  10017 


. J 


□ Frequently  NCME  makes  available 
published  papers  related  to  subjects 
presented  on  closed-circuit  television. 


Surgery  For  Acquired  Mitral  Valve  Dis- 
ease. By  F.  Henry  Ellis,  Jr.,  M.D.,  Ph.D. 

299  pages,  illustrated.  W.  B.  Saunders  Co., 

Philadelphia,  1967,  $17. 

Acquired  mitral  valve  disease  is  well  out- 
lined in  the  monograph.  The  text  is  divided 
into  five  major  sections  which  cover  most 
aspects  of  mitral  valve  surgery.  Each  section 
deals  with  a different  phase  of  acquired 
mitral  valve  disease  with  minimal  overlap 
of  material. 

Part  one  covers  the  history  of  mitral  valve 
surgery.  The  bibliography  in  this  section  is 
complete  and  up-to-date.  The  author’s  pur- 
pose in  presenting  a lengthly  bibliography 
was  to  avoid  repetition  in  the  ensuing  chap- 
ters. A thorough  bibliography  such  as  this 
enables  the  reader  to  review  specific  aspects 
of  mitral  valve  disease  in  detail  if  he  wishes 
to. 

The  second  part  presents  the  anatomic, 
physiologic,  and  radiologic  aspects  of  ac- 
quired valvular  disease.  The  illustrations  of 
diseased  valves  are  numerous  and  well  done. 
Preoperative  evaluation  of  the  patient  is 
stressed  in  this  section. 

The  third  subdivision  is  “The  Surgical 
Period.”  In  this  section  the  author  presents 
anesthesia  and  surgical  techniques.  The  var- 
ious approaches  to  the  mitral  valve,  utiliz- 
ing open  and  closed  techniques  are  outlined. 
This  section  could  be  a starting  point  for 
the  student  or  resident  who  is  interested  in 
cardiac  surgery. 

The  chapter  on  post  operative  care  of 
the  patient  emphasize  the  physiologic 
significance  of  changes  that  occur  after 
cardiac  surgery,  particulary  open  heart 
surgery.  Dr.  Ellis  has  stressed  the  applica- 
tion of  basic  physiology  in  the  care  of 
patients. 

Part  four  deals  with  hemodynamic 
changes  following  surgery.  The  clinical  re- 


sults of  mitral  valve  surgery  are  correlated 
with  the  type  of  operation  in  a concise 
manner.  They  are  presented  as  over-all 
results  from  many  centers  and  with  the 
results  obtained  at  the  Mayo  clinic. 

The  final  section  presents  the  author’s 
evaluation  of  past  and  present  achievements 
in  mitral  valve  surgery.  He  also  outlines 
future  requirements. 

The  material  set  forth  in  this  monograph 
is  useful  for  the  internist  contemplating 
referring  a patient  for  cardiac  surgery.  It 
is  also  a starting  point  for  the  resident 
participating  in  surgery  for  mitral  valve 
disease. 

Julius  Conn,  Jr.,  M.D. 

Atlas:  of  Infant  Surgery.  Edited  by  J. 

Eugene  Lewis.  257  pages,  illus.,  Nov. 
1967,  $21.00 

This  useful  atlas  reflects  the  author’s 
vast  experience  in  the  management  of  sur- 
gical problems  of  the  infant.  The  material 
is  presented  in  a concise  manner  and  illus- 
trations are  informative  and  clear.  A brief 
embryological  consideration  is  presented  in 
some  of  the  topics  such  as  congenital  dia- 
phragmatic hernia,  omphalomesenteric  duct 
anomalies  and  malrotation  of  the  small  in- 
testine and  colon.  Clinical  features,  diag- 
nosis and  management  are  described  on 
important  subjects:  respiratory  distress  of 
the  neonate,  intestinal  obstruction  and 
anomalies  of  the  esophagus.  The  author 
mentions  his  preferences  in  certain  tech- 
niques without  neglecting  others.  The  bib- 
liography is  updated  to  include  recent  pub- 
lications. Also  included  is  a list  of  text- 
books to  cover  underemphasized  areas  by 
the  author. 

This  basic  and  comprehensive  atlas  is  a 
helpful  guide  to  the  pediatric  and  general 
surgeon. 

Gabriel  Lorenzo,  M.D. 


556 


Illinois  Medical  Journal 


Pediatric  Plastic  Surgery— Volume  I, 
Trauma.  Francis  X.  Paletta.  C.  V.  Mosby 
Company,  St.  Louis,  1967.  245  pages,  419 
illustrations. 

The  author  indicates  in  his  preface  that 
this  volume  is  an  atlas  which  has  been  pro- 
duced to  serve  as  a guide  in  the  manage- 
ment of  injured  children,  a problem  of 
increasing  frequency.  Dr.  Paletta  is  to  be 
congratulated  upon  his  accomplishment. 
He  has  presented  a well  organized,  sound 
and  comprehensive  atlas.  The  book  is  well 
illustrated  with  photographs  of  good  qual- 
ity and  line  drawings,  with  adequate  leg- 
ends. 

The  book  begins  with  a brief  but  inter- 
esting historical  account  of  the  develop- 
ment of  plastic  surgery.  The  following  chap- 
ter is  concerned  with  the  Emergency  Room. 
Included  are  specific  recommendations  by 
which  patients  should  be  treated  in  the 
Emergency  Room  and  which  require  hos- 
pital care.  A valuable  list  of  equipment 
for  emergency  room  surgery  is  presented. 
Basic  technics  in  suture  for  lacerations  of 
the  face  and  scalp  are  illustrated.  The  third 
chapter  is  devoted  to  the  prevention  and 
treatment  of  thalamus  and  includes  a case 
presentation.  Tracheostomy  and  local  an- 
esthesia are  dealt  with  in  the  next  chap- 
ters. 

The  discussion  of  major  soft  tissue  in- 
juries seems  particularly  valuable.  The  text 
and  illustrations  lucidly  describe  the  steps 
that  are  required  in  wound  management, 
wound  closure,  and  application  of  dress- 
ings. 

Facial  fractures  are  treated  in  a separate 
chapter  and  hand  injuries  in  another.  The 
chapter  on  bites  includes  those  caused  by 
humans,  dogs,  snakes,  and  insects.  The  final 
chapter  details  the  management  of  burns 
and  their  complications.  A bibliography 
is  provided  that  is  organized  by  chapter 
and  is  placed  at  the  end  of  the  book.  Ref- 
erences are  pertinent  and  well  selected. 

The  author  has  emphasized  good  sound 
surgical  techniques  and  basic  principles  of 
patient  management.  Some  of  the  patients 
who  illustrate  injuries  do  not  appear  to 
be  in  the  usual  pediatric  age  group,  but 
this  minor  question  does  not  detract  from 
the  good  quality  of  the  atlas.  This  book 
should  be  of  particular  interest  to  interns 
and  residents  who  are  involved  in  the  care 
of  injured  patients. 

John  M.  Beal,  M.D. 


Neuro-Ophthalmology.  Edited  by  J.  Law- 

ton  Smith.  The  C.  V.  Mosby  Co.,  St. 

Louis,  1965.  278  pages,  $21.75. 

This  book  is  a transcript  of  the  second 
symposium  on  clinical  neuro-ophthalmolo- 
gy sponsored  by  the  University  of  Miami 
and  was  held  in  Miami  in  January  1965. 
Like  the  first  symposium  it  was  directed  to 
the  clinician  but  unlike  the  first  the  papers 
presented  represented  the  current  interests 
of  the  speakers  rather  than  an  arbitrary 
topic  which  had  been  assigned  to  them. 
For  this  reason  the  communications  are 
authoritative,  timely  and  interesting.  For 
example  Smith  writes  on  seronegative  neu- 
rosyphilis, Norton  writes  on  fluorescein  an- 
giography of  the  retina,  Hollenhorst  con- 
tributes a paper  on  strokes  and  Hedges 
speaks  on  occlusive  vascular  disease.  It  will 
be  noted  that  these  (and  other  topics  not 
mentioned)  are  all  of  clinical  interest.  Basic 
anatomy  and  physiology  of  nerve  pathways 
were  not  discussed  except  where  they  ap- 
plied immediately  to  the  subject  at  hand. 
A beautiful  illustration  of  this  is  the  paper 
by  Lindenberg  on  neuropathology  involv- 
ing the  lateral  geniculate  bodies,  the  optic 
radiation  and  the  calcarine  cortex.  In  all 
of  the  three  sections  there  is  a short  pres- 
entation of  the  anatomy  involved  but  the 
major  portion  of  the  discussions  are  devoted 
to  case  reports  that  illustrate  the  effect  of 
vascular,  degenerative  or  neoplastic  lesions 
on  the  structures  noted  above.  Indeed  this 
article  alone  is  worth  the  price  of  the  en- 
tire book. 

Perhaps  the  best  recommendation  that 
can  be  given  is  to  say  that  this  volume  has 
the  same  aura  of  authoritative  pedagogy 
that  surrounds  the  editor  when  he  lectures 
to  an  audience.  All  ophthalmologists  with 
an  interest  in  neuro-ophthalmology  (and 
this  should  include  all  ophthalmologists) 
will  benefit  from  reading  this  compilation 
of  the  current  work  of  the  authorities  in 
the  field. 

David  Shoch,  M.D. 


We  flatly  state  that  a person  with  a 
physical  disability  is  a much  better  (in- 
surance) risk  than  his  so-called  normal 
counterpart  provided  he  is  properly 
screened  and  placed  and  provided  the 
company  has  an  intelligent  safety 
program. ...  L.  A.  Hyland,  general 
manager,  Hughes  Aircraft  Company. 


/or  October,  1968 


557 


This  advertisement  for  TAO®  (tri- 
acetyloleandomycin),  published  at 
the  request  of  the  Food  and  Drug 
Administration,  replaces  a recent 
one  which  the  FDA  regards  as  mis- 
leading. 


The  advertisement  headlined 
“new  evidence  for  TAO  . . and 
emphasized  thatthedrug  is  “forthe 
frequently  seen  respiratory  infec- 
tion in  the  office  and  for  a problem 
pathogen*  in  the  hospital.  '"Staphy- 
lococcus aureus.” 

We  emphasize  that  triacetylole- 
andomycin  is  to  be  used  only  for 
acute,  severe  bacterial  infections 
where  adequate  sensitivity  testing 
has  demonstrated  susceptibility  to 
this  drug  and  resistance  to  other 
less  toxic  agents.  I n view  of  the  pos- 
sible, but  reversible,  jaundice  and 
hepatotoxicity  of  this  drug,  other 
less  toxic  agents  should  be  used  un- 
less the  organism  is  resistant  to 
those  agents,  or  in  those  cases 
where  hypersensitivity  precludes 
their  use. 

TAO  is  contraindicated  in  pre- 
existing liver  disease  or  dysfunc- 
tion, and  in  individuals  who  have 
shown  hypersensitivity  to  the  drug. 


The  advertisement  emphasized 
that  no  tooth  staining  has  been  re- 
ported after  ten  years  of  use  of  this 
antibiotic.  The  Food  and  Drug  Ad- 
ministration regards  this  claim  as 
an  implied  comparison  suggesting 
that  triacetyloleandomycin  and  tet- 
racycline have  a similar  antibacteri- 
al spectrum  of  effectiveness,  and 
that  TAO  has  less  toxic  potential. 
Any  such  implication  is  not  intend- 
ed and,  of  course,  would  be  invalid. 

The  advertisement  referred  to  a 
research  study  in  which  patients 
were  given  triacetyloleandomycin 
prior  to  determining  the  susceptibil- 
ity of  the  offending  organism.  Any 
suggestion  that  triacetyloleando- 
mycin be  used  clinically  without 
first  determining  susceptibility  of 
the  offending  organism  should  be 
disregarded. 

J.B.ROERIG  DIVISION 

CHAS.  PFIZER  8t  CO.,  INC. 

235  EAST 42nd  STREET 
NEW  YORK,  N.Y.  10017 


558 


Illinois  Medical  Journal 


TAO®(triacetyloleaniloinycin) 
Brief  Summary 

INDICATIONS:  Include  streptococci, 
staphylococci,  pne^jmococci  and  gono- 
cocci. Recommended  for  acute,  severe  in- 
fections where  adequate  sensitivity  test- 
ing has  demonstrated  susceptibility  to 
this  antibiotic  and  resistance  to  less 
toxic  agents. 

CONTRAINDICATIONS:  Contraindicated  in 
pre-existing  liver  disease  or  dysfunction, 
and  in  individuals  hypersensitive  to  the 
drug. 

PRECAUTIONS:  CAUTION:  USE  OF  THIS 
DRUG  MAY  PRODUCE  ALTERATIONS  IN 
LIVER  FUNCTION  TESTS  AND  JAUNDICE.  CLI- 
NICAL EXPERIENCE  AVAILABLE  THUS  FAR 
INDICATES  THAT  THESE  LIVER  CHANGES 
WERE  REVERSIBLE  FOLLOWING  DISCONTIN- 
UATION OF  THE  DRUG. 

Not  recommended  for  prophylaxis  or  in 
the  treatment  of  infectious  processes, 
which  may  require  more  than  ten  days 
continuous  therapy.  In  view  of  the  possi- 
ble hepatotoxicity  of  this  drug  when  ther- 
apy beyond  ten  days  proves  necessary, 
other  less  toxic  agents  should  be  used.  If 
clinical  judgment  dictates  continuation 
of  therapy  for  longer  periods,  serial  moni- 
toring of  liver  profile  is  recommended, 
and  the  drug  should  be  discontinued  at 
the  first  evidence  of  any  form  of  liver 
abnormality.  When  treating  gonorrhea  in 
which  lesions  of  primary  or  secondary 
syphilis  are  suspected,  proper  diagnostic 
procedures,  including  dark-field  examina- 
tions, should  be  followed.  In  other  cases 
in  which  concomitant  syphilis  is  sus- 
pected, monthly  serological  tests  should 
be  made  for  at  least  four  months.  When 
used  in  streptococcal  infections,  therapy 
should  be  continued  for  ten  days  to  pre- 
vent the  development  of  rheumatic  fever 
or  glomerulonephritis.  The  use  of  antibi- 
otics may  occasionally  permit  overgrowth 
of  nonsusceptible  organisms.  A resistant 
infection  or  superinfection  requires  re- 
evaluation  of  the  patient’s  therapy,  in  the 
event  such  occurs  with  this  drug  the 
medication  should  be  discontinued,  and 
specific  antibacterial  and  supportive 
therapy  instituted. 

ADVERSE  REACTIONS:  Although  reactions 
of  an  allergic  nature  are  infrequent  and 
seldom  severe,  those  of  the  anaphylac- 
toid type  have  occurred  on  rare  occasions. 

J.B.ROERIG  DIVISION 
CHAS.  PFIZER  & CO..  INC. 
235  EAST 42nd  STREET 
NEW  YORK.  N.Y.  10017 


New  Pharmaceutical  Specialties 

(Continued  from  page  550) 

GEVRAMET 


Geriatric  Elixir  Vitamins  and  Hormones 
Manufacturer:  Lederle  Laboratories 
Composition: 

15  cc  Pentylenetetrazol  NF  100  mg. 

Niacin  NF  50  mg. 

Ascorbic  Acid  (Vit.  C USP)  45  mg. 

Methyltestosterone  NF  2 mg. 

Ethinyl  Estradiol  USP  0.01  mg. 

Alcohol  USP  20%  V. 

Indications:  Adjunct  in  the  management  of  pa- 
tients having  mental  and  physical  changes  as- 
sociated with  the  aging  process. 
Contraindications:  Neurologic  disorders,  agitated 
patients,  alcoholism,  mammary  or  genital  can- 
cer, severe  hepatic  or  cardiovascular  disease. 
Dosage:  15  cc.  one  to  three  times  daily;  females 
— 3 weeks  cyclic  therapy  with  one  week  rest. 
Supplied:  Bottles — 16  oz. 


TEDRAL  Expectorant  Bronchial  Dilator 


Manufacturer:  Warner- Chilcott  Laboratories 


Composition: 

Theophylline  130  mg. 

Ephedrine  HCl  24  mg. 

Glyceryl  Guaiacolate  100  mg. 

Phenobarbital  8 mg. 


Indications:  Symptomatic  relief  of  bronchial  as- 
thma, asthmatic  bronchitis,  and  bronchospastic 
disorders. 

Contraindications:  Sensitivity  to  any  of  the  in- 
gredients; porphyria. 

Dosage:  Adults:  one  or  two  tables  q.i.d. 

Supplied:  Tablets;  bottles  of  100. 

NEW  DOSAGE  FORMS 


TAO  Chewable  Tablets 

Antibiotic-Broad  Spectrum  B 

Manufacturer:  J.  B.  Roerig  & Co. 
Nonproprietary  Name:  Troleandomycin  (triace- 
tyloleandomycin) 

Indications:  Primarily  effective  against  infections 
due  to  staphylococci,  streptococci,  pneumococci 
and  gonococci. 

Contraindications:  Pre-existing  liver  disease  or 
dysfunction  and  in  individuals  who  have 
shown  hypersensitivity  to  the  drug. 

Dosage: 

Adults:  250  to  500  mg.  q.i.d. 

Children:  125  to  250  mg.  q-6-h;  depending 
upon  severity  of  infection. 

Supplied:  Tablets;  bottles  of  50. 


A new  film  catalog  listing  U.S.  Govern- 
ment 8mm  medical  films  is  now  available. 
The  113  medical  films  in  this  catalog  have 
been  produced  by  the  National  Medical 
Audiovisual  Center,  Atlanta,  Ga.  Many  re- 
habilitation films  have  been  produced  in 
cooperation  with  the  Institute  of  Rehabili- 
tation Medicine,  New  York  University  Medi- 
cal Center.  The  National  Medical  Audio- 
visual Center  plans  a continuing  series  of 
8 mm.  films  for  the  medical  profession. 
The  catalog  is  available  through  Modern 
Talking  Picture  Service,  Inc.,  1212  Avenue 
of  the  Americas,  New  York,  N.Y.  10036. 


for  October,  1968 


559 


Do  you  have  patients 
who  try  to  hide  fear 
behind  bravado? 


Eli  Lilly  and  Company 
Indianapolis,  Indiana  46206 


see  many  depressed  patients 
who  hide  their  real  anxieties  behind  a smoke  screen  of 
pretense.  The  more  they  try  to  conceal  reality,  the  more 
entrenched  the  disturbances  become.  The  role  they  assume 
is  not  adequate  to  suppress  their  inner  turmoil.  Unchecked, 
the  turmoil  finds  expression  in  other  symptoms. 

Tdiey  want  your  help  and  Aventyl 
HCl  can  help  you.  Whether  depression  is  open  or  secretive, 
Aventyl  HCl  assists  you  in  relieving  the  symptoms  and 
the  state  of  depression  itself.  It  may  aid  in  removing 
the  emotional  distortions  and,  in  lifting  the  depression, 
help  patients  face,  accept,  or  change  their  life  patterns. 


Helps  remove  the  symptoms, 
lift  the  depression, 
and  release  the  patient 

AyentyFHCl 

Nortriptyline*'Hydrochloride 


800322 


(See  last  page  for  prescribing  information.) 


OBITUARIES 

*Dr.  Martin  Brann,  Chicago,  died  Aug.  19 
at  Edgewater  Hospital  where  he  was  a staff 
member. 

*Dr.  Leo  E.  Braunstein,  Lincolnwood, 
died  Aug.  14  at  the  age  of  66.  He  was  a fel- 
low of  the  International  College  of  Sur- 
geons and  a diplomate  of  the  American 
Board  of  Abdominal  Surgeons. 

*Dr.  Henry  S.  Cambridge,  Wilmette,  died 
Aug.  4 at  the  age  of  76.  He  had  served  as 
chief  dermatologist  at  Illinois  Masonic  Hos- 
pital and  as  a consultant  at  St.  Francis  Hos- 
pital. 

^'Dr.  Burdick  G.  Clark,  Peoria  Heights, 
died  Aug.  31  at  the  age  of  51.  He  was  a 
member  of  North  Central  Urology  Associa- 
tion, a fellow  of  the  American  College  of 
Surgeons,  and  associate  professor  at  North- 
western University  School  of  Medicine. 
*Dr.  Fay  S.  Comer,  Cairo,  died  Aug.  10  at 
the  age  of  62.  He  was  past  president  of 
Alexander  County  Medical  Society,  a mem- 
ber of  the  American  College  of  Surgeons 
and  American  College  of  Physicians. 

Dr.  Barry  N.  Kelner,  Chicago,  died  Aug. 
25  at  the  age  of  27.  He  w'as  chief  resident 
surgeon  at  Michael  Reese  Hospital. 

"^Dr.  W.  B.  Kilton,  a Sullivan  physician 
for  more  than  50  years,  died  Aug.  3 at  the 
age  of  88.  He  had  served  as  both  president 
and  secretary  of  the  Moultrie  County  Med- 
ical Society  and  was  a member  of  the  ISMS 
Fifty-Year  Club. 

*Dr.  Nicholas  B.  Pavletic,  Oak  Lawn,  63, 
died  Aug.  30  at  Little  Company  of  Mary 
Hospital,  where  he  had  been  a member  of 
the  staff. 

Dr.  W.  J.  Reuter,  Bethalto,  died  July  20 
at  the  age  of  65. 

*Dr.  Elmer  T.  Swann,  Oquawka,  died 
Aug.  28  at  the  age  of  76.  He  was  currently 
serving  as  president  of  the  Henderson  Coun- 
ty Medical  Society  and  a member  of  ISMS 
Fifty-Year  Club. 

*Dr.  Albert  M.  Wolf,  Chicago,  died  Aug. 
23  at  the  age  of  62.  He  was  medical 
director  of  the  Michael  Reese  Blood  bank 
and  had  been  on  the  hospital’s  staff  for  30 
years. 

♦Indicates  member  of  Illinois  State  Medical  Society. 

The  Veterans  Administration  is  guard- 
ian to  approximately  650,000  incompetent 
veterans,  incompetent  dependents  and 
minor  children.  Their  estates  amount  to 
almost  §700  million. 


Just  one  tablet  at  bedtime  • Prevents  pain- 
ful night  leg  cramps  • Permits  restful  sleep 

How  many  of  your  patients  stamp  their  feet  at  night 
and  lose  sleep  because  of  painful  leg  cramps?  Un- 
less prompted,  they  usually  fail  to  report  this  dis- 
tressing condition  and  suffer  needlessly. 

One  tablet  of  QUINAMM  at  bedtime  usually  con- 
trols distressing  night  cramps  and  permits  restful 
sleep  with  the  initial  dose. 

Prescribing  information— Composition:  Each  white,  beveled, 
compressed  tablet  contains:  Quinine  sulfate,  260  mg.,Amino- 
phylline,  195  mg.  Indications:  For  the  prevention  and  treat- 
ment of  nocturnal  and  recumbency  leg  muscle  cramps,  in- 
cluding those  associated  with  arthritis,  diabetes,  varicose 
veins,  thrombophlebitis,  arteriosclerosis  and  static  foot  de- 
formities. Contraindications:  QUINAMM  is  contraindicated  in 
pregnancy  because  of  its  quinine  content.  Side  Effects/ 
Precautions:  Aminophylline  may  produce  intestinal  cramps 
in  some  instances,  and  quinine  may  produce  symptoms  of 
cinchonism,  such  as  tinnitus,  dizziness,  and  gastrointestinal 
disturbance.  Discontinue  use  if  ringing  in  the  ears,  deafness, 
skin  rash,  or  visual  disturbances  occur.  Dosage:  One  tablet 
upon  retiring.  Where  necessary,  dosage  may  be  increased  to 
one  tablet  following  the  evening  meal  and  one  tablet  upon 
retiring.  Supplied:  Bottles  of  100  and  500  tablets. 

THE  NATIONAL  DRUG  COMPANY 

DIVISION  OF  RICHARDSON  MERRELL  INC. 

PHILADELPHIA.  PENNSYLVANIA  19144 


for  October,  1968 


567 


THE  BETTSfANN  ARCHIVE 


MEETING  MEMOS 


Oct.  25— ISMS  will  be  one  of  six  cooperat- 
ing agencies  at  the  Professional  Conference 
on  Sex  Education  and  Venereal  Disease. 
The  conference,  sponsored  by  the  Illinois 
Social  Hygiene  League,  will  take  place  at 
the  Drake  Hotel,  Chicago,  and  will  present 
the  latest  techniques  in  sex  education  pro- 
grams and  information  on  VD  control. 

Oct.  28-30  and  Nov.  11-13-The  Staff  of 
the  Mayo  Clinic  and  the  Faculty  of  the 
Mayo  Foundation  are  presenting  clincial  re- 
views during  both  these  periods.  The  pro- 
gram is  acceptable  for  credit  by  the  Amer- 
ican Academy  of  General  Practice  and  the 
College  of  General  Practice.  The  registra- 
tion fee  is  $20.  Those  wishing  to  attend 
should  contact  M.  G.  Brataas,  Mayo  Clinic, 
Rochester,  Minn.  55901,  indicating  which 
session  they  would  prefer  to  attend. 

Nov.  6-7— The  Cleveland  Clinic  Education- 
al Foundation  is  presenting  a postgraduate 
course  in  “Upper  Gastrointestinal  Disease- 
Clinical  Aspects.”  For  further  information 
write  to:  Director  of  Education,  The  Cleve- 
land Clinic,  Educational  Foundation,  2020 
E.  93rd  St.,  Cleveland,  Ohio  44106. 

Nov.  7-9— The  American  Society  of  Anes- 
thesiologists is  sponsoring  a Conference  on 
Respiratory  Therapy.  To  be  held  at  the 
Statler  Hilton  Hotel,  Boston,  Mass. 

Nov.  7-9— The  Second  Annual  Postgradu- 
ate Conference  on  “Today’s  Hospital  Prob- 
lems: An  Interdisciplinary  Approach,”  is 
being  sponsored  by  the  Mound  Park  Hos- 
pital Foundation  along  with  the  University 
of  Florida’s  J.  Hillis  Miller  Health  Center. 
To  be  held  in  Redington  Beach,  Fla.,  the 
course  is  designed  specifically  for  physicians 
who  hold  hospital  staff  leadership  positions, 
hospital  administrators,  hospital  trustees 
and  allied  personnel.  The  American  Acad- 
emy of  General  Practice  is  offering  18 
credit  hours  for  the  course.  For  further  in- 
formation write  to:  Postgraduate  Medical 
Education,  Mound  Park  Hospital  Founda- 
tion, 701-6th  St.,  St.  Petersburg,  Fla.  33701. 
Nov.  11-15— The  American  Public  Health 
Association  is  holding  its  95th  Annual 
Meeting  in  Detroit,  Mich.,  at  Cobo  Hall. 
Over  7,000  public  health  specialists  from 
all  parts  of  the  world  and  representing 
more  than  70  related  health  organizations 
are  expected  to  attend.  Topics  of  the  major 
sessions  include:  citizens’  participation, 

sex  education,  drug  abuse  and  prevention 
approaches,  prospects  for  dose  reduction  in 
nuclear  medicine,  new  developments  in  hos- 


pital environment  control  and  children’s 
health  problems  that  interfere  with  learn- 
ing. For  further  information  contact:  Amer- 
ican Public  Health  Association,  1740  Broad- 
way, New  York,  N.Y.  10019. 

Nov.  15-16— A Seminar  on  Hematology, 
jointly  sponsored  by  the  Illinois  Medical 
Technologists  Association,  Illinois  Associa- 
tion of  Clinical  Laboratories  and  Illinois 
State  Society,  American  Medical  Technolo- 
gists, will  be  held  in  Chicago.  Topics  will 
include  “Quality  Control  in  Hematology,” 
“Coagulation  Procedures,”  “Normal  and 
Abnormal  Blood  Cell  Morphology.”  Regis- 
tration fee  $30.00.  Additional  information 
from  Mr.  Stanley  Lullo,  P.O.  Box  13, 
Dwight,  Illinois  60420. 

Nov.  21-24— The  American  Heart  Associa- 
tion will  hold  its  1968  Scientific  Sessions  at 
the  Americana  Hotel,  Bal  Harbour,  Fla. 

Nov.  22-24— The  Hahnemann  Medical 
College  and  Hospital  of  Philadelphia  is 
sponsoring  a meeting  entitled,  “Psychede- 
lic Drugs.” 

Nov.  24-27— The  Jamaica  Cancer  Society  is 
sponsoring  its  Second  Caribbean  Cancer 
Congress  at  the  Medical  Auditorium,  Uni- 
versity College  Hospital,  Mona,  Kingston, 
Jamaica.  The  congress  will  review  recent 
advances  in  research  and  treatment  of  ma- 
lignant disease  with  special  emphasis  on 
the  problems  relating  to  the  Caribbean  and 
Latin  American  countries.  For  further  in- 
formation write  to:  Kenneth  A.  McNeil, 
F.R.C.S.,  F.A.C.S.,  Secretary  General,  Sec- 
ond Caribbean  Cancer  Congress,  5 Tanger- 
ine PI.,  Kingston  10,  Jamaica.  W.  I. 

Dec.  1— The  Tenth  National  Conference 
on  the  Medical  Aspect  of  Sports  will  be 
held  in  Miami  Beach,  Fla.,  in  conjunction 
with  the  Annual  Clinical  Convention  of 
the  AMA.  Included  will  be  forums  on  the 
management  of  knee  injuries,  back  prob- 
lems and  problems  related  to  vision  in 
sports.  For  further  information  contact: 
Committee  on  the  Medical  Asepcts  of 
Sports,  AMA,  535  N.  Dearborn  St.,  Chicago 
60610. 

Dec.  1-4— The  22nd  Clinical  Meeting  of 
the  American  Medical  Association.  To  be 
held  in  Miami  Beach,  Fla.  This  year’s  con- 
vention will  feature  three  postgraduate 
courses:  Fluid  and  Electrolyte  Balance, 
Diabetes,  and  Hyperthyroidism  in  the  Eld- 
erly Patient. 


568 


Illinois  Medical  Journal 


When  it’s  more  than  a had  cold 


your  patient  can  feel  better 
^^e  he’s  getting  better 


Achroddih 

Tetracycline  HCl— Antihistamine— Analgesic  Compound 

Each  tablet  contains:  ACHROMYCIN'S  Tetracycline  HCl  125  mg.;  Phenacetin  120  mg.; 
Caffeine  30  mg.;  Salicylamide  150  mg.;  Chlorothen  citrate  25  mg. 


In  tetracycline-sensitive  bacterial  injection  complicating  respiratory  allergy,  ACHROCIDIN 
brings  the  treatment  together  in  a single  prescription— prompt  relief  of  headache  and  conges- 
tion together  with  effective  control  of  the  organisms  frequently  responsible  for  complications 
leading  to  prolonged  disability  in  the  susceptible  patient. 

For  children  and  elderly  patients  you  may  prefer  caffeine-free  ACHROCIDIN  Syrup.  Each 
5 cc  contains:  ACHROMYCIN  (Tetracycline)  equivalent  to  Tetracycline  HCl  125  mg.;  Phen- 
acetin 120  mg.;  Salicylamide  150  mg.;  Ascorbic  Acid  (C)  25  mg.;  Pyrilamine  Maleate  15  mg. 


Contraindications:  Hypersensitivity  to  any  compo- 
nent. 

Warning:  In  renal  impairment,  since  liver  toxicity  is 
possible,  lower  doses  are  indicated;  during  prolonged 
therapy  consider  serum  level  determinations.  Photo- 
dynamic reaction  to  sunlight  may  occur  in  hyper- 
sensitive persons.  Photosensitive  individuals  should 
avoid  exposure;  discontinue  treatment  if  skin  dis- 
comfort occurs. 

Precautions:  Drowsiness,  anorexia,  slight  gastric  dis- 
tress can  occur.  In  excessive  drowsiness,  consider 
longer  dosage  intervals.  Persons  on  full  dosage 
should  not  operate  vehicles.  Nonsusceptible  organ- 
isms may  overgrow;  treat  superinfection  appropri- 
ately. Treat  beta-hemolytic  streptococcal  infections 
at  least  10  days  to  help  prevent  rheumatic  fever  or 
acute  glomerulonephritis.  Tetracycline  may  form  a 
stable  calcium  complex  in  bone-forming  tissue  and 


may  cause  dental  staining  during  tooth  development 
(last  half  of  pregnancy,  neonatal  period,  infancy, 
early  childhood). 

Adverse  Reactions:  Gastrointestinal— 2inorex\z.,  nau- 
sea, vomiting,  diarrhea,  stomatitis,  glossitis,  entero- 
colitis, pruritus  ani.  maculopapular  and 

erythematous  rashes;  exfoliative  dermatitis;  photo- 
sensitivity; onycholysis,  nail  discoloration.  Kidney 
-dose-related  rise  in  BUN.  Hypersensitivity  reac- 
tions—urticaria,  angioneurotic  edema,  anaphylaxis. 
Intracranial— h\x\gm%  fontanels  in  young  infants. 
Jee//?— yellow-brown  staining;  enamel  hypoplasia. 
B/ooJ— anemia,  thrombocytopenic  purpura,  neutro- 
penia, eosinophilia.  L/\  er— cholestasis  at  high  dosage. 

Upon  adverse  reaction,  stop  medication  and  treat 
appropriately.  ======^ 


for  October,  1968 


569 


The  Voluntary  Health  Insurance  Coun- 
cil of  Australia^  sent  questionnaires  to  730 
physicians  with  British  degrees  practicing 
in  Australia.  Where  possible,  personal  in- 
terviews were  conducted.  The  aim  of  the 
survey,  patterned  after  the  fact-finding  mis- 
sion conducted  by  the  British  Ministry  of 
Health  in  America,  was  to  woo  ‘truant’ 
British  doctors  back  to  England.  Replies 
were  obtained  from  360  physicians— an  ex- 
cellent return  which  indicated  interest  in 
the  survey. 

Three  main  findings  emerge  from  the 
survey.  First,  a majority  of  doctors  who 
have  left  Britain  to  practice  in  Australia 
consider  the  Australian  voluntary  system 
superior  to  the  British  National  Health 
Service.  Second,  after  experience  in  both 
countries,  85%  of  them  would  not  consider 
returning  to  practice  under  the  National 
Health  Service.  But,  third,  nearly  half  the 
doctors,  while  favoring  the  Australian  sys- 
tem over  all,  believe  that  health  insurance 
benefits  are  in  various  ways  inadequate. 

Details  of  attitudes  are  seen  in  answer 
to  questions  on  the  British  system  of  ‘free’ 
hospital  and  medical  services  financed  from 
taxation:  70%  of  the  doctors  believed  the 
system  led  to  an  unsatisfactory  standard  of 
service  to  patients;  80%  thought  the  Na- 
tional Health  Service  was  inefficiently  run; 
90%  said  it  created  an  unsatisfactory  re- 
lationship between  the  patient  and  doctor; 
and  94%  said  the  nationalized  health  service 
led  to  over-use  of  doctors  and  medical  fa- 
cilities. 

One  truant  physician  believed  that  “A 
nationalized  health  service  produces  a gen- 


TRUANT  BRITISH  PHYSICANS 

eration  of  spoon-fed  weak-kneed  specimens 
unable  to  put  a sticking  plaster  on  a cut 
finger.”  Another  told  of  a woman  who 
had  a lump  on  the  breast  and  walked  into 
the  surgery  eight  times  and  left  because  it 
was  overcrowded.  ‘‘The  system  killed 
her.”  Still  another  remarked,  ‘‘The  wastage 
of  powerful  drugs  is  immense  in  the  United 
Kingdom.” 

The  British  migrant  doctors  were  also 
asked  to  comment  on  the  Australian  sys- 
tem. The  majority  (53%)  believed  that 
Commonwealth  benefits  were  adequate  and 
should  be  paid  whether  the  patient  con- 
tributed or  did  not  contribute;  78%  be- 
lieved the  free  enterprise  system  with  a 
choice  of  insurance  promoted  greater  ef- 
ficiency than  other  systems  in  providing 
health  services.  More  than  85%  believed 
in  the  principle  of  voluntary  health  insur- 
ance and  91%  that  the  Australian  system 
promoted  better  doctor-patient  rapport 
than  a nationalized  service. 

Conversely,  the  Australian  system  was 
thought  to  be  inadequate  for  large  families 
and  for  those  suffering  from  chronic  ill- 
nesses. In  addition,  it  did  not  give  proper 
coverage  for  major  surgery  or  long  illnesses 
requiring  hospitalization.  There  was  also 
too  big  a gap  between  benefits  and  normal 
fees  charged. 

T.  R.  Van  Dellen,  M.D. 

Editor 

Reference 

1.  Attitudes  of  British  Migrant  Doctors  In 
Australia.  Medical  Jou7~nal  of  Australia  (Mar. 
9)  1968,  pp.  419-420. 


570 


Illinois  Medical  Journal 


Smiles  speak  louder  than  words 


for  the  good  taste  of  Soyalac 

Milk-free,  hypo-allergenic  Soyalac  has  a pleasing  taste  that 
is  eagerly  accepted  by  most  infants.  It’s  similar  to  mother’s 
milk  in  composition  and  assimilation,  much  like  cow’s  milk 
in  consistency  and  completely  free  of  fibre.  Extensive  clini- 
cal data  support  Soyalac’s  value  in  promoting  growth  and 
development.  Soyalac  is  also  excellent  for  growing  children 
and  adults. 


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will  bring  to  you  complete  information  and  a supply  of  samples. 


Available  in 
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Soyalac 


a product  of 

LOMA  LINDA  FOOD‘S 

MEDICAL  PRODUCTS 

RIVERSIDE,  CALIFORNIA 
Mount  Vernon,  Ohio,  U.S.A. 


for  October,  1968 


571 


Clinics  for  Crippled  Children 


Twenty  six  clinics  for  Illinois’  physically 
handicapped  children  have  been  scheduled 
for  November  by  the  University  of  Illinois, 
Division  of  Services  for  Crippled  Children. 
There  will  be  twenty  general  clinics  provid- 
ing diagnostic  orthopedic,  pediatric,  speech 
and  hearing  examination  along  with  med- 
ical social,  and  nursing  service,  four  special 
clinics  for  children  with  cardiac  conditions 
and  rheumatic  fever,  and  two  for  children 
with  cerebral  palsy.  Clinicians  are  selected 
from  among  private  physicians  who  are  cer- 
tified Board  members.  Any  private  physi- 
cian may  refer  to  bring  to  a convenient 
clinic  any  child  or  children  for  whom  he 
may  want  examination  or  consultative  serv- 
ices. 

November  5,  Alton  General— Alton  Me- 
morial Hospital 

November  5,  Pittsfield— Illini  Community 
Hospital 

November  6,  Hinsdale— Hinsdale  Sanitar- 
ium 

November  7,  Sterling— Community  Gen- 
eral Hospital 

November  7,  DuQuoin— Marshall-Brown- 
ing Hospital 

November  7,  Peoria  Cerebral  Palsy 
(A.M.)— Zeller  Zone  Center 
November  8,  Chicago  Heights  Cardiac— 
St.  James  Hospital 

November  12,  Fairfield— Fairfield  Memor- 
ial Hospital 

November  12,  East  St.  Louis— Christian 
Welfare  Hospital 

November  12,  Peoria  General— Children’s 
Hospital 

November  13,  Champaign-Urbana— Mc- 
Kinley Hospital 


November 

November 

November 

November 

November 

November 

November 

November 

November 

November 

November 

November 

November 

November 

November 


13,  Joliet— St.  Joseph’s  Hospital 

14,  Macomb— McDonough  Dis- 
trict Hospital 

14,  Springfield  General— St. 
John’s  Hospital 

20,  Centralia— St.  Mary’s  Hos- 
pital 

20,  Springfield  Cerebral  Palsy 
(P.M.)— Diocesan  Center 

20,  Evergreen  Park— Little  Com- 
pany of  Mary  Hospital 

21,  Effingham  Rheumatic  Eever 
& Cardiac— St.  Anthony  Me- 
morial Hospital 

21,  Elmhurst  Cardiac— Memor- 
ial Hospital  of  DuPage 
County 

21,  Decatur— Decatur  8c  Macon 
County  Hospital 

22,  Chicago  Heights  Cardiac— 
St.  James  Hospital 

26,  Danville— Lake  View  Hos- 
pital 

26,  East  St.  Louis— Christian 
Welfare  Hospital 

26,  Peoria  General— Children’s 
Hospital 

27,  Rockford— St.  Anthony’s 
Hospital 

27,  Elgin— Sherman  Hospital 


The  Division  of  Services  for  Crippled 
Children  is  the  official  state  agency  estab- 
lished to  provide  medical,  surgical,  correc- 
tive, and  other  services  and  facilities  for 
diagnosis,  hospitalization  and  after-care  for 
children  with  crippling  conditions  or  who 
are  suffering  from  conditions  that  may  lead 
to  crippling. 


What  It  Takes 

What  seems  to  be  a common  sense  view  indicates  that  the  fledgling  M.D. 
should  have: 

1.  An  adequate  stock  of  ''facts''  at  his  command  to  use  as  tools, 

2.  A good  understanding  of  mechanisms  of  disease  in  order  to  act  intel- 
ligently rather  than  by  rote, 

3.  A knowledge  of  where  to  acquire  new  or  modified  data  over  the  years 
with  a strong  motivation  to  do  so, 

4.  An  insatiable  desire  to  know  "why"  and  a constant  effort  to  find  out 
(This  is  research  whether  it  be  basic  or  clinical), 

5.  Sufficient  humility  and  compassion  to  allow  him  to  get  along  with 
contemporaries  and  patients. 

"A  Teacher  Looks  at  Medical  Education."  An  Editorial  by  Warner  F.  Bowers, 
International  Surgery  (May)  1966.  Resident  Physician  (July)  1968;  pg.  53. 


572 


Illinois  Medical  Journal 


...but  her  other  symptoms: 
depressed  mood,  insomnia, 
anorexia,  feelings  of  guilt 
strongly  suggest 
an  underlying  depression. 


when  the  diagnosis  is  depression 

ELAVIE''"^ 

(AMITRIPTYLINE  HCl  I MSD) 

Indications:  Mental  depression  and  mild  anxiety  accompany- 
ing depression. 

Contraindications:  Glaucoma  and  predisposition  to  urinary  re- 
tention. Not  recommended  in  pregnancy. 

Precautions  and  Side  Effects:  Drowsiness  may  occur  within  the 
first  few  days  of  therapy.  Patients  should  be  warned  against 
driving  a car  or  operating  machinery  or  appliances  requiring 
alert  attention.  When  depression  is  accompanied  by  anxiety 
or  agitation  too  severe  to  be  controlled  by  ELAVIL  HCl  alone, 
a phenothiazine  tranquilizer  may  be  given  concomitantly. 
Suicide  is  always  a possibility  in  mental  depression  and  may 
remain  until  significant  remission  occurs.  Supervise  patients 
closely  in  case  they  may  require  hospitalization  or  concomitant 
electroshock  therapy.  Untoward  reactions  have  been  reported 
after  the  combined  use  of  antidepressant  agents  having 
varying  modes  of  activity.  Accordingly,  consider  possibility 
of  potentiation  in  combined  use  of  antidepressants.  Mono- 
amine oxidase  inhibitor  drugs  may  potentiate  other  drugs  and 
such  potentiation  may  even  cause  death;  permit  at  least  two 
weeks  to  elapse  between  administration  of  two  agents;  in 
such  patients,  initiate  therapy  with  ELAVIL  HCl  cautiously  with 
gradual  increase  in  dosage  required  to  obtain  a satisfactory 
response.  Caution  patients  about  errors  of  judgment  due  to 
change  in  mood,  and  that  the  response  to  alcohol  may  be 
potentiated.  May  provoke  mania  or  hypomania  in  manic-de- 
pressive patients. 

Side  effects  include  drowsiness;  dizziness;  nausea;  excitement; 
hypotension;  fine  tremor;  Jitteriness;  weakness;  headache; 
heartburn;  anorexia;  increased  perspiration;  incoordination; 
allergic-type  reactions  manifested  by  skin  rash,  swelling  of 
face  and  tongue,  itching;  numbness  and  tingling  of  limbs, 
including  peripheral  neuropathy;  activation  of  schizophrenia 
which  may  require  phenothiazine  tranquilizer  therapy;  epi- 
leptiform seizures  in  chronic  schizophrenics;  temporary  con- 
fusion, disturbed  concentration  or,  rarely,  transient  visual 
hallucinations  on  high  doses;  evidence  of  anticholinergic  ac- 
tivity, such  as  tachycardia,  dryness  of  the  mouth,  blurring  of 
vision,  urinary  retention,  constipation;  paralytic  ileus;  jaun- 
dice; agranulocytosis. 

Careful  observation  of  all  patients  is  recommended.  The  anti- 
depressant activity  may  be  evident  within  3 or  4 days  or 
may  take  as  long  as  30  days  to  develop  adequately,  and  lack 
of  response  sometimes  occurs.  Response  to  medication  will 
vary  according  to  severity  as  well  as  type  of  depression  pres- 
ent. Elderly  patients  and  adolescents  can  often  be  managed 
on  lower  dosage  levels. 

Supplied:  Tablets  ELAVIL  HCl,  containing  10  mg.,  25  mg.,  and 
50  mg.  amitriptyline  HCl,  bottles  of  100  and  1000;  Injection 
ELAVIL  HCl,  in  10-cc.  vials,  containing  per  cc.:  10  mg.  ami- 
triptyline HCl,  44  mg.  dextrose,  1.5  mg.  methylparaben,  and 
0.2  mg.  propylparaben. 

For  more  detailed  information,  consult  your  Merck  Sharp  & 
Dohme  representative  or  see  the  package  circular. 

® MERCK  SHARP  & DOHME  Division  of  Merck  & Co  Inc  West  Point  Pa  19486 

WHERE  today’s  THEORY  IS  TOMORROWS  THERAPY 


AMA  Posture  on  Public  Comment 


The  AMA  Board  is  cognizant  of  the  great 
increase  in  attention  being  given  in  the 
press  and  broadcast  media  to  medicine  and 
health  care.  Our  profession  is  now  the  focus 
of  one  of  America's  greatest  interests.  It 
will  constantly  be  in  the  spotlight,  ending 
the  professional  reticence  and  privacy  in 
which  medicine  functioned  most  of  the  time 
in  the  past. 

Even  though  this  interest  is  a tribute  to 
the  importance  of  medicine  and  the  public's 
desire  for  its  benefits,  it  brings  with  it  the 
problems  facing  any  person  or  organization 
with  a key  public  position;  much  of  the 
coverage  is  critical  or  displays  a lack  of  un- 
derstanding. 

The  Board  of  Trustees  has  consulted  with 
AMA  staff  and  public  relations  counsel  on 
this  increasingly  important  situation.  The 
conclusions  that  have  resulted  from  this  in- 
tensive and  thoughtful  consideration  are: 

1.  When  statements  about  medicine  are 
misguided  or  unfair,  corrective  statements 
will  be  issued  promptly  when  the  facts  are 
available  and  an  orderly  response  is  pos- 
sible. 

2.  We  must  recognize  that  the  promin- 
ence and  complexity  of  medicine  in  the 
United  States  today  results  in  many  limi- 
tations. Medicine  is  a constant  subject  of 
news  and  comment,  much  of  which  cannot 
be  subject  to  a later  response.  Often  re- 
plies cannot  be  carried  by  the  broadcast 
medium  or  publication,  or  at  best  will  be 
much  less  prominent  than  the  original  cov- 
erage. Quite  often  a responsible  statement 
cannot  be  issued  until  the  facts  have  ben 
obtained,  and  these  may  be  scattered  about 
the  country  or  involve  a local  situation  or 


require  a great  deal  of  time. 

3.  The  frequency  and  complexity  of 
these  matters  have  increasingly  diverted 
the  officers  and  staff  of  AMA  to  reacting 
to  what  others  do  and  say.  This  decreases 
the  ability  to  work  on  constructive,  ongoing 
activities  that  are  vital  to  our  future. 

4.  Staff  is  developing  in  written  form  the 
best  possible  anticipatory  statements  re- 
garding all  foreseeable  circumstances.  By 
having  such  matters  thought  out  and  docu- 
mented when  a need  arises,  we  will  be 
able  to  reduce  the  instances  of  surprise,  de- 
crease the  time  required  for  response,  and 
assure  consistency  in  AMA  statements  on 
these  matters. 

5.  We  will  concentrate  on  building  a 
positive  posture  by  getting  understanding 
for  medicine's  functions  and  its  positions  on 
various  considerations;  and  by  educating 
the  press,  broadcasters  and  opinion  lead- 
ers. This  will  help  forestall  much  misguided 
criticism  and  build  a favorable  climate  that 
will  inocuTate  against  susceptibility  to  un- 
fair criticism. 

6.  All  state  and  county  medical  societies 
are  urged  to  follow  these  same  procedures. 

One  will  see  many  instances  in  which 
AMA  responds  to  public  comment,  many  in 
which  we  have  acted  but  our  effectiveness 
will  be  in  correcting  the  source  and  may 
not  be  visible  immediately,  and  instances 
when  judgment  indicates  a response  should 
not  be  made.  In  each  case  the  best  judg- 
ment and  skills  will  have  been  applied  to 
the  complexities  of  the  situation. 

(Ed.  Note:  This  statement  was  adopted  by  the 
AMA  House  of  Delegates,  San  Francisco,  June 
1968.) 


Cardiovascular  Disease  and  Alcoholism 

The  medical  histories  of  922  problem  drinkers  were  compared  with  those 
of  an  equal  number  of  matched  controls  to  measure  differences  in  preva- 
lence of  various  forms  of  cardiovascular  disease.  The  drinkers  were  divided 
into  three  categories:  (1)  known,  uncontrolled  alcoholics;  (2)  suspected  cases; 
and  (3)  recovered  cases. 

The  prevalence  of  hypertension  was  2.3  times  greater  among  the  drink- 
ers than  the  controls.  Differences  in  blood  pressure  between  the  drinkers  and 
controls  were  greater  for  the  systolic  than  the  diastolic.  Hypertension  was 
less  prevalent  among  the  recovered  cases  than  in  the  known  and  suspected 
groups,  suggesting  that  hypertension  is  reversible  to  some  extent  when 
drinking  is  stopped.  (Cardiovascular  Disease  Among  Problem  Drinkers.  C.  A. 
D'Alonzo  and  Sidney  Pell,  Jl.  of  Occupational  Med.  [July]  1968;  10:7;  pgs. 
344-350.) 


574 


Illinois  Medical  Journal 


issue,  at 
.teaiber  & 


sr*fTF 


Sept. 

liicurredahrnt.^  ,-  Patrolman  d r,  „ 


He’s  had  enough 
excitement 
for  one  day. 


'»*  uicta^ 
Althoog 
Mou, 
aowa  a ^ 
Shari 
flat<«)j^ 

^as  passfe 

Board  i 

^^redlr^ 
tioa”  s* 
elimjnr 
Bio  sta.. 
d*. 

®eot  cal> 
amt  raf 
Mte  II 

”cat-o« 
public  • 

<treo 

priift 
be  b» 
or  th. 
schooj 
1?ie/ 
so  sot' 
rather* 


For  the  patient  who  has  been  through  an  accident,  the  worry  and 
anxiety  foliowing  the  experience  may  actually  heighten  the  per- 
ception of  pain.  This  is  why  there’s  a classic  V4  grain  sedative 
dose  of  phenobarbital  in  Phenaphen  with  Codeine— fo  take  the 
nervous  “edge”  off,  so  the  rest  of  the  formula  can  control  the 
pain  more  effectively. 

Phenaphen'  with  Codeine 

Phenaphen®  with  Codeine  No.  2,  No.  3,  or  No.  4 contains:  Phenobarbital  (Va  gr.),  16.2  mg. 
(Warning:  may  be  habit  forming);  Aspirin  {2'h  gr.),  162.0  mg.;  Phenacetin  (3  gr.),  194.0  mg.; 
Hyoscyamine  sulfate,  0.031  mg.;  Codeine  Phosphate,  ’A  gr.  (No.  2),  'h  gr.  (No.  3),  or  1 gr. 
(No.  4).  (Warning:  may  be  habit  forming). 

THE  COMPOUND  ANALGESIC  THAT  CALMS  INSTEAD  OF  CAFFEINATES 


Indications:  Phenaphen  with  Codeine  provides  re« 
lief  in  severer  grades  of  pain,  on  low  codeine  dos- 
age, with  minimal  possibility  of  side  effects.  Its  use 
frequently  makes  unnecessary  the  use  of  addicting 
narcotics.  Contraindications:  Hypersensitivity  to  any 
of  the  components.  Precautions:  As  with  ali  phen- 
acetin-containing  products  excessive  or  prolonged 
use  should  be  avoided.  Side  effects:  Side  effects 
are  uncommon,  although  nausea,  constipation  and 
drowsiness  may  occur.  Dosage:  1 or  2 capsules  at 
2 to  4 hour  intervals,  or  as  directed  by  physician. 
For  further  details  see  product  literature. 

A.  H.  ROBINS  COMPANY  /|,lJ,rir|PI  MC 
RICHMOND.  VA.  23220  / 1 1 1 |/UDI1TI3 


National  Intern  and  Resident 
Matching  Program  Formed 


At  a recent  special  meeting  of  the  Na- 
tional Intern  Matching  Program  (NIMP), 
the  program  was  reincorporated  as  the  Na- 
tional Intern  and  Resident  Matching  Pro- 
gram (NIRMP). 

The  original  National  Intern  Matching 
Program  (NIMP)  was  established  in  1951 
for  the  purpose  of  organizing  and  con- 
ducting a national  clearing  service  to  match 
the  preference  of  medical  students  for  in- 
ternships with  those  of  hospitals  for  interns. 

Although  the  program  was  designed  pri- 
marily for  students  graduating  from  medi- 
cal schools  in  the  United  States,  graduates 
of  foreign  schools,  who  have  been  certified 
by  the  Educational  Council  for  Foreign 
Medical  Graduates  (ECFMG),  may  partic- 
ipate in  the  matching  program.  Canadians 
may  participate  without  certification. 

All  hospitals  having  internship  programs 
that  are  approved  by  the  Council  on  Medi- 
cal Education  and  Hospitals  of  the  Ameri- 
can Medical  Association  are  eligible  to  par- 
ticipate in  the  program. 

In  initiating  their  participation  in  NIMP, 
both  students  and  hospitals  sign  and  file 
with  NIMP  an  agreement  to  comply  with 
the  terms  of  the  program.  Neither  may  ne- 
gotiate with  nonparticipants  until  the 
matching  is  complete  and  the  results  are 
announced.  Both  students  and  representa- 
tives of  the  hospitals  are  free  to  conduct 
whatever  investigations  or  discussions  may 
be  necessary  to  formulate  judgments  for 
ranking  purposes.  However,  neither  stu- 
dents nor  hospitals  may  make  a final  com- 
mitment without  going  through  the  pre- 
scribed matching  process. 

AMA  Lists  Approved  Programs 

In  September  of  the  year  prior  to  the 
internship  appointments,  the  American 
Medical  Association  publishes  a directory 
that  lists  and  describes  all  approved  intern- 
ships and  residencies  offered  by  all  U.S. 
hospitals.  One  section  of  this  directory  con- 
tains all  of  the  information  necessary  for 
students  to  participate  in  NIMP.  Then  in 
October,  NIMP  sends  each  participating 
hospital  a directory  containing  the  name 
and  medical  school  of  each  participating 
student. 

From  October  until  January  of  the  fol- 
lowing year,  the  students  make  applica- 


tion for  internships  to  the  hospitals  of 
their  choice,  filing  copies  of  their  applica- 
tions with  their  dean’s  office.  During  this 
time,  the  dean  submits  the  student’s  cre- 
dentials and  recommendations  to  the  hos- 
pitals where  the  student  has  applied  for 
internship.  The  hospitals  then  have  this 
information  should  the  student  make  an 
appointment  for  an  interview.  The  Christ- 
mas holiday  is  the  time  when  most  of  these 
interviews  take  place. 

By  late  January,  both  students  and  hos- 
pitals must  have  filed  their  confidential 
rank  order  lists  at  the  NIMP  office.  Stu- 
dents list  all  hospitals  to  which  they  have 
made  application  in  order  of  their  prefer- 
ence and  indicate  those  hospitals  at  which 
they  do  not  wish  to  intern.  Hospitals  list, 
in  order  of  their  preference,  all  students 
applying  for  their  internship  vacancies. 

Matching  Begins  in  February 

After  NIMP  confirms  this  information 
to  both  students  and  hospitals,  the  match- 
ing begins  in  mid-February;  and  the  re- 
sults of  the  matching  are  mailed  to  the 
students  and  the  hospitals  in  mid-March. 

Following  the  announcement  of  the 
matching  results,  hospitals  with  vacancies 
and  students  who  have  been  unmatched 
are  free  to  negotiate  for  appointments. 
Each  year  about  60  per  cent  of  the  avail- 
able internships  are  filled  through  the 
matching  program. 

A record  8,000  medical  graduates  par- 
ticipated in  the  sixteenth  annual  National 
Intern  Matching  Program  in  1967.  The 
proportion  of  interns  matched  to  federal 
service  hospitals  and  hospitals  with  minor 
teaching  affiliations  has  remained  relative- 
ly constant  over  the  past  eight  years.  Hos- 
pitals with  major  affiliations  have  drawn 
increasingly  larger  proportions  of  NIMP 
participants. 

The  success  of  each  matching  depends 
upon  the  distribution  of  carefully  prepared 
materials  to  medical  students,  medical 
schools,  and  hospitals;  upon  the  coopera- 
tion of  all  of  those  involved  in  meeting 
NIMP  deadlines;  and  upon  meticulous  exe- 
cution of  the  matching  process  at  the  NIMP 
office. 

(Continued  on  page  580) 


m 


Illinois  Medical  Journal 


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NAME 


ADDRESS. 
CITY 


-STATE- 


-ZIP. 


DATE  OF  BIRTH. 

867  I 


Month 


Day 


Year 


for  October,  1968 


oil 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  an  effort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  phy- 
sicians, the  Journal  is  publishing  synopses 
submitted  to  the  Physicians  Placement  Serv- 
ice concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  who  know  of  any  out-of-state 
physicians  seeking  an  Illinois  residence  are 
asked  to  notify  the  placement  service. 

Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addi- 
tional physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave., 
Chicago  60601. 

GRUNDY  COUNTY:  Morris,  population 
9,000  and  trade  area  25,000.  Urgent  need 
for  physicians  to  join  Clinic  Corporation 
group  of  3 G.P.’s  New  119  bed  hospital, 
clinic  one  block  away.  Clinic  is  well  equip- 
ped and  staffed  with  ten  examining  rooms, 
minor  surgery,  nurses  station,  administra- 
tive areas,  large  waiting  room  and  ample 
parking.  Growing  commercial  and  industri- 
al community.  Good  schools  ten  Protestant 
and  Catholic  Churches,  various  recreational 
facilities.  Country  Club  and  also  active  civic 
and  social  groups.  One  hour  from  Chicago. 
Salary  with  opportunity  of  increasing  salary- 
ownership  after  one  year.  Contact:  Barry  S. 
Seng,  M.D.,  Tratt  Clinic,  S.C.,  Morris,  312- 
942-3000 

HANCOCK  COUNTY:  Carthage;  pop- 
ulation: 3,500.  Four  physicians,  ages  54,  37, 
61  and  45.  Memorial  Hospital  50  miles 
from  Quincy;  population  47,000.  Two 
prescription  drug  stores.  Office  space  avail- 
able in  hospital  extended  care  complex  if 
desired.  Agriculture  and  industry  area. 
Ten  Catholic  and  Protestant  churches. 
Three  grade  and  one  high  school.  Robert 
Morris  Junior  College  located  here.  Near- 
by country  club,  municipal  swimming 
pool.  For  further  details  contact:  Marion 
Smith  Geissler,  Administrator,  Carthage 
Memorial  Hospital,  Carthage.  Phone:  217- 
357-3408. 

HANCOCK  COUNTY:  Nauvoo;  popu- 
lation: 1,100.  Trade  area,  4,000.  Nearest 


doctor  at  Hamilton  12  miles.  Nearest  hos- 
pitals at  Ft.  Madison  and  Keokuk,  la.  12 
miles;  50  miles  from  Quincy.  One  pre- 
scription drug  store.  Office  space  available; 
equipment  if  desired.  Financial  assistance 
available.  Predominant  nationality:  Ger- 
man and  English.  Agriculture  and  indus- 
try area.  Churches:  Catholic  and  Protes- 
tant. Beautifully  located  on  Mississippi. 
Portion  of  the  old  Nauvoo  being  re- 
stored. One  million  dollars  spent  in  pre- 
liminary steps.  For  further  details  contact: 
E.  J.  Kron,  Nauvoo.  Phone:  217-453-2717. 

HENRY  COUNTY:  Geneseo;  popula- 
tion: 6,000.  Trade  area,  20,000.  Eight  phy- 
sicians, ages  33,  63,  38,  38,  58,  58,  63,  and 
65.  Hammond  Henry  District  Hospital  lo- 
cated here.  New  hospital— $2,500,000,  110 
beds— short  term  hospital— includes  new  50 
bed  extended  care  section.  Office  space 
available.  Predominant  nationality:  Swed- 
ish and  Belgian.  Agricultural  community 
area.  Located  on  highway  Interstate  80. 
Eleven  Protestant  and  Catholic  churches. 
Grade  and  high  schools.  Local  country  club 
and  swimming  pool.  For  further  details 
contact:  Clement  McNamara,  Hospital  Ad- 
ministrator, Geneseo. 

IROQUOIS  COUNTY:  Danforth;  pop- 
ulation: 400.  Trade  area,  3,000.  Nearest 
physicians  at  Gilman,  Watseka,  and  Kan- 
kakee, 4,  18  and  25  miles.  No  physician  for 
several  years.  Nearest  hospital  at  Watseka, 
18  miles,  60  miles  from  Champaign.  Office 
space  available.  Financial  assistance  if  de- 
sired. Predominant  nationality:  Dutch  and 
German.  Agricultural  community  area. 
Three  Protestant.  Churches.  Recreational 
facilities:  golf,  =^wimming,  boating,  flying 
and  bowling.  Town  supported  a physician 
for  60  years.  For  further  details  contact: 
Mr.  Sebo  S.  Wilken,  Mayor,  Danforth. 

IROQUOIS  COUNTY:  Gilman;  popula- 
tion: 1,704.  Trade  area,  8,000.  One  phy- 
sician in  limited  practice  due  to  health. 
Two  in  nearby  towns.  Nearest  hospitals  at 
Watseka  and  Clifton,  12  and  14  miles.  One 
prescription  drug  store;  50  miles  from 
Champaign.  Office  space  available.  Pre- 
dominant nationality:  German.  Agricultur- 
al area.  Churches:  Catholic,  Methodist, 
Lutheran,  Church  of  Christ,  Presbyterian 
and  Nazarene.  Grade  and  high  schools.  For 


:'78 


Illinois  Medical  Journal 


further  details  contact:  Miss  Evelyn  Mar- 
lett.  Secretary,  Chamber  of  Commerce,  Gil- 
man, or  R.  A.  Buckner,  M.  D.,  Gilman. 

JACKSON  COUNTY:  Ava;  population: 
650.  No  physician  for  10  years.  Nearest  at 
Murphysboro,  15  miles.  Nearest  hospital,  15 
miles;  75  miles  from  St.  Louis.  Office  space 
available;  financial  assistance  if  desired. 
Agricultural  and  mining  community. 
Churches:  Protestant  and  Catholic.  Grade 
and  high  schools.  Kinkaid  Lake  to  be  con- 
structed within  short  time  by  state  and  fed- 
eral governments.  For  further  information 
contact  Mr.  Ardell  W.  Kimmel,  Secretary, 
Chamber  of  Commerce,  Ava. 

JACKSON  COUNTY:  Grand  Tower; 
population:  850.  Trade  area,  3,600.  Only 
physician  died  in  1964.  Nearest  physician, 
19  miles;  90  miles  from  St.  Louis.  Office 
space  available.  Financial  assistance  if  de- 
sired. Predominant  nationalities:  English, 
German.  Agricultural  community.  Church- 
es: Protestant  and  Catholic.  Bus  service  to 
nearest  high  school.  Good  hunting  and  fish- 
ing. Sears  Roebuck  Foundation  survey  in- 
dicates community  could  support  a phy- 
sician well.  For  further  information  con- 
tact: Mrs.  W.  B.  Lyon,  Grand  Tower. 
Phone  618-565-2682. 

JO  DAVIESS  COUNTY:  Elizabeth;  popu- 
lation: 800.  Trade  area,  2,000.  No  physi- 
cian since  1963.  Nearest  hospital  at  Galena, 
14  miles;  34  miles  from  Dubuque,  Iowa. 
One  prescription  store.  Office  built  under 
supervision  of  Sears  Foundation  in  1958. 
Predominant  nationality:  German.  Agricul- 
tural community.  Churches:  Protestant  and 
Catholic.  Grade  and  high  schools.  Nearest 
golf  course,  8 miles.  Good  hunting  and  fish- 
ing in  area.  For  further  information  con- 
tact: Mr.  Lyle  Francomb,  Elizabeth,  (815) 
858-3727  after  5 p.m.,  or  Mario  Specht, 
Elizabeth. 

JOHNSON  COUNTY:  Goreville;  popula- 
tion: 750.  Six  small  towns  in  trade  area 
without  physicians.  Nearest  doctors  at 
Marion  and  Vienna,  14  miles.  Nearest  hos- 
pital at  Marion;  75  beds.  Paducah,  Ky.,  60 
miles.  Agricultural  area.  Four  Protestant 
churches.  Grade  and  high  schools.  Fern 
Cliff  State  Park  1/2  mile.  Lake  of  Egypt, 
1 1/2  miles.  Good  fishing  and  hunting  in  sur- 
rounding area.  Federal  prison,  8 miles. 
Goreville  Boosters  Club  willing  to  give  all 
possible  assistance  to  a physician.  For  fur- 
ther information  contact:  Gleniia  Killey, 
Technician,  Marion  Memorial  Hospital, 


Goreville,  or  Alma  Ray,  Goreville. 

JOHNSON  COUNTY:  Vienna;  popula- 
tion: 1,200.  One  physician,  age  76;  need  for 
a second.  Nearest  hospitals  at  Metropolis 
and  Marion,  20  and  32  miles.  Two  prescrip- 
tion drug  stores.  Remodeled  and  new  of- 
fice space  available.  Agricultural  communi- 
ty. Nearby  state  hospital,  security  prison 
and  glove  factory  to  be  opened  soon.  Grade 
and  high  schools.  Nearest  college  at  Carbon- 
dale.  Churches:  Protestant  and  Catholic. 
Organizations  include  Masonic  Lodge,  Ki- 
wanis  and  Chamber  of  Commerce.  Fast 
growing  recreational  area.  For  further  in- 
formation contact:  Executive  Secretary, 

Johnson  County  Farm  Bureau,  Vienna. 

JOHNSON  COUNTY:  population:  7,- 
000.  County  seat,  Vienna,  population:  1,- 
200.  No  physician  in  entire  county.  Nearest 
hospitals  at  Metropolis  and  Anna,  20  miles, 
and  Marion,  30  miles.  Two  prescription 
stores  and  a 49  bed  nursing  home  in  Vien- 
na. Remodeled  modern  physician  office 
with  equipment  including  x-ray  in  Vienna. 
Agricultural  community.  Nearby  state  hos- 
pital. Minimum  Security  Prison  in  county, 
glove  factory.  Grade  and  high  schools. 
Churches:  Protestant  and  Catholic.  Fast 
growing  recreational  area.  For  further  in- 
formation contact:  Executive  Secretary, 

Johnson  County  Farm  Bureau,  Vienna, 
62995. 

The  following  towns  in  the  above-listed 
counties  are  also  reported  to  be  in  need  of 
additional  general  practitioners.  For  de- 
tailed information  contact  the  county  so- 
ciety secretaries  shown  below: 

Hancock  County:  Plymouth 
Use  Erika  Brueshel,  M.D. 

Warsaw. 

Henry  County:  Galva 
Fred  Colby,  M.D. 

213  W.  First  St. 

Geneseo. 

Iroquois  County:  Onarga,  Buckley,  Cis- 
sna  Park,  Beaverville,  Watseka  and 
Milford 

Ryland  Buckner,  M.D. 

Gilman. 

Jackson  County:  Carbondale 
Homer  H.  Hanson,  M.D. 

P.O.  Box  1030 
Carbondale. 

JoDaviess  County:  Galena 
William  G.  Gillies,  M.D. 

300  Summit  Street 
Galena. 


for  October,  1968 


579 


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Matching  Program 

f Continued  from  page  576) 

Residency  Matching  Program 

Now  that  the  National  Intern  Matching 
Program  has  become  the  National  Intern 
and  Resident  Matching  Program,  match- 
ing programs  for  residencies  as  well  as  for 
internships  are  beginning  to  develop.  The 
purpose  of  NIRMP  is  to  conduct  a na- 
tional clearing  office  for  matching  the  pref; 
erences  of  medical  students  for  internships 
and  of  interns  for  residencies,  both  against 
the  rank  order  of  the  preferences  of  the 
hospitals  to  which  the  students  and  interns 
have  applied.  In  other  words,  matching 
programs  will  operate  in  much  the  same 
way  that  they  have  for  internships. 

The  corporate  members  of  the  NIRMP 
are:  The  Advisory  Board  for  Medical  Spe- 
cialties, The  American  Hospital  Associa- 
tion, The  American  Medical  Association, 
The  American  Protestant  Hospital  Asso- 
ciation, The  Association  of  American 
Medical  Colleges,  The  Catholic  Hospital 
Association  and  the  Student  American 
Medical  Association.  Representatives  of 
these  agencies  plus  representatives  of  the 
medical  students,  interns,  and  residents  at 
large  form  the  Board  of  Directors  of  the 
Corporation. 

The  U.S.  Air  Force,  the  U.S.  Army,  the 
U.S.  Public  Health  Service,  the  Veterans 
Administration  and  the  Association  of  Hos- 
pital Directors  of  Medical  Education  all 
have  liaison  representation  upon  the  board. 


"Cancer  Detection:  Routine  Proctosig- 

moidoscopy," a new  20-minute  color  film, 
is  now  available  for  professional  organiza- 
tions, hospitals,  clinics,  etc.  without  charge 
from  C.  B.  Fleet  Co.,  Inc.,  P.O.  Box  1100, 
Lynchburg,  Va.  24505.  This  demonstration 
film  was  produced  to  help  physicians  per- 
form a simple  office  procedure  for  early 
detection  of  asymptomatic  cancer  and  ade- 
nomas of  the  colon  and  rectum.  Over  44,- 
000  persons  in  the  U.S.  die  each  year  of 
colon-rectum  cancer,  according  to  the  Amer- 
ican Cancer  Society.  More  than  half  of 
these  deaths  are  needless  and  could  be 
prevented  by  the  use  of  the  examination 
featured  in  the  film. 


580 


Illinois  Medical  Journal 


Abstracts  of  Board  Actions 

(Continued  from  page  366) 

MANDATORY  TB  TESTING 

It  was  requested  that  with  respect  to  mandatory  tuberculin 
tests,  approved  by  action  of  the  House  of  Delegates,  the 
Board  support  the  Council  on  Scientific  Services  opinion 
that  the  action  of  the  House  of  Delegates  should  be  rescind- 
ed. The  Council  felt  this  would  allow  physicians  to  practice 
medicine  according  to  their  best  judgment  and  remove  the 
mandatory  aspect  in  this  area.  It  was  the  consensus  that 
this  was  not  within  the  power  of  the  Board  of  Trustees,  to 
rescind  any  action  taken  by  the  House  of  Delegates. 

APPOINTMENT  OF  MEDICAL  CONSULTANTS 

The  recommendation  was  adopted  that  the  Board  of  Trustees 
request  all  State  of  Illinois  agencies  having  medical  con- 
sultants to  appoint  to  each  advisory  panel  at  least  one 
physician  who  is  an  active  member  of  a corresponding  or  ap- 
propriate committee  of  the  Illinois  State  Medical  Society. 

TWO-PIANO  CONCERT  TOUR  SPONSORSHIP 

The  Educational  & Scientific  Foundation  was  granted  ap- 
proval for  the  sponsorship  of  a two-piano  team  to  tour  the 
state  under  the  auspices  of  the  Woman’s  Auxiliary,  with  all 
profits  derived  therefrom  to  accrue  to  the  Foundation. 


^^asy  on 

on 

thc51[fother 

GAGAT ablets  ElixiryGVo) 

^ron  j^eficiency  Qy^nemia 


FAMOUS 


BREON  LABORATORIES  INC. 

Subsidiary  of  Sterling  Drug  Inc. 

90  Park  Avenue,  New  York,  N.Y.  10016 


brand  of  FERFROUS 


on 

GLUCONATE 


for  October^  1968 


581 


After  the  picnic 
even  Gramps 

Was  a victim  of 
intestinal  cramps 


Parepectolin  for  quick  relief  of  acute  diarrhea 
. . . soothes  colicky  pain  with  paregoric* 

. . . consolidates  fluid  stools  with  pectin 
. . . adsorbs  irritants  with  kaolin, 
and  protects  intestinal  mucosa 

In  elderly  patients  it  is  particularly  important 
to  stop  the  diarrhea  fast.  Parepectolin  helps  you 
control  diarrhea  promptly  and  gain  the  patient’s 
confidence  until  etiology  has  been  determined. 


Each  fluid  ounce  of  creamy  white  suspension  contains: 

*Paregoric  (equivalent)  (1.0  dram)  3.7  ml. 

Contains  opium  (%  grain)  15  mg.  per  fluid 
ounce. 

warning : may  he  habit  forming 

Pectin (2V2  grains)  162  mg. 

Kaolin  (specially  purified)  ....  (85  grains)  5.5  Gm. 
(alcohol  0.69%) 

Usual  Adult  Dose:  One  or  two  tablespoonfuls  three  times 
daily. 


WILLIAM  H.  RORER,  INC. 

Fort  Washington,  Pa. 


Instructing  Pati 
To  Inc 

A revolutionary  approach  to  alleviation 
of  the  health-manpower  shortage  has  been 
announced  by  a newly  organized  firm 
staffed  by  specialists  in  medicine,  commu- 
nications, and  learning,  called  Media 
Medica,  Inc.  (MMI).  Its  objectives,  meth- 
ods, products,  and  services  were  described 
at  a press  seminar  held  at  the  New  York 
Academy  of  Medicine.  It  will  be  located 
at  555  Fifth  Ave.,  New  York,  10017. 

The  company’s  goal  is  to  achieve  an  in- 
crease in  physician  productivity  simultan- 
eously with  an  improvement  in  patient 
care.  To  achieve  this  goal  it  is  concentrat- 
ing its  activity  in  problem  areas  of  medical 
service.  Its  focus  will  be  on  those  medical 
conditions  and  situations  which  require 
repetitive  patient  counseling  and  instruc- 
tion. 

The  availability  of  well-designed  ma- 
terials which  the  patient  can  take  home 
for  review  will  permit  the  physician  to 
devote  more  time  to  individualized  atten- 
tion, thus  improving  both  the  quality  of 
patient  care  and  the  doctor-patient  rela- 
tionship-while the  physician  is  assured 
that  the  repetitive  kinds  of  instruction  are 
comprehended  and  followed,  with  a mini- 
mum of  postinterview  telephone  calls  and 
conferences  for  clarification. 

To  lighten  the  physician’s  load  of  pa- 
tient counseling  and  at  the  same  time  im- 
prove quality  and  effectiveness,  MMI  will 
apply  its  talents  to  the  development  of 
patient-oriented  learning  aids.  These  will 
include  scientifically  designed  and  clinically 
validated  instructional  manuals,  booklets, 
phonograph  records,  films,  and  other  ma- 
terials to  supplement  the  physician’s  di- 
rections. Such  counseling  materials  will  be 


“Horizons  Unlimited,’’  designed  to  tie  in 
with  the  American  Medical  Association’s 
paperback  of  the  same  name,  has  been  pro- 
duced in  a 28-minute  color  film  as  a fur- 
ther means  of  encouraging  young  men  and 
women  to  enter  careers  allied  to  medicine. 
It  is  the  only  recently  produced  film  cover- 
ing a broad  variety  of  health  career  op- 
portunities, zeroing  in  on  12  in  particular, 
and  is  distributed  through  AMA  head- 
quarters. 


582 


Illinois  Medical  Journal 


ler  MD  Supervision- 
sician  Productivity 

available  to  patients  only  on  prescription 
by  their  physicians.  Patients  will  be  moti- 
vated to  follow  the  physician’s  instructions 
by  assuring  an  understanding  of  a pre- 
scribed medical  regimen.  Other  assistance 
to  physicians  will  result  from  MMI’s  de- 
velopment of  continuing  education  ma- 
terials. 

Also  under  development  by  MMI  is  a 
computerized  service  through  which  medi- 
cal research  information  will  be  gathered, 
organized,  evaluated  and  made  available 
to  hospital-based  physicians. 

While  the  problem  of  delivery  of  medi- 
cal care  is  greater  than  ever,  current  ad- 
vances in  behavioral  science  and  communi- 
cations offer  opportunities  for  solution  that 
were  never  before  available.  All  materials 
will  be  developed  with  precise  instructional 
objectives  aimed  at  proven  needs  for  spe- 
cific groups.  Materials  will  be  tested  at  all 
critical  stages  of  development,  and  will 
undergo  validation  tests  to  assure  that  they 
achieve  their  instructional  objectives. 

Besides  physicians,  the  audiences  for 
various  types  and  levels  of  material  will 
be  laymen  of  differing  degrees  of  reading 
ability.  Materials  will  also  be  designed  to 
serve  the  medical  and  health  needs  of  func- 
tional illiterates  and  non-English  speaking 
people.  Other  materials  will  be  developed 
to  meet  the  special  communications  prob- 
lems of  patients  in  the  ghetto  areas  and 
other  deprived  sectors  of  the  population. 
Among  the  circumstances  which  brought 
MMI  into  being  are  the  constantly  grow- 
ing number  of  patients,  the  shortage  of 
physicians,  and  the  scarcity  of  hospital  beds, 
equipment  and  trained  personnel. 


anticostive* 

hematinic 


PERITINIC’ 

Hematinic  with  Vitamins  and  Fecal  Softener 

A tablet^day  provides: 

• Elemental  Iron  (as  Ferrous  Fumarate) . 1(X)  mg 

• Dioctyl  Sodium  Sulfosuccinate  (to 

counteract  constipating  effect  of  iron)  100  mg 


Vitamin  Bi 7.5  mg 

Vitamin  B2 7.5  mg 

Vitamin  Bs 7.5  mg 

Vitamin  B12 50  mcg^ 

Vitamin  C 200  mg 

Niacinamide 30  mg 

Folic  Acid 0.05  mg 

Pantothenic  Acid 15  mg 


Bottles  of  60 

anticostive,  adj,  (anti  opposed  to 
+ costive  causing  constipation.) 
Against  constipation.  (Now  isn’t 
that  a good  idea  in  an  iron-contain- 
ing hematinic  ?) 


We  have  great  untapped  sources  of 
brainpower  housed  in  handicapped 
bodies.  Employers  should  realize  that 
if  an  individual  is  properly  trained 
and  properly  placed,  his  physical 
handicap  will  not  be  a job  handi- 
cap  Mrs.  Jayne  B.  Spain,  presi- 

dent, Alvey-Ferguson  Operations, 
Hewitt-Robins,  Inc. 


LEDERLE  LABORATORIES 
A Division  of  American  Cyanamid  Company 
Pearl  River,  New  York  10965 

488-7R-6062 


for  October,  1968 


583 


if  you  are  not  already  a member  of  IMPAC  please  tear  off  the  coupon  and  send 
it  in  with  your  check 


ILLINOIS  MEDICAL  POLITICAL  ACTION  COMMIHEE 

360  NORTH  MICHIGAN  • CHICAGO,  ILLINOIS  • 60601 


MEMBERSHIP  APPLICATION 

(PLEASE  PRINT  OR  TYPE) 

NAME 

VOTING  ADDRESS 

CITY 

COMBINED  MEMBERSHIPS  (IMPAC  AND  AMPAC) 
n SUSTAINING  ($199)  □ REGULAR  ($25) 

□ PLEASE  ENROLL  MY  WIFE  AS  A REGULAR  MEMBER  ($20) 

Principal  Hospital  Affiliation  

U.S.  Congressional  District  No Precinct  or  Ward 


584 


Illinois  Medical  Journal 


Professional  Protection  Exclusively  since  1899 


CHICAGO  OFFICE:  Tom  J.  Hoehn  and  E.  M.  Braier,  Representatives 
S5  East  Washington  Street,  Room  1334,  Chicago  60602  Telephone:  312-782-0990 

MOUNT  PROSPECT  OFFICE:  Theodore  J.  Pandak,  Representative 
709  Hackberry  Lane  (P.  O.  Bex  105)  Mount  Prospect  60056  Telephone:  312-259-2774 

ST.  CHARLES  OFFICE:  Joseph  C.  Kunches,  Representative 
1220  Wing  Avenue,  St.  Charles  60174  Telephone:  312-584-0920 

SPRINGFIELD  OFFICE:  William  J.  Nattermann,  Representative 
1124  South  Fifth  Street,  Springfield  62703  Telephone:  217-544-2251 


^peciCLilzed 


eruice 


/• 

l6  a Itian  mati 


k of  didtinction 


Nervous 

Geriatrics 


Mental 

Custodial 


This  modernly  equipped  institution  located  in  the  beautiful  Fox  River  Valley  35 
miles  west  of  Chicago,  cooperates  with  physicians  to  the  fullest  extent. 

It  provides  accommodations  for  100  patients  in  single  and  double  rooms.  Rest- 
haven  accepts  patients  by  referral  and  direct  admission. 

RESTHAVEN  HOSPITAL,  600  VILLA  ST.,  ELGIN,  ILL. 

Phone:  SH  2-0327 


Long  Term 
and  Short 
Term  Care 


Day  Care 
and  Mental 
Health  Clinic 


Est.  1909 

RESTHAVEN 


/or  October,  196S 


585 


Tuberculosis?  Influenza? 
Pneumonia?  Leukemia? 
Hodgkin’s  Disease?  Syphilis? 
Systemic  Fungal  Diseases? 
Chronic  Chest  Diseases? 
or 

HISTO? 

(Histoplasmosis— "The  Masquerader”) 


A new  aid  in  differential  diagnosis 

HISTOPUSMINJINE  TEST 

(Rosenthal) 

The  LEDERTINET^M  Applicator  with  the  Blue  Handle 

Precautions— Nonspecific  reactions  are  rare,  but 
may  occur.  Vesiculation,  ulceration  or  necrosis 
may  occur  at  test  site  in  highly  sensitive  persons. 
The  test  should  be  used  with  caution  in  patients 
known  to  be  allergic  to  acacia,  or  to  thimerosal 
(or  other  mercurial  compounds). 


Ask  your  representative  for  details  or  write  Medical  Advisory  Dept., 
Lederle  Laboratories,  Pearl  River,  New  York  10965.  406-8 


1 


2 ways  Doctor... 

you  can  help  achieve 
TOTAL  REHABILITATION 
in  your  handicapped  patients. . . 

DIRECT  THEM  TO  EMPLOYMENT  OPPOR- 
TUNITY— by  referring  them  to  the  Gover- 
nor’s Committee  on  Employment  of  the 
Handicapped. 

BECOME  AN  ACTIVE  FORCE  FOR  EQUAL 
EMPLOYMENT  OPPORTUNITY  IN  YOUR 
COMMUNITY:  Join  your  Local  Council  on 
Employment  of  the  Handicapped. 

For  complete  information  write  . . . 
Louis  A.  Sabella 
Executive  Dir.— Governor’s  Committee 
on  Employment  of  the  Handicapped 
Frank  J.  Jirka,  M.D.,  Chairman 
188  W.  Randolph  St.  / Chicago,  III.  60601 
(AC  312)  372-3437 


Circulation  Discovery 

A discovery  about  the  circulation  of 
blood,  which  could  lead  to  a better  under- 
standing of  the  mechanism  of  certain  lung 
disorders,  was  reported  at  The  University 
of  Chicago  during  a Labor  Day  Weekend 
conference  at  the  Center  for  Continuing 
Education.  In  addition  to  the  University, 
other  co-sponsors  of  the  conference  were 
Michael  Reese  Hospital  and  Medical  On- 
ter,  the  Chicago  Heart  Association,  and  the 
Tuberculosis  Institute  of  Chicago  and  Cook 
County. 

Dr.  Solbert  Permutt,  professor  of  environ- 
mental medicine  at  The  Johns  Hopkins 
University,  said  that  a vast  network  of  small 
blood  vessels  in  the  lung  stand  open  and 
empty,  ready  to  be  filled  with  blood  as 
needed.  In  medical  terms,  this  is  called  re- 
cruitment. 

While  simple  in  concept.  Dr.  Permutt’s 
finding  helps  explain  a long-standing  medi- 
cal puzzle:  just  how  does  blood  circulating 
through  the  lungs  increase  in  volume  in 
response  to  bodily  needs?  The  old  notion 
was  that  the  large  vessels  in  the  chest  in- 
creased in  size  and  volume.  Instead,  Dr. 
Permutt  has  found  that  smaller  vessels, 
just  larger  than  capillaries,  are  involved. 

Dr.  Permutt’s  experiments  in  laboratory 
animals  showed  that  recruitment  occurs  in 
response  to  alveolar  pressure.  The  alveolae 
are  the  tiniest  sacs  in  the  lung,  where  oxy- 
gen from  the  air  is  exchanged  with  carbon 
dioxide  from  the  blood. 

Thus,  when  the  lungs  are  fully  inflated, 
all  of  the  blood  vessels  which  serve  it  are 
full  of  blood.  In  the  dog,  pulmonary  blood 
volume  can  increase  four  times,  from  100 
milliliters  to  400  milliliters. 

‘‘We  have  found,”  Dr.  Permutt  explained 
in  a press  interview,  ‘‘that,  together,  the 
small  vessels  of  the  lung  can  hold  more 
blood  than  can  the  large  vessels.” 

The  finding,  he  explained,  is  intimately 
related  to  diseases  of  the  lungs  and  should 
help  explain  pulmonary  disease  processes. 
For  instance,  if  tiny  blood  clots  called  em- 
boli lodge  in  the  small  recruitment  vessels 
and  block  blood  flow,  pressure  in  the  ves- 
sels could  build  up,  forcing  fluid  to  leak 
and  causing  edema,  or  fluid  accumulation 
in  the  lungs.  Another  example  would  be 
the  drug-induced  constriction  or  tightening 
of  these  vessels  at  a time  when  they  should 
be  open. 


586 


Illinois  Medical  Journal 


Togetherness .... 


...can  be  rough  when  epidemics  of  nausea  and 
vomiting  strike  a family.  Emetrol  offers  prompt,  safe  relief.  It  is 
free  from  toxicity^  or  side  eff  ects^’^  and  will  not  mask  symptoms  of 

serious  organic  disorders.  ^ l.  Bradley,  J.  E„  et  al.-.  J.  Pedlat.  35: 41  (Jan.>  1951, 

o 2.  Bradley,  J.  E.:  Mod.  Med.  20: 71  (Oct.  15)  1952. 

3.  Crunden,  A.  B.,  Jr.,  and  Davis,  W.  A.;  Am.  J.  Obst. 
& Gynec.  65:311  (Feb.)  1953. 


|ro|er|  william  H.  RORER,  INC. 
Fort  Washington,  Pa. 


Emetrol® 

phosphorated  carbohydrate 
solution 

emesis  control 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1968 

SPECIALTY  REVIEW  COURSE  IN  OG-GYN,  October  21 
SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  I,  October  28 
SPECIALTY  REVIEW  COURSE  IN  ORTHOPEDICS,  Nov.  18  & 
D6c  9 

SPECIALTY  REVIEW  COURSE  IN  UROLOGY,  Four  Days, 
Nov.  18 

SPECIALTY  REVIEW  COURSE  IN  PEDIATRICS,  December  9 
PAHTOLOGY  REVIEW  COURSES  FOR  SPECIALTIES,  Request 
Dates 

MANAGEMENT  OF  COMMON  FRACTURES,  One  Week,  Oc- 
tober 21 

SURGERY  OF  COLON  & RECTUM,  One  Week,  November  11 
VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Dec.  9 
GENECOLOGY,  One  Week,  November  11 
OBSTETRICS,  One  Week,  November  18 
INTERMEDIATE  CARDIOLOGY,  One  Week,  October  21 
GENERAL  PRACTICE  REVIEW,  One  Week,  October  28 
ADVANCES  IN  PEDIATRICS,  One  Week,  November  11 
ADVANCES  IN  MEDICINE,  One  Week,  December  2 
RADIOISOTOPES,  One  or  Two  Weeks,  First  Monday  Each 
Month 

Information  concerning  numerous  other 
continuation  courses  available  upon  request. 

TEACHING  FACULTY 
Attending  StaflF  of 
Cook  County  Hospital 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


Full  speed  ahead, 
Fred.  These  solid 
Cough  Calmers 
can  control  that 
cough  for  6 to 
8 hours. 


- Gotta  make  a 
pit  stop  to  take 
my  cough  syrup. 


Each  Cough  Calmer’^”  contains  the  same  active  ingredients 
as  a half-teaspoonful  of  Robitussin-DM®:  Glyceryl  guaiaco- 
late,  50  mg.;  Dextromethorphan  hydrobromide,  7.5  mg. 
A.  H.  Robins  Company,  Richmond,  Virginia  23220 


Toxicity  Laboratory 
Studies  Air  Pollution 

Sulfur  dioxide  pollution  of  the  air  from 
burning  coal  is  a growing  health  problem 
in  American  cities.  According  to  Dr.  Ken- 
neth P.  DuBois,  Director  of  The  Univer- 
sity of  Chicago  Toxicity  Laboratory,  sul- 
fur dioxide  produced  by  coal  burning  ad- 
heres to  coal  dust  particles  and  spreads 
through  the  urban  air.  These  particles  get 
into  our  lungs  and  create  sulfuric  acids. 

The  Toxicity  Laboratory  has  been  ex- 
amining air  pollution  and  its  effects  for 
two  decades,  in  addition  to  conducting  re- 
search on  the  modern  environmental  haz- 
ards of  pesticides,  radiation,  and  chemical 
agents.  In  its  air  pollution  program,  the 
Laboratory  has  concentrated  on  identifying 
toxic  or  poisonous  agents,  determining 
maximum  allowable  levels  in  circulating 
air.  The  Laboratory  also  samples  atmos- 
pheric particle  sizes  to  determine  relative 
danger. 

The  Toxicity  Laboratory  was  originally 
created  during  World  War  II  to  examine 
the  effects  of  potential  chemical  warfare 
agents.  “Many  of  the  techniques  and  much 
of  the  basic  information  developed  at  that 
time,”  said  Dr.  DuBois,  “is  now  being  ap- 
plied to  the  important  current  problem  of 
environmental  air  pollution.” 

In  addition  to  the  insecticides,  there  is 
some  evidence  that  solvents  used  in  home 
aerosols  can  also  affect  detoxification  sys- 
tems in  the  liver  and  may  be  changing  the 
susceptibility  of  man  to  drugs  and  other 
chemicals.  The  production  of  detoxifica- 
tion enzymes  in  the  liver  is  a seemingly 
delicate  process.  It  has  been  found  recently 
that  turpines  in  animal  bedding  affect  the 
detoxification  process  and  alter  drug  reac- 
tions. 

In  additional  to  studying  interactions  be- 
tween pesticides  and  other  chemicals,  the 
Laboratory  is  testing  potential  antimalarial 
drugs.  Drugs  which  might  effectively  com- 
bat malaria  have  to  be  studied  to  insure 
that  they  do  not  cause  poisoning  at  the  dos- 
age levels  needed  to  treat  malaria.  Dr.  Du- 
Bois and  his  staff  examine  drugs  submitted 
by  U.S.  Army  researchers  to  determine  the 
no-effect  toxicity  level.  These  tests  then  de- 
cide whether  the  dose  needed  to  combat 
malaria  is  safe  from  the  standpoint  of  toxi- 
city to  the  patient. 


588 


Illinois  Medical  Journal 


r 

1 


BLUE  SHIELD 


u\ 


FOR 


PUBLISHED  MONTHLY  BY:  BLUE  SHIELD  PLAN  OF  ILLINOIS  MEDICAL  SERVICE  • 425  NORTH  MICHIGAN  AVENUE  • CHICAGO.  ILLINOIS  60690 


Vol.  2,  No.  11 


November,  1968 


NABSP  Membership  Changes 

The  National  Association  of  Blue  Shield  Plans  at 
a special  meeting  October  8,  in  Chicago,  amended 
membership  standards  to  require  that  each  Plan 
ofiFer  a Blue  Shield  program  based  on  physicians’ 
Usual,  Customary,  and  Reasonable  charges.  In  ad- 
dition to  this  becoming  a condition  of  Plan  member- 
ship, the  National  Association’s  resolution  also 
called  for  such  programs  to  show  evidence  of  pro- 
fessional support;  contain  provision  for  the  develop- 
ment and  maintenance  of  physicians’  charges;  and 
regular  professional  review  and  analysis  of  charges 
consistent  with  each  Plan’s  responsibility  to  the 
profession  and  its  subscribers. 

In  May  1967  the  Blue  Shield  Plan  of  Illinois 
Medical  Service  sought  approval  of  the  Illinois 
State  Medical  Society’s  House  of  Delegates  to  offer 
contracts  which  would  permit  us  to  make  payments 
to  physicians  based  on  Usual,  Customary  and  Reas- 
onable charges  in  accordance  with  the  Society’s 
definitions.  The  House  of  Delegates  of  the  Illinois 
State  Medical  Society  at  its  1967  annual  meeting 
approved  of  this  method  of  payment  to  physicians 
which  we  applied  August  1,  1967  for  the  first  time 
in  Illinois. 

At  the  time  Blue  Shield  gained  support  of  the 
House  of  Delegates,  we  assured  the  Illinois  State 
Medical  Society  that  Usual  and  Customary  charges 
would  not  become  fixed  but  would  be  kept  current 
by  regular  professional  review  and  analysis  of 
physicians’  charges  as  they  became  available  so 
that  appropriate  adjustments  could  be  made. 

The  support  of  the  Society’s  House  of  Delegates 
of  payment  to  physicians  on  the  basis  of  their 
Usual  and  Customary  charges  demonstrates  a belief 
shared  by  Blue  Shield  that  the  best  interests  of 
physicians,  their  patients,  and  the  financing  mechan- 
ism will  be  served. 

Usual  and  Customary  certificates  will  not  totally 
replace  our  existing  indemnity  contracts,  but  will 
offer  greater  choice  to  groups  wishing  broader  pro- 
tection. They  provide  an  opportunity  for  members 
to  have  their  medical  costs  prepaid  on  a more 
predictable  basis  with  realistic  payments  to  physi- 
cians for  the  services  they  provide. 

The  NABSP  at  the  same  meeting  adopted  a com- 
prehensive scope  of  benefits  which  should  be  made 
available  by  member  Plans  no  later  than  April  1, 
1969.  There  was  no  implication  that  all  Plans,  na- 
tional or  local,  will  or  should  incorporate  all  the 


Important  Points  to  Speed  Claims 

1.  Correct  Certificate  number  as  shown  on  the 
member’s  Blue  Shield  Identification  Card. 

2.  Report  services  under  only  one  Blue  Shield 
Certificate  Number. 

3.  Correct  spelling  of  patient’s  and  subscriber’s 
names. 

4.  Correct  age  of  the  patient. 

5.  Designate  place  of  service  (hospital  inpatient, 
hospital  outpatient,  office,  home). 

6.  Include  dates  of  service  including  date  of  ad- 
mission and  discharge  from  the  hospital;  date 
surgery  was  performed,  if  any;  and  number  of 
daily  hospital  visits  if  for  medical  care. 

7.  Indicate  if  injury  occurred  at  patient’s  place  of 
employment. 

8.  Give  details  as  to  diagnosis,  correct  name  of 
operation,  if  any,  and  sufficient  descriptions, 
for  example; 

Vein  Ligations:  Stripping,  multiple  resec- 

tions, both  greater  and 
lesser  saphenous,  unilater- 
al or  bilateral. 

Lacerations:  Location,  length,  depth 

and  identify  vessels,  mus- 
cles, and  tendons  repaired, 
if  any. 

9.  Check  only  the  type  of  service  you  personally 
rendered  indicating  date(s)  and  description  of 
the  service(s). 

10.  Indicate  your  fee  for  each  service  you  report 
and  indicate  whether  the  fee  has  been  paid 
by  the  patient. 

11.  Personal  signature  of  the  Physician. 

(continued) 

benefits  listed  nor  that  the  availability  of  compre- 
hensive scope  of  benefits  will  necessarily  alter  a 
Plan’s  coverage. 

The  National  Association  urged  Plan  members  to 
develop  guidelines  promptly  to  assure  compatibility 
of  benefits  from  Plan  to  Plan  in  an  effort  to  coor- 
dinate benefits  offered  by  the  numerous  Blue  Shield 
Plans  throughout  the  country. 

We  will  be  happy  to  discuss  this  matter  with  you 
at  your  Medical  Society  meetings,  staff  meetings,  or 
answer  questions  you  may  have  relating  to  our 
existing  programs  or  future  plans  being  developed 
to  serve  the  best  interests  of  the  public  and  the 
profession. 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 


• • • ABOUT  MEDICARE 

Q What  is  “durable  medical  equipment”? 

A Durable  medical  equipment  is  defined  by  the 
Soc.  Sec.  Adm.  as  “that  equipment  which  (1)  can 
withstand  repeated  use  and  (2)  is  primarily  and 
customarily  used  to  serve  a medical  purpose,  and 
(3)  generally  is  not  useful  to  a person  in  the  absence 
of  illness  or  injury.” 

This  category  includes  such  items  as  wheel  chairs, 
hospital  beds,  inhalators,  iron  lungs,  commodes,  and 
suction  machines. 

Q When  is  the  cost  of  “durable  medical  equip- 
ment” covered  for  my  patient? 

A Medicare  will  pay  the  rental  charges  of  such 
equipment  (1)  when  it  meets  the  definition  of  dur- 
able medical  equipment  and  (2)  when  the  equip- 
ment is  necessary  for  the  treatment  of  an  illness  or 
injury. 

When  a claim  for  such  equipment  is  submitted 
by  a patient,  it  must  be  accompanied  by  a statement 
from  the  attending  physician  giving  the  diagnosis 
and  stating  that  the  equipment  is  medically  neces- 
sary for  the  treatment  of  the  patient. 

Q Why  must  specific  dates  of  service  be  included 
on  an  itemized  statement? 

A Specific  dates  are  necessary  to  determine  the 
$50  deductible  and  to  apply  the  allowable  amounts 
to  carry-over  to  the  following  year.  Also  the  dates 
are  used  to  avoid  duplicate  payments  or  disallow- 
ing legitimate  claims.  For  example,  a beneficiary 
may  be  hospitalized  in  June  for  a period  of  10 
days  and  have  a Medicare  claim  submitted  for 
medical  visits.  The  same  beneficiary  may  again  be 
hospitalized  in  November  for  a period  of  10  days. 
An  identical  medical  claim  would  be  submitted 
without  dates  of  service.  The  November  claim  may 
be  judged  to  be  a duplicate  of  the  claim  submitted 
in  June  and  payment  would  be  disallowed. 

Q When  two  physicians  perform  services  simul- 
taneously for  the  same  patient,  must  each  bill  sepa- 
rately? 

A Yes.  In  order  to  pay  the  claim,  we  must  know 
the  specific  service  rendered  by  each  physician,  the 
date  of  service  and  the  charge  for  each  service. 

Q How  do  I file  for  Medicare  and  Public  Aid 
benefits  simultaneously? 

A To  file  for  both  Medicare  and  Public  Aid 
benefits,  two  copies  of  the  SSA  form  1490  must  be 
prepared.  In  block  5 enter  the  patients  Public  Aid 
number.  Send  one  copy  to  the  Medicare  carrier  and 
the  other  copy  to  the  Department  of  Public  Aid, 
Medical  Unit,  1305  Outer  Park  Drive,  Springfield, 
Illinois  62701.  When  Medicare  payment  is  made,  a 
copy  of  the  Explanation  of  Benefits  form  will  be 
sent  to  the  Department  of  Public  Aid  for  their 
further  payment. 


Submit  1967  Medicare  ^ 
Claims  Now 

The  time  is  fast  approaching  when  claims  for 
services  prior  to  October  1,  1967  will  no  longer  be 
allowed.  Any  claim  for  services  prior  to  this  date 
must  be  filed  on  or  before  December  31,  1968. 

The  time  limits  established  by  the  Social  Secur- 
ity Administration  for  submitting  claims  for  pay- 
ment are  as  follows: 

Claims  for  services  provided  from  October  1, 

1966  through  September  30,  1967  must  be  sub- 
mitted by  December  31,  1968. 

Claims  for  services  provided  from  October  1, 

1967  through  September  30,  1968  must  be  submitted 
by  December  31,  1969. 

This  process  continues  in  such  a manner  that 
claims  for  services  rendered  prior  to  October  1st  of 
one  year  must  be  filed  by  December  31st  of  the 
following  year. 

The  cut-off  date  for  claims  in  the  first  nine 
months  of  1967  is  drawing  near  therefore,  we  rec- 
ommend that  such  claims  be  submitted  for  payment 
to  the  Medicare  office  as  soon  as  possible. 


Part  B $50  Deductible  Carry-Over 

Any  covered  Part  B Medicare  expenses  incurred 
in  the  months  of  October,  November,  and  Decem- 
ber which  are  applied  toward  the  $50  deductible 
for  that  year  will  also  be  applied  toward  the  de- 
ductible for  the  following  year.  Thus  if  Mr.  X 
incurs  no  medical  expenses  for  the  year  1968  until 
the  month  of  October  and  then  has  covered  ex- 
penses of  $50  during  the  next  three  months,  these 
expenses  will  satisfy  the  deductible  for  1968  and 
for  1969.  As  another  example,  the  beneficiary  may 
incur  expenses  of  $20  prior  to  October  and  another 
$30  in  November  and  December.  The  $30  will  be 
applied  toward  the  1969  deductible  as  well  as  the 
remaining  1968  deductible. 

The  “carry-over”  rule  has  been  established  to 
help  the  beneficiary  who  might  otherwise  have  to 
meet  the  $50  deductible  twice  in  a comparatively 
short  period. 


NOTICE 

To  help  speed  Medicare  payments,  physicians 
in  the  counties  of  Cook,  DuPage,  Kane,  Lake 
and  Will  may  obtain  a supply  of  SSA  1490  Re-  ( 
quest  for  Payment  forms  with  their  name  im- 
printed on  them  by  writing  to  Government  Con- 
tracts Division,  Blue  Cross-Blue  Shield,  300 
North  State  Street,  Chicago,  Illinois  60690. 


(This  is  not  an  advertisement) 


That’s  why  Abbott  offers 
you  a pill  plus  a program. 


The  Product 


For  smooth  appetite 
control  plus  mood 
elevation 


DESOXYKGradumet 

Methamphetamine  Hydrochloride 
in  Long-Release  Dose  Form 


5 mg.  10  mg.  15  mg. 


For  patients  who  can’t  DESBUTAL  10  Gradumet 

take  plain  amphetamine  10  mg.  Methamphetamine  Hydrochloride, 

60  mg.  Sodium  Pentobarbital 


FRONT  SIDE 


DESBUTAL  15  Gradumet 

15  mg.  Methamphetamine  Hydrochloride, 

90  mg.  Sodium  Pentobarbital 


FRONT  SIDE 


The  Program 


Weisht  Control  Booklet  Spedfically  written  to  help  your  patients  under- 
^ Stand  why  they  are  overweight,  and  what  they  can 

do  about  it.  The  booklet  stresses  the  importance  of 
changing  lifelong  eating  habits  and  explains  how  this 
can  be  done,  sensibly,  comfortably — and  perma- 
nently. There  is,  also,  a comprehensive  list  of  foods 
showing  their  caloric  content. 


thf 


vnntrotilnff 


Food  Diary 


Designed  to  help  the  overweight  patient  follow 
your  eating  instructions.  Space  is  provided  for 
breakfast,  lunch,  supper,  and  even  snacks.  By  writ- 
ing down  everything  that’s  eaten  each  day,  the 
patient  is  constantly  reminded  that  she’s  trying  to 
change  her  eating  habits.  And  you  are  furnished 
with  a written  record  of  how  well  she’s  doing. 


Picture  Menu  Booklet 


Please  see  Brief  Summary 
on  next  page. 


A large  (10"  x 10")  booklet  which  features  appetiz- 
ing lunch  and  dinner  menus  for  every  day  of  the 
week.  The  meals  are  depicted  in  full  color  and  the 
correct  portion  size  so  that  the  dieter  can  see  the 
amount  of  food  that’s  recommended.  Patients  are 
pleasantly  surprised  to  learn  that  each  day’s  meals 
add  up  to  only  1,000  calories.  aoi444 


Ask  Your  Abbott  Man  For  Free  Supplies 


i 

Lr#-;?' 


Brief  Summary 
DESOXYN®Gradumet® 

Methamphetamine  Hydrochloride 
in  Long-Release  Dose  Form 

DESBUTAI!  10  Gradumet 

10  mg.  Methamphetamine  Hydrochloride, 

60  mg.  Sodium  Pentobarbital 

DESBUTAL  15  Gradumet 

15  mg.  Methamphetamine  Hydrochloride, 

90  mg.  Sodium  Pentobarbital 

Indications:  Desoxyn  and  Desbutal 
are  used  orally  as  appetite  suppres- 
sants, for  reduction  of  mild  mental 
depression,  and  to  help  in  manage- 
ment of  psychosomatic  complaints 
or  neuroses.  Desoxyn,  when  ad- 
ministered parenterally,  may  be 
used  as  a vasopressor  agent  or  ana- 
leptic. 

Contraindications : Methampheta- 
mine (in  Desoxyn  and  Desbutal) 
is  contraindicated  in  patients  tak- 
ing a monoamine  oxidase  inhibitor. 
Do  not  use  pentobarbital  (in 
Desbutal)  in  persons  hypersensi- 
tive to  barbiturates. 

Precautions,  Side  Effects:  Observe 
caution  in  patients  with  hyperten- 
sion, cardiovascular  disease,  hyper- 
thyroidism, old  age,  or  those 
sensitive  to  sympathomimetic 
drugs.  Prolonged  usage  may  lead 
to  tolerance  or  psychic  dependence. 
Careful  supervision  is  necessary  to 
avoid  chronic  intoxication  and 
drug  dependence. 

Amphetamine  side  effects  such 
as  headache,  excitement,  agitation, 
palpitation  or  cardiac  arrhythmia 
usually  may  be  controlled  by  re- 
ducing the  dose.  Paradoxically- 
induced  depression  is  an  indication 
to  withdraw  the  drug.  Pentobarbi- 
tal (in  Desbutal)  may  cause  skin 
rash.  Nervousness  or  ex- 
cessive sedation  with 
Desbutal  is  often  transient. 


NEW 

PHARMACEUTICAL 
SPECIALTIES 
by  Paul  deHaen 


For  detailed  information  regarding  indications, 
dosage,  contraindications,  and  adverse  reactions, 
refer  to  the  manufacturers’  package  insert  or 
brochure. 

Single  Chemicals — Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products — Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products — Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms — Of  a previously  introduced 
product. 

DUPLICATE  SINGLE  PRODUCTS 

FLUONID  Corticoid-Local  R 

Manufacturer:  Derm-Arts  Laboratories  (Div. 

Marion  Labs.) 

Nonproprietary  Name:  Fluocinolone  acetonide 
Indications:  Adjunctive  treatment  of  acute  and 
chronic  dermatoses. 

Contraindications:  Tuberculous,  fungal,  and 

most  viral  infections  of  the  skin;  hypersensi- 
tivity to  it;  not  for  ophthalmic  use. 

Dosage:  Apply  locally,  two  or  three  times  daily 
as  needed. 

Supplied:  Cream — 0.01%  and  0.025%)  tubes  of  15 

Ointment — 0.025%  ) and  60  gm. 

Solution — 0.01%,  bottles  of  20  60cc. 

Histoplasmin  Tine  Test  Diagnostic-Dermal  R 
Manufacturer:  Lederle  Laboratories 
Nonproprietary  Name:  Histoplasmin 
Indications:  Diagnostic  test  for  histoplasmosis. 
Contraindications:  None  mentioned. 

Dosage:  One  application  on  forearm. 

Supplied:  Individual  test  units,  sterile. 

PROSERUM  5 Hospital  Solution  R 

Manufacturer:  Pitman-Moore 
Nonproprietary  Name:  Albumin,  Normal  Serum 
(Human) 

Indications:  Emergency  treatment  of  hypovo- 
lemic shock. 

Contraindications:  None  mentioned. 

Dosage:  To  be  determined  individually. 
Supplied:  Vials-250  cc.  (5%  sol.) 

COMBINATION  PRODUCTS 

BLUBORO  Dermatologic  Prep.-Other  o-t-c 

Manufacturer:  Derm-Arts  Laboratories  (Div. 

Marion  Labs.) 

Composition:  Aluminum  sulfate 
Calcium  acetate 
Boric  acid 
FD&C  Blue  #1 

Indications:  Relief  of  inflammed,  ozing,  and 
itching  conditions  of  the  skin. 
Contraindications:  None  mentioned. 

Dosage:  Dissolve  in  water  and  apply  as  wet 
dressing. 

Supplied:  Powder-dual  packets,  cartons  of  12 
and  100. 

(Continued  on  page  611) 


801444 


()06 


Jllinois  Aledical  Journal 


New  Pharmaceutical  Specialties 

(Continued  from  page  606) 

FLUONID-N  Corticoid-Local 
Manufacturer:  Derm-Arts  Laboratories  (Div. 
Marion  Labs.) 

Composition:  Fluocinolone  acetonide  0.025% 
Neomycin  sulfate  0.5% 

Indications:  Adjunctive  treatment  of  acute  and 
chronic  dermatoses  in  the  presence  of  infection 
susceptible  to  neomycin. 

Contraindications:  Tuberculous,  fungal,  and  most 
viral  infections  of  the  skin;  hypersensitivity 
to  any  of  the  ingredients;  not  for  ophthalmic 
use. 

Dosage:  Apply  locally,  two  or  three  times  daily 
as  needed. 

Supplied:  Cream-tubes  of  15  and  60  gm. 
HISTASPAN-D  Nasal  Decongestant 
Manufacturer:  USV  Pharmaceuticals 
Composition:  Chlorpheniramine  maleate  8 mg. 
Phenylephrine  HCl  20  mg. 

Methscopolamine  nitrate  2.5  mg. 

Indications:  Symptomatic  relief  of  common  cold, 
sinusitis,  hay  fever,  and  other  allergic  condi- 
tions. 

Contraindications:  Hypersensitivity  to  any  of  the 
ingredients,  glaucoma,  paralytic  ileus,  pyloric 
obstruction,  prostatic  hypertrophy. 

Dosage:  One  capsule  q.l2h. 

Supplied:  Capsules,  sustained  release-bottles  of 

100. 

RONDEC-C  Nasal  Decongestant 
Manufacturer:  Ross  Laboratories 
Composition:  Carbinoxamine  maleate  2.5  mg. 

Pseudoephedrine  (equiv.  to  the  HCl)  60  mg. 
Indications:  Adjunctive  therapy  in  upper  and 
lower  respiratory  tract  disorders  of  allergic, 
infectious  or  non-specific  etiology. 
Contraindications:  None  known. 

Dosage:  Children:  half  to  one  tablet  q.i.d. 

Adults:  one  tablet  q.i.d. 

Supplied:  Chewable  Tablets-bottles  of  100. 

NEW  DOSAGE  FORMS 

RONDEC-D  Nasal  Decongestant  R 

Manufacturer:  Ross  Laboratories 
Composition:  Each  1 cc.  contains 
Carbinoxamine  maleate  1 mg. 
Pseudoephedrine  HCl  30  mg. 

Indications:  Adjunctive  therapy  in  upper  and 
lower  respiratory  tract  disorders  of  allergic, 
infectious  or  nonspecific  etiology. 
Contraindications:  None  known. 

Dosage:  Infants:  0.25  to  1 cc.  q.i.d. 

Supplied:  Oral  Drops-bottles  of  20cc. 
RONDEC-S  Nasal  Decongestant  R 

Manufacturer:  Ross  Laboratories 
Composition:  Each  5cc  contains: 

Carbinoxamine  maleate  2.5  mg. 
Pseudoephedrine  HCl  60  mg. 

Indications:  Adjimctive  therapy  in  upper  and 
lower  respiratory  tract  disorders  of  allergic,  in- 
fectious or  non-specific  etiology. 
Contraindications:  None  known. 

Dosage:  Half  to  one  teaspoon  q.  i.  d. 

Supplied:  Syrup-bottles  of  16  fl.  oz. 


Everybody  has  limitations,  but  what 
really  counts  are  the  abilities  that  re- 
main  Dr.  Clarence  D.  Selby,  first 

medical  director  of  General  Motors 
Corporation. 


Just  one  tablet  at  bedtime  • Prevents  pain- 
ful night  leg  cramps  • Permits  restful  sleep 

How  many  of  your  patients  stamp  their  feet  at  night 
and  lose  sleep  because  of  painful  leg  cramps?  Un- 
less prompted,  they  usually  fail  to  report  this  dis- 
tressing condition  and  suffer  needlessly. 

One  tablet  of  QUINAMM  at  bedtime  usually  con- 
trols distressing  night  cramps  and  permits  restful 
sleep  with  the  initial  dose. 

F.'escribing  information— Composition:  Each  white,  beveled, 
compressed  tablet  contains:  Quinine  sulfate,  260  mg.,  Amino- 
phylline,  195  mg.  Indications:  For  the  prevention  and  treat- 
ment of  nocturnal  and  recumbency  leg  muscle  cramps,  in- 
cluding those  associated  with  arthritis,  diabetes,  varicose 
veins,  thrombophlebitis,  arteriosclerosis  and  static  foot  de- 
formities. Contraindications:  QUINAMM  is  contraindicated  in 
pregnancy  because  of  its  quinine  content.  Side  Effects/ 
Precautions:  Aminophylline  may  produce  intestinal  cramps 
in  some  instances,  and  quinine  may  produce  symptoms  of 
cinchonism,  such  as  tinnitus,  dizziness,  and  gastrointestinal 
disturbance.  Discontinue  use  if  ringing  in  the  ears,  deafness, 
skin  rash,  or  visual  disturbances  occur.  Dosage:  One  tablet 
upon  retiring.  Where  necessary,  dosage  may  be  increased  to 
one  tablet  following  the  evening  meal  and  one  tablet  upon 
retiring.  Supplied:  Bottles  of  100  and  500  tablets. 

THE  NATIONAL  DRUG  COMPANY 

DIVISION  OF  RICHARDSON  MERRELL  INC. 

PHILADELPHIA,  PENNSYLVANIA  19144 


1 


for  November,  1968 


611 


THE  BETTMANN  ARCHIVE 


by  two  independent  national  research  organizations 


Finally.. .a  salicylate 
superior  to  aspirin? 

Not  at  ali,  Doctor...but 

nnagan 

(magnesium  salicylate, W-T 

should  be  considered  for  your  arthritic 

and  rheumatic  patients  who  cannot  tolerate  aspirin. 

Surveys ""  made  in  1 966  and  1 967  among  private  practice 
physicians  showed  an  incidence  of  intolerance  to  aspirin 
ranging  from  3-85%.  The  majority  of  physicians  surveyed 
reported  an  intolerance  in  1 0-30%  of  their  patients. 

How  does  this  compare  with  your  experience? 


■« 


WARREN-TEED  PHARMACEUTICALS  INCORPORATED 

COLUMBUS,  OHIO  43215 

SUBSIOIARY  OF  ROHM  AND  HAAS  COMPANY 


T 


“The  inconvenience  of  a cold” 


For  a cold?  NTz®  Nasal  Spray  provides  rapid  relief  of 
nasal  symptoms.  Relief  starts  with  the  first  spray  which 
opens  the  inferior  part  of  the  common  meatus.  A second 
spray,  a few  minutes  later,  will  shrink  the  turbinates  to 
help  provide  sinus  drainage  and  ventilation.  Dosage 
may  be  repeated  every  three  or  four  hours  as  needed, 
Ifor  temporary  relief  of  symptoms.  nTz  is  well  tolerated 
but  overdosage  should  be  avoided. 

As  a sinusitis  deterrent,  NTz  Nasal  Spray  can  be  used  to 
keep  the  nasal  passages  open  during  a cold  to  help  pre- 
vent development  of  acute  sinusitis -or  to  help  prevent 
the  acute  condition  from  becoming  chronic. 


Supplied:  NTz  Nasal  Spray,  plastic  squeeze  bottles  of 
20  ml.;  NTz  Nasal  Solution,  bottles  of  30  ml.  (1  fl.  oz.) 
with  dropper. 


nTz  is  more  than  a simple  vasoconstrictor. 

Neo-Synephrine®  (brand  of  phenylephrine) 
HCI  0.5  per  cent,  the  major  component, 
virtually  synonymous  with  fast,  efficient 
but  gentle  nasal  vasoconstriction. 
Thenfadil®  (brand  of  thenyidiamine)  HCI 
0.1  per  cent,  topical  antihistamine  for 
reduction  of  rhinorrhea,  sneezing  or 
itching.  It  combats  the  allergic  reac- 
tions that  may  occur  in  colds  or  sinusitis 
Zephiran®  (brand  of  benzalkonium,  as 
chloride,  refined)  1 :5000,  antiseptic 
preservative  and  wetting  agent  to 
promote  penetration  and  spread  of 
the  formula. 


It  contains 


Winthrop  Laboratories,  New  York,  N.  Y.  10016 


Cause  of 

Bacterial  Flair-up 
Into  Tuberculosis  Study 


Most  types  of  mycobacteria  are  common 
and  harmless.  They  may  be  found  on 
leaves,  in  hay  and  in  tapwater,  for  example. 
However,  a few  types  cause  serious  disease 
such  as  tuberculosis. 

There  is  growing  evidence  that  under 
certain  conditions  even  harmless  myco- 
bacteria can  become  harmful  (virulent) 
causing  benign  cases  of  lymph  node  tuber- 
culosis or  tuberculosis  of  other  organs. 

Stephen  E,  Juhasz,  M.D.,  associate  pro- 
fessor of  microbiology  at  Loyola  Univer- 
sity Stritch  School  of  Medicine,  will  be 
studying  the  origin  of  the  virulence  with 
the  support  of  a $5,980  grant  from  the 


Tuberculosis  Institute  of  Chicago  and 
Cook  County, 

Dr.  Juhasz  strongly  suspects  that  a virus 
comes  into  play  to  convert  the  mycobacter- 
ia from  harmless  to  harmful  organism. 

“It’s  not  a simple  mutation  as  once 
thought,”  he  said.  “I  believe  the  virus  be- 
comes part  of  the  bacterial  genetic  mater- 
ial, endowing  it  with  virulence.” 

Dr.  Juhasz  notes  that  the  same  principle 
is  involved  in  diphtheria.  Viral  infection 
of  the  bacillus  is  necessary  for  diphtheria 
to  flare.  Stop  the  virus  and  the  bacilli  will 
not  cause  disease. 


22nd  Sltnlcal  Convention 


^ecemlret  !-4,  1968  o Convention  4jall 


. . . the  American  "Riviera."  Where  glittering  luxury  hotels 
tower  above  glamorous  Collins  Avenue;  and  medicine,  sea  and 
sunshine  mix  in  a delightful  subtropical  setting. 

Register  now,  and  be  on  hand  for  the  world's  largest  winter 
medical  meeting— the  AMA's  22nd  Clinical  Convention.  At  this 
midwinter  "summer"  session  in  medicine  there  will  be  Three 
Postgraduate  Courses:  Fluid  and  Electrolyte  Balance,  Diabetes, 
and  Hyperthyroidism  in  the  Elderly  Patient  • 17  Scientific 
Sessions  • Breakfast  Roundtable  Conferences  • Color  Tele- 
vision • and  Medical  Motion  Pictures.  The  modern,  air-condi- 
tioned Convention  Hall  will  house  hundreds  of  scientific  and 
industrial  exhibits  to  show  you  the  very  latest  in  equipment, 
services  and  drugs. 

Plan  now  to  join  your  colleagues  in  Miami  Beach.  Be  sure 
to  look  for  the  complete  scientific  program,  plus  forms  for 
advance  registration  and  hotel  accommodations  in  the  October 
21st  issue  of  JAMA. 


ON  THE  COVER 

The  autumn  scene  depicted  on  this  month's  cover  may  be  found  a short  distance 
southwest  of  Chicago.  The  Old  Graue  Mill  in  Oakbrook  is  the  last  operating  waterwheel 
gristmill  in  Illinois. 

Surrounding  the  old  village  of  Brush  Hill  (known  today  as  Hinsdale),  virgin  farmland 
produced  bounteous  crops  of  grain  in  the  early  Illinois  years.  These  were  taken  to  this 
indispensable  unit  of  the  economy,  the  mill.  Built  in  1847-52,  the  mill  stands  on  the 
site  formerly  occupied  by  a lumber  mill  destroyed  in  1846. 

One  may  visualize  miller  Graue  on  a long  ago  day  showing  off  his  fine  mill  to  a 
rising  young  politician  from  down  Springfield  way,  who  had  dropped  in  at  the 
neighboring  Castle  Inn  to  pass  the  time  of  day,  and  perhaps  discuss  the  burning  ques- 
tion of  slavery.  For  the  German  miller,  who  had  sought  freedom  in  the  New  World, 
had  established  in  the  cellar  of  the  mill  one  of  the  few  authenticated  Underground 
Railway  stations  in  Illinois. 

But  this  is  all  of  times  past.  We  are  reminded  by  the  serenity  and  tranquility  of  the 
scene,  by  the  antiquated  equipment  and  quaint  implements,  of  the  good  life  we  presently 
have.  We  are  made  aware  of  the  tremendous  progress  which  has  been  made  in  all 
of  man's  endeavors.  We  especially  should  feel  humble  and  grateful  for  the  many 
goodnesses  experienced  today. 


618 


Illinois  Medical  Journal 


president’s  page 


A Medical  School 
For  Southern  Illinois 

“What  about  a medical  school  for 
Southern  Illinois?” 

This  was  a pressing  question  among 
physicians— and  other  citizens— as  we  car- 
ried the  ISMS  President’s  Tour  ’68  into 
that  part  of  the  state. 

And  I have  tried  my  best  to  answer  it— 
although  ISMS  has  taken  no  official  posi- 
tion on  the  location  of  a next  medical 
school. 

Southern  Illinois  doctors  are  not  express- 
ing a “gimme”  attitude  in  seeking  “a  piece 
of  the  action”  for  their  area.  Their  posi- 
tion is  selfless,  earnest  and  idealistic,  be- 
cause it  boils  down  to  these  two  points: 

1.  The  31  southernmost  counties  gen- 
erally are  hardest-hit  by  the  state’s  M.D. 
shortage. 

2.  Medical  training  facilities  in  that 
area  would  encourage  graduates  to  prac- 
tice there. 

No  one  can  deny  these  points  . . . and 
I have  said  so. 

The  various  suggestions  offered  for  a 
med  school  in  Southern  Illinois  deserve 
every  consideration— from  us,  from  our 
state  government  and  from  all  Illinoisans 
. . . and  I have  said  so. 

Southern  Illinois  University  has  offered 
a proposal  for  a regional  medical  training 
program,  which  would  use  its  educational 
facilities  and  Springfield  clinics.  And  in 
Carbondale,  I described  that  proposal  as 
thoughtful  and  inspired. 

Firm,  solid  action  must  be  taken  to  re- 
lieve the  medical  pinch  in  the  31  southern- 
most counties.  They  have  only  one  prac- 
ticing physician  per  1,450  inhabitants,  ac- 


Philip G.  Thomsen,  M.D. 

cording  to  a recent  estimate.  Statewide  the 
number  of  doctors  per  capita  is  almost 
twice  as  high. 

We  are  told  that  in  Johnson  County 
there  were  only  two  doctors,  and  both  have 
moved  away.  That  means  7,000  people 
without  a local  physician.  Pulaski  County, 
according  to  our  figures,  is  the  next  hard- 
est-hit, with  only  one  doctor  per  5,200 
people. 

Unless  there  is  one  doctor  per  1,500 
people,  the  public  health  is  jeopardized. 
That’s  what  the  War  Manpower  Commis- 
sion ruled  in  World  War  II. 

Trained  in  big  cities,  Illinois  doctors 
have  gravitated  to  metropolitan  areas.  But 
many  new  M.D.’s  would  want  to  practice 
in  our  state’s  agricultural  heartland  if  they 
could  be  trained  in  it  ...  if  they  could  ab- 
sorb its  way  of  life,  its  needs  and  wants. 

In  our  membership  survey  of  last  Aug- 
ust, we  did  not  ask  you  where  you  wanted 
the  proposed  sixth  med  school  for  Illinois. 
We  did  not  ask  questions  that  could  be 
construed  as  sectional  in  focus.  However, 
there  is  no  reason  why  we  cannot  ponder 
this  problem— wisely  and  sympathetically. 
And  in  doing  so,  let  us  not  think  locally— 
but  as  Illinoisans  and  as  members  of  a 
statewide  medical  society. 

(Ed.  note:  after  this  writing  Johnson  County  gained 
a physician.) 

A 


for  November,  1968 


621 


Cancer  in  Pregnancy 

A Northwestern  University  physician  has 
reported  studies  of  therapy  using  only 
drugs  that  dramatically  reversed  death 
rates  in  pregnant  women  suffering  from 
a rare  form  of  cancer. 

John  Brewer,  M.D.,  professor  of  obstet- 
rics and  gynecology.  Northwestern  Univer- 
sity, presented  the  results  of  his  treatment 
technique  for  choriocarcinoma,  cancer  of 
the  placenta,  at  the  sixth  National  Can- 
cer Conference  held  in  Denver  and  spon- 
sored by  the  American  Cancer  Society. 

Standard  treatment  for  cancer  general- 
ly involves  the  use  of  surgery,  radiation  or 
drugs,  or  a combination  of  each.  However, 
Dr.  Brewer  reported  that  the  administration 
of  the  drugs  alone,  such  as  methotrexate 
and  actinomycin-D,  caused  remission  of  the 
cancer  and  saved  the  lives  of  75  women 
out  of  the  85  treated. 

Before  the  development  of  this  chem- 
otherapy at  both  Dr.  Brewer's  laboratory 
and  the  National  Cancer  Institute,  the  dis- 
ease (which  could  only  be  treated  surgi- 
cally) killed  as  many  as  85  per  cent  of  the 
women  who  contracted  it. 

Dr.  Brewer  followed  the  75  survivors  in 
a study  lasting  almost  two-and-a-half 
years,  and  found  that  almost  all  had  no 
ill  effects.  A number  of  them  were  able  to 
have  children  again  following  the  drug 
treatment. 

The  only  other  form  of  cancer  which  ap- 
pears to  respond  to  a "drugs-only  therapy" 
is  Burkitt's  lymphoma,  a cancer  frequently 
Involving  the  facial  bones. 

Past  national  death  rates  from  chor- 
iocarcinoma, using  the  surgery-only  treat- 
ment, were  as  high  as  81  to  86%.  Chor- 
iocarcinoma occurs  in  only  one  of  20,000 
full-term  pregnancies. 

Future  research  by  Dr.  Brewer  will  cen- 
ter on  possible  genetic  causes,  stemming 
from  broken  chromosomes  in  placental 
cells,  of  choriocarcinoma. 


The  striking  change  that  has  taken 
place  in  America  in  our  methods  of 
earning  a living,  and  the  changes  that 
are  in  prospect  for  the  future,  greatly 
improve  our  opportunities  for  utilizing 
the  skills  of  the  handicapped.  There 
are  more  and  more  jobs  to  be  filled, 
and  there  are  fewer  and  fewer  of 
them  which  require  the  physical  dex- 
terity which  a handicapped  person 
may  not  have.  . . . W.  P.  Gullander, 
president.  National  Association  of 
Manufacturers. 


ACHROMYCIN*  V 

TETRACYCLINE 

Contraindications:  Hypersensitivity 
to  tetracycline. 

Warning:  In  renal  impairment,  since 
liver  toxicity  is  possible,  lower 
doses  are  indicated;  during  pro- 
longed therapy  consider  serum 
level  determinations.  Photody- 
namic reaction  to  sunlight  may 
occur  in  hypersensitive  persons. 
Photosensitive  individuals  should 
avoid  exposure;  discontinue  treat- 
ment if  skin  discomfort  occurs. 

Precautions:  Nonsusceptible  organ- 
isms may  overgrow;  treat  superin- 
fection appropriately.  Tetracycline 
may  form  a stable  calcium  com- 
plex in  bone-forming  tissue  and 
may  cause  dental  staining  during 
tooth  development  (last  half  of 
pregnancy,  neonatal  period,  in- 
fancy, early  childhood). 

Side  Effects:  Gastrointestinal— 
anorexia,  nausea,  vomiting,  diar- 
rhea, stomatitis,  glossitis,  entero- 
colitis, pruritus  ani.  S/c/n— maculo- 
papular  and  erythematous  rashes; 
exfoliative  dermatitis;  photosensi- 
tivity; onycholysis,  nail  discolora- 
tion. /(/dney— dose-related  rise  in 
BUN.  Hypersensitivity  reactions— 
urticaria,  angioneurotic  edema, 
anaphylaxis,  /nfracran/a/— bulging 
fontanels  in  young  infants.  Teeth— 
yellow-brown  staining;  enamel  hy- 
poplasia. B/ood— anemia,  thrombo- 
cytopenic purpura,  neutropenia, 
eosinophilia.  /./Ver— cholestasis  at 
high  dosage. 

Upon  adverse  reaction,  stop  medi- 
cation and  treat  appropriately. 


LEDERLE  LABORATORIES 

A Division  of 

American  Cyanamid  Company 
Pearl  River,  New  York  10965 

359-8 


622 


Illinois  Medical  Journal 


Illinois  Medical  Journal 


volume  134,  number  5 


November,  1968 


The  Role  of  the 
Physician 

More  children  are  smoking  cigarettes^ 
and  at  an  earlier  age,  than  ever  before. 

There  appears  to  he  a definite  relation- 
ship between  the  smoking  of  cigarettes  and 
the  later  development  of  lung  and  cardio- 
vascular diseases. 

Parental  smoking  behavior  may  have  an 
influence  on  the  smoking  patterns  of  chil- 
dren. 

The  educational  methods  used  to  discour- 
age smoking  in  school  children  are  discuss- 
ed. 

Physicians  should  assume  an  active  role 
in  the  fight  against  smoking  in  children. 

Extraordinary  progress  has  been  made 
during  the  past  thirty  years  in  reducing 
the  mortality  rate  of  many  of  the  diseases 
in  infancy  and  childhood.  These  changes 
have  been  the  result  of  a combination  of 
various  factors:  (1)  The  introduction  of 

chemotherapeutic  drugs  and  antibiotic 
agents.  (2)  New  and  more  effective  immun- 
ization procedures.  (3)  A clearer  under- 
standing of  the  chemical  balance  of  the 
body.  (4)  Advances  in  surgical  techniques 
and  pediatric  anesthesiology.  (5)  Further 
advances  in  the  treatment  of  the  diseases 
caused  by  endocrine,  genetic  and  enzymatic 
disorders. 


Daniel  J.  Pachman,  M.D.,  is  Clinical  Professor 
of  Pediatrics,  the  University  of  Illinois  College  of 
Medicine,  Chairman,  Department  of  Pediatrics,  Illi- 
nois Central  Hospital,  and  is  Associate  Attending 
Pediatrician,  Presbyterian-St.  Lukes  Hospital.  He 
is  president  elect  of  the  Illinois  Chapter,  American 
Academy  of  Pediatrics,  and  is  a member  of  the 
Public  Education  Committee,  the  Illinois  Division, 
American  Cancer  Society.  Dr.  Pachman  has  pub- 
lished extensively  in  the  field  of  pediatrics  and 
serves  in  numerous  capacities  in  the  cause  of  child 
care. 


The  Fight 

Against  Smoking 
In  Children 

By  Daniel  J.  Pachman,  M.D. /Chicago 

Admirable  as  the  overall  record  appears 
to  be,  there  are  still  a number  of  impor- 
tant pediatric  health  problems  in  this 
country  which  remain  unsolved.  Facilities 
and  competent  personnel  for  the  care  and 
treatment  of  behavior,  emotional  and  men- 
tal disorders  in  children,  are  grossly  in- 
adequate. Accidents  continue  to  be  the 
foremost  cause  of  death  in  children  be- 
tween one  and  fifteen  years  of  age.^  Fatal 
accidents  in  the  first  years  of  life  have  ac- 
tually been  on  the  increase  since  1960.^ 
The  infant  mortality  rate  (deaths  from  all 
causes  under  one  year  of  age),  a figure 
which  is  often  used  as  an  index  of  the  na- 
tion’s health,  has  remained  almost  station- 
ary during  the  ten  year  period  from  1956- 
65.^  Drug  addiction  and  venereal  disease 
in  the  teen-ager  has  risen  sharply  during 
the  past  ten  years.  Gonorrhea  has  increased 
over  50%  and  syphilis  has  quadrupled  in 
this  age  group.^  As  would  be  expected, 
congenital  syphilis  has  increased  markedly 
during  the  past  few  years. ^ 

Cancer,  a disease  which  takes  a heavy 
toll  in  adult  life,  has  now  become  the  sec- 
ond most  frequent  cause  of  death  in  young 
children.®  The  leukemia-lymphoma  group, 
and  tumors  of  the  brain  and  central  ner- 
vous system  account  for  almost  two-thirds 
of  the  fatalities  caused  by  childhood 
neoplasms.  Though  there  are  types  of  can- 


for  November,  1968 


625 


INCIDENCE  OF  SMOKING 
IN  SCHOOL  CHILDREN 


4th,  5th,  6th 
GRADES 


?REG^  8% 


HAVE  SMOKED 


53% 


9th  GRADE 


SREGULAR? 


23% 


HAVE  SMOKED 


68% 


lOth  GRADE 


31.4% 


HAVE  SMOKED 


68% 


^regularI 


36% 


11th  GRADE 


HAVE  SMOKED 


69% 


12th  GRADE 


HAVE  SMOKED 


77% 


Fig.  1.  Source:  Survey  Conducted  in  Schools  of  a Number  of 
Southern  Illinois  Counties  Nov.  1967.  Illinois  Division,  American 
Cancer  Society. 


cer  in  children  which,  at  the  present  time, 
cannot  be  helped,  there  are  others  which 
can  be  cured  if  the  diagnosis  is  made  early, 
and  adequate  treatment  given.  Then  too, 
life  expectancy  has  been  prolonged  in  a 
small  percentage  of  childhood  leukemia 
patients  for  five  years  or  even  longer.'^ 

Association  Between  Smoking 
and  Cancer 

Cancer  of  the  lung,  a disease  which  rare- 
ly causes  death  in  childhood,  has  had  a 
spectacular  rise  in  adults  and  is  now  sec- 
ond only  to  diseases  of  the  heart  and  blood 
vessels  as  a cause  of  death  in  the  older  age 
group. Various  reports  have  indicated  that 
there  is  a close  association  between  the 
smoking  of  cigarettes  and  deaths  caused 
by  cancer  of  the  lung,  and  by  cardio-vas- 
cular  disorders. During  the  past  half 
century,  since  the  introduction  of  cigar- 


ettes in  1910,  there  has  been  a marked 
shift  from  the  smoking  of  cigars  and  pipes 
and  the  chewing  of  tobacco,  to  the  con- 
sumption of  tobacco  by  the  smoking  of 
cigarettes.  Cigar  and  pipe  smoke,  which  is 
heavy  and  alkaline,  cannot  be  inhaled  eas- 
ily without  coughing  or  becoming  dizzy 
or  nauseated.  Cigarette  smoke,  on  the 
other  hand,  is  neutral  and  can  be  inhaled 
easily  without  discomfort.  More  than  one- 
fourth  of  cigarette  smokers  inhale,  in  con- 
trast with  the  very  few  cigar  or  pipe  smok- 
ers who  do  so.®  Those  who  begin  smoking 
under  the  age  of  21  years,  according  to  a 
report  of  the  Surgeon  General’s  “Commit- 
tee on  Smoking  and  Health,”  inhale  more, 
smoke  more  cigarettes,  and  run  a greater 
risk  of  illness,  disability  and  loss  of  life 
than  those  who  begin  later.'^ 

Concomitant  with  the  rapid  rise  in  the 
consumption  of  cigarettes  has  been  the 


626 


Illinois  Medical  Journal 


marked  increase  in  the  use  of  cigarettes  by 
women  and  the  introduction  of  smoking  to 
young  children  of  both  sexes.  A recent 
survey  conducted  by  the  Illinois  division; 
the  American  Cancer  Society,  has  revealed 
that  more  than  half  of  the  boys  of  the  4th, 
5th  and  6th  grades  of  an  elementary  school 
in  southern  Illinois  had  already  experi- 
enced the  smoking  of  cigarettes.  What  was 
more  astounding  was  that  8%  of  the  boys 
were  already  regular  smokers.  The  inci- 
dence of  smoking  in  elementary  and  high 
school  students  in  this  locality  increased 
through  the  higher  grades  to  the  point 
where  over  40%  of  the  boys  were  con- 
firmed smokers  by  the  time  they  reached 
the  12th  grade  (Fig.  1). 

Another  extensive  survey  recently  com- 
pleted in  1967,  of  the  smoking  habits  of 
children  in  the  Chicago  Public  Schools 
(465  schools— 222,560  children),  showed 
similar  results— 44%  of  the  boys  and  28% 
of  the  girls  in  the  sixth  grade  had  already 
tried  smoking  and  7%  of  the  boys  and  2% 
of  the  girls  in  that  grade  were  smokers 
(Fig.  2).  This  same  study  also  showed  an 
increase  in  older  students— 42%  of  the  12th 
grade  boys  and  28%  of  the  girls  were  smok- 
ers. 


BY  THE  SIXTH  GRADE  A SIZABLE  PROPORTION  OF 
STUDENTS  HAVE  ALREADY  TRIED  SMOKING.  SOME 
CONTINUE  TO  SMOKE. 


GRADE  6:  BOYS 
44% 


TRIED 

SMOKING 


GRADE  6:  GIRLS 


PRESENT 

SMOKERS 


28% 


TRIED  PRESENT 

SMOKING  SMOKERS 


Fig.  2.  Source:  Survey  on  Student  Smoking 
Habits  in  the  Chicago  Public  Schools.  Chicago 
Chapter,  American  Cancer  Society,  Oct.-Nov., 
1967. 


Effects  of  Parental  Smoking 

Parental  smoking  habits  may  have  a 
profound  effect  on  the  smoking  behavior 
of  children.  A research  study  in  the  Port- 


land, Ore.  high  schools  by  Florn  and  his 
associates  in  1959  revealed  that  when  both 
parents  smoked,  32%  of  the  boys  and 
18.5%  of  the  girls  were  regular  smokers 
by  the  time  they  were  in  the  senior  class 
of  high  school.  These  figures  were  reduced 
by  half  when  neither  parent  smoked.  When 
only  one  parent  smoked,  there  was  a signi- 
ficant decrease  in  the  incidence  of  smoking. 
The  Horn  study  indicated  that  boys  tend 
to  imitate  the  smoking  habits  of  their 
fathers,  whereas  girls  tend  to  follow  their 
mothers.  When  one  or  both  parents  stop- 
ped smoking,  the  rate  of  confirmed  smok- 
ers in  both  boys  and  girls  declined  sharply. 
The  smoking  of  cigars  or  a pipe  by  the 
father  instead  of  cigarettes  also  tended  to 
lower  the  incidence  of  smoking  in  his  chil- 
dren^2  (Fig.  3). 

A University  of  Illinois  research  team,  in 
1967,  repeated  the  Horn  study  in  the  high 
schools  of  Rockford. Xhe  findings  of  this 
group  were  very  similar  to  those  obtained 
almost  a decade  earlier  in  Oregon.  How- 
ever, the  Rockford  students  showed  higher 
smoking  rates  at  the  9th  and  10th  grade 
levels,  but  lower  in  the  11th  and  12th 
grades.  The  total  smoking  rate  for  grades  9 
through  12  were  identical  in  both  studies. 
These  investigators  concluded  that  a high- 
er percentage  of  school  children  are  start- 
ing to  smoke  earlier  today,  as  compared  to 
a decade  ago.  The  incidence  of  smoking  in 
girls  has  also  increased  significantly  in  the 
9th  and  10th  grade  of  high  school.  The  Il- 
linois Research  group  found,  in  contrast 
to  findings  in  the  earlier  study,  that  the 
smoking  behavior  of  children,  both  male 
and  female,  tended  to  follow  very  closely 
the  father’s  smoking  habits. 

Trends  in  Mortality 

Physicians,  especially  pediatricians,  have 
long  been  leaders  in  the  battle  to  lower  the 
mortality  and  morbidity  of  childhood  dis- 
eases. Many  of  us  who  have  practiced  pe- 
diatrics for  over  three  decades,  have  had 
the  warm  satisfaction  of  witnessing  drama- 
tic changes  in  the  prevention  and  treat- 
ment of  illnesses  which  once  exacted  a ter- 
rible toll  of  children’s  lives  or  left  them  in- 
capacitated. Yet,  for  some  time,  we  have  ap- 
parently ignored  a health  area  which  has 
become  a major  national  problem.  Eightv 
years  ago,  a male  teenager  had  about  1 out 
of  500  chances  of  idtimately  dying  of  can- 
cer of  the  lung  in  adult  life,  whereas  to- 


for  November,  1968 


627 


PARENTAL  SMOKING  BEHAVIOR 


INFLUENCE  ON  HIGH  SCHOOL  STUDENTS 
(PORTLAND,  OREGON) 


BOTH  PARENTS 
SMOKE  CIGARETTES 


GIRLS  WHO  SMOKE  - 18.5% 


ONE  PARENT 
SMOKES 


NEITHER  PARENT 
SMOKES 


FATHER  ONLY 
MOTHER  ONLY 
MOTHER  ONLY 
FATHER  ONLY 


ONE  OR  BOTH  PARENTS 
STOPPED  SMOKING 


GIRLS  - 8.8% 


FATHER  -C, 


PIPE 


CIGAR 
MOTHER  — CIGARETTES 

FATHER  'C' 

CIGAR 

MOTHER  NOT  A SMOKER 


Fig.  3.  Source:  Horn,  D.,  et 


day,  if  the  present  rate  continues,  1 of  7 
male  youths  will  succumb  to  this  neoplasm. 
These  startling  figures  still  remain  valid 
even  though  the  changing  age  composition 
of  the  population  is  considered.!^ 

Sufficient  evidence  has  accumulated  to 
implicate  the  smoking  of  cigarettes  as  a 
contributory,  if  not  the  most  important 
factor  in  the  development  of  lung  cancer. 
Organizations  such  as  the  Illinois  Chapter 
of  the  American  Academy  of  Pediatrics, 
and  the  Illinois  State  Medical  Society, 
should  bring  the  weight  and  prestige  of 
their  membership  to  bear  in  an  intensive 
effort  to  reduce  the  number  of  children 
who  will  initiate  the  smoking  habit. 

If  any  appreciable  progress  is  to  be  made 


in  decreasing  the  percentage  of  children 
who  will  become  regular  smokers,  then 
considerable  attention  also  must  be  given 
to  the  following: 

(1)  the  content  of  the  anti-smoking 
propaganda  materials  used  in  the 
schools; 

(2)  the  education  methods  employed; 

(3)  the  optimum  grade  levels  at  which 
to  present  and  stress  these  materials. 
Children  in  lower  grades  of  elementary 

school  are  not  at  all  concerned  with  mortal- 
ity or  morbidity  figures  which  show  how 
early  and  prolonged  smoking  will  affect 
them  later  in  adult  life.  To  them,  the 
fourth  or  fifth  decade  of  life  is  a long  way 
off  and  they  simply  are  not  interested. 


628 


Illinois  Medical  Journal 


These  same  children  may,  however,  be 
greatly  influenced  by  selected  informative 
audio-visual  material  (films,  filmstrips, 
posters,  etc.).  At  the  First  World  Confer- 
ence on  Smoking  and  Health,  which  was 
held  recently,  it  was  strongly  recommended 
that  anti-smoking  education  should  start 
as  early  as  kindergarten. 

The  attitude  of  the  teen-ager  towards 
health  matters  differs  considerably  from  the 
younger  student.  The  adolescent  is  very 
much  interested  in  health  problems,  par- 
ticularly in  the  areas  of  personal  health, 
(acne,  dysmenorrhea,  growth  patterns, 
athletic  injuries),  sex  education,  smoking 
and  the  use  of  drugs,  mental  health  (home 
conflicts,  relation  to  parents,  careers),  and 
nutrition. 

Suggestions  for  Discouragement 
Programs 

Five  main  anti-smoking  educational  ap- 
proaches have  evolved,  each  with  its  own 
theme 

(1)  Contemporary  message— this  theme 
stresses  the  current  effects  of  smoking 
(school  children  who  smoke  have  more 
coughing  and  other  respiratory  disorders, 
are  therefore  less  likely  to  become  pro- 
ficient in  athletics  or  be  leaders). 

(2)  Remote  message— the  effects  of 

smoking  on  conditions  occurring  later  in 
life  (lung  cancer,  heart  disease). 

(3)  Both  sided  message— this  approach 
gives  both  sides  of  the  smoking  problem 
and  lets  the  youngster  make  up  his  own 
mind  about  smoking. 

(4)  Authoritative  theme— the  influence 
of  parent,  doctor,  teacher  or  coach  is  used 
to  discourage  smoking. 

(5)  Adult  role-taking  approach— the 

teen-ager  acts  as  an  adult  to  influence  other 
adults  not  to  smoke  (father,  mother,  etc.); 
hopefully  then,  this  may  cause  him  not  to 
smoke. 

The  results  of  the  recent  investigation 
of  the  Illinois  research  group  in  the  Rock- 
ford schools  indicated  that  the  contempor- 
ary approach  had  the  maximum  effect  in 
the  reduction  of  smokers  in  these  high 
school  students.  This  is  in  direct  contrast 
to  earlier  findings  of  the  Horn  study 
which  favored  the  remote  message.  The 
Rockford  study  also  found  that  the  adult 
role-taking  theme  was  more  effective  than 
the  remote  method. 

The  manner  in  which  anti-smoking 


propaganda  is  presented  to  children  at  all 
age  levels  is  also  of  great  importance. 

There  are  two  main  techniques  used:  (1) 
the  mass  communication  method;  and  (2) 
the  student  centered  approach.  In  the  mass 
communication  method,  a large  section  or 
the  entire  population  of  a school  is  ex- 
posed, at  various  times,  to  anti-smoking 
propaganda,  delivered  by  experts.  In  the 
student  centered  approach,  the  children 
learn  through  a symposium  of  peer  groups, 
in  which  they  are  all  asked  to  participate. 

The  Rockford  study  found  that  the  con- 
temporary message  utilizing  the  student 
centered  aproach  was  the  most  productive 
combination,  particularly  at  the  8th  grade 
level.i^ 

Children  are  starting  to  smoke  at  an 
earlier  age.  This  fact  has  been  adequately 
documented  by  the  recent  Chicago  School 
survey  as  well  as  the  Rockford  and  South- 

THE  PROPORTION  OF  THOSE  WHO  TRY  SMOKING  AND 
CONTINUE  TO  SMOKE  INCREASES  STEADILY, 
PARTICULARLY  IN  GRADES  7-10. 


BOYS: 


60% 


9 


66% 

10 


||||[|(I|(]j  BOYS 

GIRLS 

HAVE  TRIED 

HAVE  TRIED 

ffin  SMOKING 

SMOKING 

CONTINUE 
TO  SMOKE 


Fig.  4.  Survey  on  Student  Smoking  Habits  in 
Chicago  Public  Schools.  Chicago  Chapter, 
American  Cancer  Society,  Oct.-Nov.,  1967. 


for  November,  1968 


629 


ern  Illinois  reports.  The  Rockford  study 
showed  that  the  8th  grade  is  the  critical 
point  at  which  male  students  will  either 
become  established  smokers  or  ex-smokers. 
Girls  however,  usually  smoke  on  an  oc- 
casional basis  for  a longer  time.  The  Chica- 
go school  survey  also  confirmed  that  the 
change  from  occasional  smoker  to  smoker 
accelerates  markedly  between  grades  7 
through  10,  and  the  trend  was  especially 
noted  in  young  girls  between  the  eighth 
and  ninth  grades  (Fig.  4).  It  would  appear 
from  these  findings  that  anti-smoking  edu- 
cation should  start  with  the  first  school  ex- 
perience or  even  earlier,  and  be  stressed  in 
the  last  two  years  of  elementary  school  and 
the  first  year  of  high  school. 

What  the  Physician  Can  Do 

What  can  the  individual  physician  who 
treats  children  do  to  discourage  the  habit 
of  smoking  in  his  young  patients?  Physi- 
cians in  their  day-to-day  contact  with  pa- 
tients and  their  parents  can  be  powerful 
instruments  to  disseminate  meaningful  in- 
formation on  the  harmful  aspects  of  smok- 
ing. The  physician  can  point  out  to  the  par- 
ents how  important  is  the  effect  of  paren- 
tal smoking  on  their  children’s  smoking 
behavior.  Since  it  has  been  shown  that 
smoking  starts  at  a very  early  age,  physi- 
cians should  take  the  lead  in  contacting 
and  instructing  responsible  groups  in  their 
local  elementary  and  high  schools,  and 
community  youth  organizations,  in  order 
to  discuss  with  them  the  medical  aspects 
of  smoking  and  the  methods  to  reduce  the 
number  of  young  smokers.  Physicians 
should  also  support  many  of  the  leading 
health  agencies  in  this  country  and  abroad 
which  have  proposed  the  passage  of  legis- 
lation to  regulate  cigarette  advertising  on 
television  and  in  other  mass  news  media. 
The  physician,  himself,  when  talking  with 
his  teen-age  patients  on  the  subject  of 
smoking,  will  find  that  these  adolescents 
will  respond  more  favorably  to  sound  facts 
rather  than  strong  admonition.  The  phy- 
sician can  also  inform  the  parents  of  his 
patients  (by  periodic  releases  and  office 
literature)  of  any  new  information  on  the 
smoking  habit  and  its  health  conse- 
quences.i® 

Finally,  all  physicians  should  heed  the 
following  resolution  on  cigarette  smoking, 
adopted  by  the  Board  of  Directors  of  the 
American  Cancer  Society  on  May  5,  1967, 


and  endorsed  by  the  executive  committee 
of  the  American  Academy  of  Pediatrics, 
urging  “ (1)  that  physicians,  dentists, 
nurses  and  other  medical  personnel  do 
everything  possible  to  reduce  further 
cigarette  smoking  both  by  example  and  by 
advice.  (2)  The  sale  of  cigarettes  by  medi- 
cal and  health  institutions  be  discontinued. 

(3)  That  hospitals,  clinics,  health  centers 
and  physician’s  and  dentists’  offices  dis- 
courage smoking.” 

Hopefully,  then,  with  the  combined  co.- 
operation  and  resolution  of  physicians, 
parents  and  young  patients,  we  can  ulti- 
mately make  significant  progress  against 
the  health  hazards  of  cigarette  smoking  in 
children. 

References 

1.  Various  Reports  of  the  National  Vital  Sta- 
tistics Division  National  Center  for  Health 
Studies,  Public  Health  Service. 

2.  Public  Health  Service  Publication  No.  600, 
Page  15,  Revised  1967. 

3.  International  Comparison  of  Prenatal  and 
Infant  Mortality,  National  Center  for  Health 
Statistics,  Public  Health  Service,  March,  1967. 

4.  Association  of  State  and  Territorial  Health 
Officers,  American  Venereal  Disease  Associa- 
tion and  American  Social  Health  Associa- 
tion: loint  Statement  on  Today’s  V.D.  Con- 
trol Problem.  (New  York:  American  Social 
Health  Association  1967.) 

5.  Alford,  C.  A.  Jr.:  Symposium  on  Intrauterine 
Infections,  New  York,  N.Y.  Jan.  10,  1968, 

6.  The  Challenge  of  Childhood  Cancer  Ca.  1: 
35-40  (Jan.-Feb.)  1968. 

7.  Smoking  and  Health,  Report  of  the  Advisory 
Committee  to  the  Surgeon  General  of  the 
Public  Health  Service.  Publication  1103, 
1964. 

8.  Hammond,  E.  C.  The  Effects  of  Smoking. 
Scientific  American  (New  York)  207  (1):  3-15, 
July,  1962. 

9.  Doll,  R.  and  Hill,  A.  B.:  Lung  Cancer  and 
Other  Causes  of  Death  in  Relation  to  Smok- 
ing. Brit.  Med.  J.  2:1071-1081  (November  10) 
1956. 

10.  Hammond,  E.  C.,  and  Street,  E.  C.:  Smoking 
Habits  and  Disease  in  Illinois.  Illinois  Medi- 
cal Journal  126:661-665  (Dec.)  1964. 

11.  Borloni,  N.  O.,  Hechter,  H.  H.,  Breslow,  R.: 
Report  of  a 10  Year  Followup  Study  of  the 
San  Francisco  Longshoremen.  Mortality  from 
Coronary  Heart  Disease  and  From  All 
Causes.  J.  Chronic  Diseases  16:1251-1266, 
1963. 

12.  Horn,  D.,  Courts,  F.  A.,  Taylor,  R.  M.  and 
Solomon,  E.  S.:  Cigarette  Smoking  Among 
High  School  Students;  American  J.  Public 
Health  49:1947,  1959. 

13.  Creswell,  W.  H.,  Huffman,  W.  J.,  Stone, 
D.  B.,  Merki,  D.  J.,  and  Newman,  I.  M.:  A 
Replication  of  the  Horn  Study  on  Youth 
Smoking  in  1967— Presented  at  a Joint  Session 
of  the  American  School  Health  Association 
and  the  School  Health  Section,  American 
Public  Health  Association,  Oct.  26,  1967. 

14.  Statistical  Research  Section,  American  Can- 
cer Society. 

15.  The  Health  Consequences  of  Smoking,  A 
Public  Health  Service  Review,  1967.  Public 


630 


Illinois  Medical  Journal 


Health  Service  Publication  No.  1696,  Revised 
1968. 

Educational  Material  on  Smoking  and  Cancer, 
(posters,  pamphlets,  booklets,  films,  filmstrips,  ex- 
hibits) suitable  for  showing  at  various  school  age 


levels  can  be  obtained  at  the  local  offices  of  the 
American  Cancer  Society  or  at  the  Illinois  Division 
Headquarters,  at  37  South  Wabash  Ave.,  Chicago, 
III.  60603.  Prepared  lectures  and  slides  are  also 
available  for  interested  physicians. 


SCHOOL, 
YOUTH  & 
SPECIAL 
GROUPS 

For  All  Ages 


4th  thru  6th 
grades 


7th  thru 
10th  grades 


High  School, 
College, 
Teachers  & 
Adults 

High  School, 
College, 
Teachers  ir 
Adults 


FOR  INDIVIDUALS  & GROUPS 


Best  Tip  Yet  (bookmark) 

Best  Tip  Yet  (po) 

More  Cigarettes-More  Lung  Ca  (po) 
Athletes  Posters,  I Don’t 
Smoke  Cigarettes  (6)  (po) 

Smoking  is  Glamorous  (po) 

Smoking  is  Sophisticated  (po) 

Where  There’s  Smoke  (cartoon 
book) 


The  Huffless  Puffless  Dragon  (fl) 

I’ll  Choose  the  High  Road  (fs) 

I’ll  Choose  the  High  Road  (pam) 
Smoking  is  for  Squares  (cartoon 
reprint) 

Is  Smoking  Worth  It?  (fl) 

To  Smoke  or  Not  to  Smoke  (fs) 

Shall  I Smoke?  (pam) 

To  Smoke  or  Not  to  Smoke  (pam) 

The  Great  Imitators  (pam)* 

We’ll  Miss  Ya  Baby  (po) 

High  School,  7th  thru  10th  above 
if  not  previously  presented 
Who,  Me?  (pam) 

Smoking  & Health  (pam) 

Your  Health  & Cigarettes  (pam) 

Lung  Ca  & Cigarettes  (reprint) 

Who,  Me?  (fl) 

The  Time  to  Stop  is  Now  (fl) 

Time  for  Decision  (fl) 

Time  for  Decision  (fs) 

300,000,000  Clues  (fs) 

The  Time  to  Stop  is  Now  (slides 
&:  talk  kit) 

Cigarette  Smoking  & Lung  Ca 
Speakers’  Charts  (9^2222.01) 

Congress  Has  Acted  (po) 

If  You  Figure  It’s  Too  Late  (po) 
Hoarseness  or  Cough  (po) 

We’ll  Miss  Ya  Baby  (po) 

To  Smoke  or  Not  to  Smoke  3’x5’  (ex) 
Lung  Ca  Prevention  & the  Physician 
3’x5’  (ex) 

The  Time  to  Stop  is  Now  4’x8’  (ex) 

No  Smoking-Ca  Control  in 
Progress  (signs) 

Fans 

Be  Smart,  Don’t  Start,  The  Time  to 
Stop  is  Now, 

(Adults  only) 

Glamour  pocket  card 


FOR  TEACHERS,  LEADERS  & 
SPEAKERS 


Answering  the  Most  Often 
Asked  Questions  (pam) 

Ca  Eacts  & Figures 
(booklet) 

Free  Teaching  Aids  (leaflet) 
Cigarettes  & Health— A 
Challenge  to  Educators  (fs) 
Working  with  Schools  to 
Develop  Programs  on 
Smoking  (Interagency 
Council) 

Smoking  Poster  Kit 
The  Effects  of  Smoking 
(pam) 

I’ll  Choose  the  High  Road 
(Teacher’s  Guide) 

Student  Questionnaire 


To  Smoke  or  Not  to  Smoke 
(Teacher’s  Guide) 
Teaching  About  Ca  (bkl) 
Youth  Looks  at  Ca  (bkl) 
Student  Questionnaire 


Who,  Me?  (film  presentation  guide) 

Time  for  Decision  (film 
discussion  guide)* 

Cigarette  Smoking  & Ca 
The  Evidence  (pam)* 
Presentation  Reel  (fl) 

Cigarette  Smoking  & Lung 
Ca  Speakers’  Kit  (ff2222) 

The  Time  to  Stop  is  Now- 
Suggested  Remarks  for 
a Physician 
State  Law 

Statistical  Tables  & Maps 
Selected  References  on  Ca 
Smoking  & Health  (Sum- 
mary of  Surgeon  Gen- 
eral’s Report) 

Smoking— The  Great 
Dilemma  (pam) 

To  Help  Implement  the 
Surgeon  General’s 
Report  (pam) 

Cigarette  Smoking  Among 
High  School  Students 
(pam) 

The  Facts  on  Teenage 
Smoking  (reprint) 

Modifying  Smoking  Habits 
in  High  School  Students 
(reprint) 

Can  We  Help  Them  Stop  (bkl 
on  withdrawal  programs) 

Student  Questionnaire 


(Bkl)=Booklet 
(Ca)=  Cancer 


(po)  = poster 
(pam)  = pamphlet 


(fl)=film 
(fs)^  filmstrip 


(ex)  = exhibit 
* = in  production 


for  November,  1968 


631 


Doctors,  Patients  and  Tranquilizers— 
Recent  Developments 

By  Paul  Lowinger,  M.D. /Detroit,  Mich. 


Family  physicians  in  Iowa  recently  esti- 
mated that  18%  of  their  patients  have  symp- 
toms determined  largely  by  emotional  ill- 
nesses.^ This  tends  to  be  confirmed  by  the 
95  million  prescriptions  a year,  10  to  15% 
of  the  total,  for  tranquilizing  and  sedative 
medication.  The  major  portion  of  the  treat- 
ment of  emotional  disturbance  is  in  the 
hands  of  the  family  physician  and  will  con- 
tinue to  be  so  and  this  means  the  general 
practitioner,  medical  and  osteopathic,  the 
internist,  pediatrician  as  well  as  others.  The 
development  of  new  classes  of  tranquilizing 
and  energizing  drugs  since  1952  has  made 
the  family  physician  more  effective  and 
therefore  more  confident  and  interested  in 
the  psychiatric  aspect  of  his  practice.  His  pa- 
tients and  his  community  are  more  aware  of 
his  concern  about  emotional  illness.  Of  im- 
portance has  been  the  development  of  over 
120  courses  in  post  graduate  medical  educa- 
tion to  extend  and  deepen  the  psychiatric 
understanding  and  education  of  the  family 
physician. 

We  will  cover  three  topics.  First  a dis- 
cussion of  the  drugs  themselves  as  they 
should  be  used  in  office  practice.  Second, 
the  doctor  will  be  treated  as  a therapeutic 
agent  who  influences  the  effect  of  the 
therapy.  Finally,  a follow-up  of  office  pa- 
tients with  emotional  disturbances  treated 
with  medication  is  offered  which  may  serve 
as  a clinical  baseline.  A new  complete  list  of 
psychotropic  drugs  and  dosage  has  been  pre- 
pared by  a colleague  in  pharmacology.^  An- 
other good  source  of  detailed  information 
is  the  1965  edition  of  Goodman  and  Gil- 
man.3 


Any  discussion  of  the  drugs  must  refer  to 
a clinical  framework  which  includes  a care- 
ful evaluation  of  the  symptomatology,  a 
diagnosis  and  a concept  of  the  emotional 
background  of  the  patient’s  problem.  In 
gaining  such  perspective  the  physician  will 
want  to  interview  the  patient  and  possibly 
his  family  and  conduct  a physical  and  lab- 
oratory examination.  The  decision  may  then 
be  made  that  the  patient  does  not  require 
hospitalization,  does  not  need  referral  to  a 
psychiatrist,  does  not  have  a primary  physi- 
cal illness  but  rather  has  anxiety  or  depres- 
sive symptoms  which  require  treatment. 
The  Iowa  family  doctors  treated  85%  of 
their  emotionally  troubled  patients  them- 
selves.^ 

The  distinction  between  anxiety  and 
depressive  symptoms  is  a useful  one  despite 
the  fact  they  sometimes  occur  together.  The 
tranquilizing  drugs  which  are  used  to  treat 
anxiety  symptoms  may  be  divided  into 
major  and  minor  tranquilizers.  The  major 
tranquilizers,  or  antipsychotic  drugs  are 
distinguished  by  their  effect  on  schizo- 
phrenic symptoms  and  their  production  of 
neurological  side  effects.  They  are  the 
phenothiazines,  reserpine  and  other  rau- 
wolfia  alkaloids  and  the  butyrophenones 
such  as  Haloperidol.  The  minor  tranquil- 
izers which  are  of  little  value  in  treating 
psychosis  are  antianxiety  drugs  which  have 
some  pharmacologic  similarities  to  the  bar- 
biturates. They  differ  from  barbiturates 
chemically  and  pharmacologically  because 
they  relieve  more  anxiety  with  less  seda- 
tion. Most  prominent  in  this  group  have 
been  meprobamate  and  the  benzodiazepines 


Paul  Lowinger,  M.D.  is  Associate  Professor  at  Wayne  State  University,  Detroit 
and  Chief  of  the  Outpatient  Service,  Lafayette  Clinic.  He  is  also  chief  of  the 
Psychiatric  Service  at  Detroit  Memorial  Hospital.  Dr.  Lowinger  received  his 
M.D.  from  the  State  University  of  Iowa  and  served  an  internship  at  Marine 
Hospital,  Staten  Island,  New  York.  His  residency  in  psychiatry  was  done  at 
the  Psychopathic  Hospital,  Iowa  City  and  he  received  his  M.S.  in  Psychiatry 
from  the  State  University  of  Iowa.  This  present:: tion  was  originally  at  the 
1967  convention  of  the  Illinois  State  Medical  Society. 


632 


Illinois  Medical  Journal 


which  include  Librium  and  Valium.  There 
is  a whole  group  of  anti-depressant  medica- 
tions used  to  treat  mood  depression  which 
include  the  sympathomimetic  drugs  such  as 
dexedrine,  the  monoamine  oxidase  inhib- 
itors and  the  tricyclics. 

Selection  of  Medication 

The  selection  of  the  right  medication  for 
the  patient  is  of  considerable  importance 
despite  the  placebo  effect  which  we  will  talk 
about  later  on.  If  the  patient  who  is  pre- 
senting with  anxiety  symptoms  has  a schizo- 
phrenic illness,  he  will  do  better  on  tran- 
quilizers of  the  anti-psychotic  class.  Your 
ambulatory  schizophrenic  patient  is  a candi- 
date for  phenothiazine  medication.  The 
most  useful  phenothiazine  is  still  Thorazine 
which  is  started  at  25  mg.  three  or  four 
times  a day  but  may  be  raised  promptly  to 
100  mg.  three  or  four  times  a day.  Thorazine 
diminishes  hallucinations  and  delusions  as 
well  as  reducing  the  reaction  to  all  stimuli. 
With  12  phenothiazines  available,  each  of 
us  need  be  familiar  with  only  two  or  three. 
The  parkinsonian  side  effects  of  Thorazine 
may  be  controlled  with  Cogentin  given  .5 
to  1 mg.  a day.  The  presence  of  mild  extra- 
pyramidal  symptoms  is  evidence  of  absorp- 
tion of  the  drug.  If  the  parkinsonian  symp- 
toms are  severe,  Mellaril  with  the  same 
dosage  as  Thorazine  may  be  substituted.  The 
piperidyl  derivatives  of  the  phenothiazines 
such  as  Mellaril  cause  less  parkinsonian 
rigidity  and  tremor  but  more  autonomic 
side  effects  including  delayed  ejaculation, 
dizziness  and  nausea.  Phenothiazines 
with  piperazine  side  chains  such  as  Stelazine 
are  more  useful  for  apathetic  schizophrenic 
patients  with  a thinking  disorder.  Stelazine 
is  given  in  doses  of  4 mg.  two  or  three  times 
a day.  Thorazine  and  Stelazine  may  be  used 
in  combination. 

Should  the  phenothiazines  be  used  with 
the  anxious  non-psychotic  patient?  There  is 
no  indication  that  they  are  superior  to  the 
milder  tranquilizers  and  they  have  a greater 
incidence  of  side  effects  and  are  not  as  well 
tolerated  in  the  non-psychotic  patient.  In 
other  words,  the  phenothiazines  can  be  re- 
stricted to  the  anxious  psychotic,  whether 
he  is  an  inpatient  or  an  outpatient. 

In  general  chloropromazine  and  the  other 
phenothiazines  have  proven  to  be  quite  safe 
despite  the  concern  about  jaundice  and 
agranulocytosis  soon  after  their  introduc- 
tion in  1954.  The  jaundice  is  a hypersensi- 


tivity manifestation  resulting  in  cholestasis 
in  the  center  of  the  liver  lobule  without 
parenchymatous  damage.  If  this  occurs,  dis- 
continuation of  the  drug  and  the  substitu- 
tion of  a different  phenothiazine  has  been 
satisfactory.  Like  jaundice,  the  rare  agranu- 
locytosis has  occurred  within  the  first  month 
of  the  administration  of  the  drug,  and  most 
often  in  older  women  with  low  white  blood 
cell  counts.  There  has  been  some  skin  hy- 
persensitivity with  an  urticarial  reaction 
early  in  treatment  which  clears  following 
discontinuation  of  the  drug.  The  skin  may 
remain  clear  even  if  the  same  phenothiazine 
or  another  one  is  reinstituted.  A few  patients 
on  phenothiazines  have  a marked  photo- 
sensitivity so  that  they  have  to  stay  out  of 
the  direct  sunlight.  Other  reactions  which 
are  usually  handled  by  an  adjustment  of 
dosage  include  faintness,  palpitation,  nasal 
stuffiness,  dry  mouth  and  drowsiness.  There 
have  been  reports  about  pigmentation  of 
the  skin  and  opacities  of  the  lens  and  the 
cornea  after  years  of  phenothiazine  treat- 
ment. The  synergism  between  phenothia- 
zine and  other  drugs  including  barbiturates, 
alcohol  and  morphine  is  worth  noting. 

Minor  Tranquilizers  Noted 

The  most  useful  of  the  minor  tranquil- 
izers in  our  experience  has  been  Librium. 
This  is  ordinarily  given  in  25  mg.  doses 
three  or  four  times  a day.  Other  minor  tran- 
quilizers with  effect  in  the  anxiety-tension 
area  include  meprobamate  and  the  Librium 
analogues.  Valium  and  Serax.  These  medi- 
cations cause  considerably  less  sedation  than 
the  barbiturates  although  there  is  some  risk 
in  a Librium  patient  driving  a car  until 
adjustments  to  the  medication  have  oc- 
curred. While  these  drugs  are  chemically 
and  pharmacologically  distinct  from  bar- 
biturates, they  do  suppress  the  barbiturate 
abstinence  syndrome  in  animals.  The  anti- 
anxiety drugs  have  little  effect  on  mood 
depression  or  on  psychotic  symptomatology 
and  do  not  cause  parkinsonian  symptoms  in 
the  usual  doses.  Meprobamate  is  ordinarily 
given  400  mg.  four  times  a day. 

It  is  important  to  emphasize  the  use  of 
an  adequate  dose  with  each  of  the  drugs  we 
have  discussed.  The  dose  recommended  by 
the  manufacturer  in  the  Physician’s  Desk 
Reference  may  be  inadequate.  Spreading  the 
dose  throughout  the  day  and  giving  the  last 
one  at  bedtime  may  eliminate  the  need  for 
a sleeping  medication.  However,  Doriden 


for  November,  1968 


633 


or  one  of  the  other  non-barbiturate  hypnot- 
ics may  be  used  for  sleep  in  patients  taking 
tranquilizers.  It  should  be  noted  that  while 
addiction  has  been  reported  with  Librium 
and  meprobamate,  like  suicide  it  is  much 
less  common  than  with  barbiturates. 

Depression  Medications 

The  anti-depressant  medications  should 
be  mentioned  even  though  they  are  ener- 
gizers rather  than  tranquilizers.  We  see  am- 
bulatory patients  with  mood  depressions 
that  are  part  of  a mild  manic  depressive  ill- 
ness, involutional  reactions,  psychoneurotic 
depressive  reactions,  depressions  during  sit- 
uational reactions  or  an  exacerbation  of 
characterologic  difficulties.  Whenever  a de- 
pression reaches  the  point  of  physiologic 
significance,  that  is,  sleep  disturbance,  ap- 
petite loss,  lack  of  energy,  slowing  of  ac- 
tivity and  loss  of  interest,  it  is  likely  that 
anti-depressant  medication  will  be  of  value. 
Where  the  depression  is  not  accompanied 
be  some  of  the  physiologic  symptoms,  it  is 
unlikely  the  medication  will  be  useful. 

The  presence  of  “masked  depression”  has 
been  frequently  reported.  In  this  situation 
the  patient’s  gastrointestinal  or  cardiovas- 
cular symptoms  are  not  organically  deter- 
mined but  are  psychogenic.  However,  they 
serve  not  just  to  hide  or  defend  against 
emotional  conflict,  but  also  to  disguise  the 
presence  of  a mood  depression.  It  is  often 
the  patient  who  complains  of  gastrointesti- 
nal symptomatology  and  who  denies  de- 
pression but  admits  to  being  under  emo- 
tional stress  who  makes  an  unexpected  sui- 
cide attempt. 

Our  drug  of  choice  in  mood  depression  is 
Tofranil  which  was  the  earliest  of  the  tri- 
cyclic anti-depressive  agents.  It  is  ordinarily 
started  in  doses  of  25  mg.  three  or  four 
times  a day  but  may  be  used  up  to  200  mg. 
a day.  Anti-depressant  medications  includ- 
ing Tofranil  require  from  two  to  six  weeks 
before  they  have  an  effect.  The  modification 
of  Tofranil  as  desimipramine  appears  to 
have  little  advantage.  Elavil  is  one  of  a 
similar  class  of  compounds,  the  dibenzo- 
cycloheptadienes,  which  may  be  substituted 
for  Tofranil.  Elavil  causes  some  relief  of 
the  anxiety  associated  with  many  depres- 
sions. If  the  depressed  patient  is  agitated  or 
anxious  and  one  wishes  to  use  Tofranil,  it 
may  be  combined  with  chloropromazine  or 
Librium.  This  combination  may  not  be 
necessary  when  using  Elavil  which  is  also 


started  at  25  mg.  three  or  four  times  a day. 

Another  reason  for  our  preference  for  the 
tricyclic  drugs  in  depression  is  that  they 
have  much  less  toxicity  than  the  MAO 
inhibitors.  Where  depressions  are  refractory 
to  the  tricyclics,  one  can  shift  to  Niamid, 
25  mg.  three  or  four  times  a day.  Most 
potent  of  the  MAO  inhibitors  is  Parnate. 
It  is  used  with  psychiatric  inpatients  but 
may  be  suitable  for  difficult  depressive  ill- 
nesses in  outpatients  in  doses  of  10  mg.  two 
to  three  times  a day.  The  concern  about 
hypertensive  crisis  has  lead  to  caution  with 
Parnate  which  should  not  be  used  with 
tyramine-containing  cheeses  because  of  the 
pressor  effect.  In  general,  different  classes 
of  anti-depressant  agents  should  not  be  com- 
bined and  several  days  should  elapse  if  a 
patient  is  shifted  from  a tricyclic  to  a MAO 
inhibitor.  At  least  a week  should  elapse  be- 
tween the  discontinuance  of  a MAO  inhib- 
itor and  the  initiation  of  the  Tofranil 
therapy  since  the  combination  has  produced 
convulsions,  coma  and  hyperpyrexia.  Like 
the  tricyclics,  the  MAO  inhibitors  may  be 
combined  with  Librium  or  a phenothiazine 
to  control  anxiety.  The  toxic  symptoms  at- 
tributed to  Tofranil  include  dry  mouth, 
sweating,  constipation,  dizziness,  tachycar- 
dia, headache,  palpitations,  blurred  vision, 
tension  and  tremor  and  urinary  retention; 
however,  these  effects  are  quite  infrequent 
and  usually  mild.  The  absorption  of  the 
drug  and  the  adequacy  of  the  dosage  may 
be  judged  by  the  presence  of  atropine-like 
actions  such  as  a dry  mouth. 

Studies  with  depressed  patients  still  show 
that  electroshock  treatment  is  effective  in 
a higher  number  of  patients  than  any  of 
the  drugs. 

Physician  Role  Discussed 

What  about  the  role  of  the  physician  him- 
self as  a therapeutic  agent?  Let  us  consider 
the  placebo  in  relationship  to  the  doctor. 
According  to  Houston^  writing  in  1938, 
there  is  no  medication  of  any  specific  value 
in  the  pages  of  Hippocrates  and  this  remains 
true  for  over  a thousand  years.  Despite  the 
presence  of  an  occasional  medication  of 
physiologic  value  such  as  the  use  of  fresh 
fruit  for  scurvy  in  1753,  the  use  of  medica- 
tion has  been  largely  on  a scientific  basis 
in  the  last  70  years.  How  was  it  possible 
for  the  physician  to  hold  an  honored  place 
for  thousands  of  years  if  his  medications 
were  worthless?  The  enthusiasm,  confidence 


634 


Illinois  Medical  Journal 


and  faith  of  the  patient  led  to  many  thera- 
peutic successes  in  which  the  doctor  him- 
self was  the  agent.  The  revival  of  interest  in 
the  placebo  begins  with  the  anesthesiologist, 
Beecher,  who  taught  us  that  the  pain  relief 
of  post  surgical  was  30%  due  to  a placebo 
reaction  and  40%  due  to  a physiologic  effect 
of  morphine  which  made  a 70%  effective- 
ness.® A summary  of  15  studies  of  the  pla- 
cebo in  1955  showed  its  therapeutic  effect 
to  be  about  35%  in  a great  variety  of  con- 
ditions ranging  from  wound  pain  to  angina 
pectoris  and  sea  sickness.® 

Our  comments  on  the  effectiveness  of  the 
physician  as  a therapeutic  agent  come  from 
observations  of  the  effects  of  placebos  and 
tranquilizers  in  our  drug  clinic'^  which  func- 
tions very  much  like  the  office  practice  of 
a family  doctor.  We  treat  ambulatory  psy- 
chiatric patients  after  a complete  evaluation 
by  visits  of  15  minutes  duration  once  or 
twice  a month  with  one  of  our  resident 
physicians.  The  use  of  rating  scales  and 
symptom  scores  allow  us  to  measure  the 
effects. 

The  placebo  effects  in  four  one  month 
double-blind  studies  conducted  in  order  to 
evaluate  tranquilizers  between  1959  and 
1964  have  varied  from  24  to  76%  patient 
improvement.®  This  represents  a 300%  varia- 
tion in  the  therapeutic  potency  of  the  pla- 
cebo control  during  a five  year  drug 
treatment  - evaluation  program  that  re- 
mained essentially  the  same  except  for  the 
variables  that  will  be  discussed.  The  studies 
were  double-blind  because  neither  the  pa- 
tients nor  the  physicians  knew  whether  the 
patient  was  receiving  a placebo  or  an  active 
drug  although  the  doctors  knew  which 
active  drugs  were  being  employed.  Just  as 
interesting  as  the  variability  in  the  placebo 
groups  containing  17  to  26  subjects  was  the 
fact  that  the  effects  of  the  active  drug  in 
each  group  tended  to  parallel  the  placebo. 
The  low  placebo  response  study  of  24% 
was  obtained  with  an  unknown  drug  with 
mild  skeletal  relaxing  properties  and  some 
tranquilizing  effects,  Trepidone.  The  resi- 
dent physicians  involved  in  this  study 
regarded  the  active  drugs  as  one  of  low 
potency  and  without  a reputation  for  pro- 
ducing either  impressive  therapeutic  results 
or  toxicity. 

The  patients  in  this  study  were  not  given 
psychological  tests  or  additional  examina- 
tions beyond  the  brief  visit  with  the  doctor. 
Like  its  placebo,  Trepidone  produced  a 30% 


repsonse  rate.  The  other  low  placebo,  35% 
patient  improvement,  occurred  in  a study 
without  psychological  testing  but  a com- 
parison to  low  daily  doses  of  Stelazine,  4 
mg.;  Librium,  40  mg.,  and  meprobamate, 
1600  mg.  Like  the  placebo,  Stelazine  pro- 
duced an  improvement  rate  of  32%,  me- 
probamate 29%  and  Librium  only  16%. 
The  high  placebo  response  rate  was  76% 
which  occurred  in  a double-blind  study  with 
the  same  agents  when  they  were  raised  to 
adequate  daily  levels,  Stelazine,  8 mg.; 
Librium,  80  mg.,  and  meprobamate,  3200 
mg.  There  was  a small  amount  of  psycho- 
logical testing.  Now  the  Stelazine  produced 
a remission  rate  of  67%,  Librium  87%  and 
meprobamate  44%.  The  other  high  pla- 
cebo study,  74%  involved  two  mild  drugs, 
Suvren  which  has  since  been  discontinued 
and  sodium  amytal  which  is  not  a tran- 
quilizer. In  this  study  each  patient  was  sub- 
ject to  a great  deal  of  testing  involving  two 
hours  with  a research  assistant  at  each  visit 
and  also  a Funkenstein  mecholyl  test.  Like 
the  placebo  in  this  study,  the  sodium-amytal 
produced  an  improvement  rate  of  78%  and 
Suvren  60%.  These  results  point  to  the 
importance  of  the  doctor’s  attitude  toward 
the  medications  he  is  using  even  in  a double- 
blind study.  It  also  shows  the  involvement 
of  the  patient  with  the  emotional  experience 
of  the  clinic  program  even  when  this  is 
conveyed  by  a research  assistant  perform- 
ing psychological  tests  or  a nurse  injecting 
mecholyl  and  measuring  blood  pressure. 

Psychopharmacology  Results 

What  kind  of  results  can  we  expect  from 
psychopharmacology  in  our  outpatients? 
The  drug  clinic  program  at  the  Lafayette 
Clinic  in  Detroit  used  a great  variety  of 
tranquilizing  and  energizing  medications 
for  anxiety  and  depressive  symptoms  in 
conjunction  with  15  minute  interviews  be- 
tween 1956  and  1959  before  we  began  our 
double-blind  studies.  Psychiatric  residents 
saw  the  patients  for  adjustment  of  medica- 
tion, review  of  symptomatology  and  con- 
sideration of  toxicity  once  a month.  Drugs 
such  as  chloropromazine  in  the  tranquilizer 
class  and  Deaner  and  Tofranil  in  the  ener- 
gizer class  were  in  use.  A follow-up  of  118 
out  of  157  patients,  80%,  was  performed 
141/2  months  after  they  terminated  outpa- 
tient drug  treatment.® 

A review  of  the  data  showed  that  at  the 
time  of  the  termination  of  drug  treatment. 


for  November,  1968 


635 


65%  of  the  patients  were  in  remission  or 
improved  while  35%  were  essentially  un- 
changed or  worse.  At  the  time  of  follow-up 
141/2  months  later,  52%  of  the  patients  re- 
mained improved.  It  should  be  noted  that 
not  all  of  those  who  were  improved  at 
termination  remained  improved  at  fol- 
low-up. The  patients  averaged  414  dif- 
ferent drugs  during  the  time  they  were  in 
treatment  which  averaged  nine  visits  in  nine 
months.  No  difference  in  results  were  seen 
by  diagnostic  groups  which  included  schizo- 
phrenia, psychoneurosis,  character  disorder 
and  the  manic  depressive,  depressed  and 
the  involutional  reaction  as  the  fourth 
group.  The  only  difference  was  that  the  im- 
proved schizophrenic  patients  had  an  aver- 
age of  13  visits  while  the  other  improved 
patients  had  an  average  of  nine  visits.  The 
patients  averaged  36  years  of  age  and  60% 
of  them  were  women;  however,  sex,  age, 
marital  status,  the  number  of  drug  clinic- 
visits,  the  number  of  different  medications 
received  and  the  frequency  of  change  of  the 
drug  clinic  doctor  did  not  influence  the 
results  of  treatment  at  either  time  the 
patient  termined  or  at  time  of  follow-up. 
The  53%  of  patients  who  terminated  by 
mutual  consent  with  the  doctor  were  no 
different  in  improvement  rate  from  the  47% 
who  stopped  by  not  keeping  appointments 
and  offering  no  explanation. 

Summary 

Obviously  this  is  not  the  whole  of  office 
psychopharmacology.  W e have  said  nothing 
about  a great  many  topics  which  are  of 
considerable  concern:  pediatric  psychophar- 
macology including  amphetamines  in  hy- 
peractive children,  the  maintenance  of  the 


chronic  manic  depressive  on  lithium  or 
anti-depressant  medication,  continuous  phe- 
nothiazine  therapy  in  the  chronic  schizo- 
phrenic, the  treatment  of  the  alcoholic  and 
the  sedation  of  the  agitated  senior  citizen. 

I suggest  that  one  should  consider 
my  views  in  the  light  of  one’s  own  experi- 
ence. First,  become  familiar  with  three 
phenothiazines  for  psychotic  patients,  a 
minor  tranquilizer  or  two  for  anxious  non- 
psychotic  patients,  and  anti-depressant 
agents  for  the  depressed.  Second,  recognize 
the  therapeutic  effect  of  the  contact  with 
the  physician  and  third,  evaluate  results  in 
the  treatment  of  emotionally  disabled  pa- 
tients. 

References 

1.  Finn,  R.  and  Huston,  P.,  “Emotional  and  Mental 
Symptoms  in  Private  Medical  Practice,  Journal  of 
Iowa  Medical  Society,  56:138-143,  1966. 

2.  Domino,  E.  F.,  “Classification  of  Psychoactive 
Drugs”,  1967. 

3.  Goodman,  L.  and  Gilman,  A.,  The  Pharmacologi- 
cal Basis  of  the  Therapeutics,  MacMillan,  New 
York,  1965. 

4.  Houston,  W.,  “Doctor  Himself  as  Therapeutic 
Agent”,  Ann.  Int.  Med.,  11:1416,  1938. 

5.  Lasagna,  L.,  Mosteller,  F.,  von  Felsinger,  J.  and 
Beecher,  H.,  “A  Study  of  the  Placebo  Response”, 
Am.  J.  Med.  16:770-779,  1954. 

6.  Beecher,  H.,  “The  Powerful  Placebo”,  J.A.M.A. 
159:1602-1606,  1955. 

7.  Lowinger,  P.,  Schorer,  C.,  Knox,  R.  S.,  “Psycho- 
logical Implications  of  Outpatient  Drug  Ther- 
apy”, The  Dynamics  of  Drug  Therapy,  Ed. 
Sarwer-Foner,  G.,  471-483,  Charles  Thomas, 
Springfield,  1960. 

8.  Lowinger,  P.,  and  Dobie,  S.,  “What  Makes  the 
Placebo  Work?  A Study  of  Placebo  Response 
Rates”,  presented  at  Divisional  Meeting  of  Amer- 
ican Psvchiatric  Association,  Honolulu,  August, 
1965. 

9.  Lowinger,  P.,  Dobie,  S.,  Reid,  S.,  “What  Happens 
to  the  Psychiatric  Office  Patient  Treated  With 
Drugs?  A Follow-up  Study”,  Psychiatric  Quar- 
terly, 41:536-549,  1967. 


NIMH  BOOK  AVAILABLE 


The  second  in  the  series  of  Mental 
Health  Program  Reports  is  now  available 
from  the  National  Institute  of  Mental 
Health. 

The  390-page  booklet  contains  progress 
reports  on  mental  health  research  con- 
ducted or  supported  by  the  NIMH.  Each 
of  the  26  chapters  cites  progress  in  specific 
areas  of  research,  training  and  service  ac- 
tivities. 

Mental  Health  Program  Reports  was 
written  by  science  writers  and  is  based 
on  intensive  interviews  with  scientists. 


clinicians  and  training  directors.  It  can  be 
easily  understood  by  the  layman. 

Single  copies  of  the  new  edition  and  the 
first  volume  of  Mental  Health  Program 
Reports  are  available  free  of  charge  from 
the  Public  Information  Branch  of  the 
NIMH.  Multiple  copies  are  for  sale  by 
the  Superintendent  of  Documents,  U.S. 
Government  Printing  Office,  Washington, 
D.C.  20402.  The  new  edition  is  $1.25  per 
copy  and  is  Public  Health  Service  Publica- 
tion No.  1743.  The  first  volume  is  $1  per 
copy  and  is  Public  Health  Service  Publi- 
cation No.  1568. 


636 


Illinois  Medical  Journal 


'^Mm 


V V 

|®®®« 

I 


Surgical  Grand  Rounds  are  held  weekly 
on  Saturday  at  8:00  A.M.;  alternating  be- 
tween the  Staff  Room,  Chicago  Wesley  Me- 
morial Hospital  and  Offield  Auditorium, 
Passavant  Memorial  Hospital.  Patient  pre- 
sentations from  these  hospitals  and  from 
the  Veterans  Administration  Research  Hos- 
pital form  the  basis  of  the  discussions.  This 
case  report  was  part  of  the  Surgical  Grand 
Rounds  held  at  Passavant  Memorial  Hos- 
pital on  February  10,  1968. 


Hypertension  and  Ileus 

Case  Presentation: 


Dr.  Joseph  Sherman:  The  patient  is  a 
47  year  old  white  male  truck  driver,  who 
was  admitted  to  Veterans  Administration 
Research  Hospital  Jan.  10  th.  Approxi- 
mately one  year  ago  he  began  having  palpi- 
tations, nervousness,  excess  sweating,  and 
occipital  headaches.  These  episodes  were 
usually  precipitated  by  heavy  labor  or  by 
anxiety,  and  each  lasted  about  one  hour. 
Relief  was  usually  obtained  by  resting.  Two 
weeks  before  admission  he  jumped  from 
the  cab  of  his  truck,  a distance  of  about 
three  feet,  and  twisted  his  left  ankle. 
Twelve  hours  after  the  accident  he  went 
into  the  emergency  room  of  a hospital,  and 
while  there  he  developed  nausea,  vomiting 
and  abdominal  distention.  Because  of  these 
symptoms  he  was  admitted  to  the  hos- 
pital. At  this  time  his  blood  pressure  was 
found  to  be  268/110.  The  examination  was 
otherwise  unremarkable  except  for  marked 
abdominal  distention  and  absent  bowel 
sounds.  An  EGG  was  obtained  which  was 
reported  to  suggest  a recent  myocardial  in- 
farction. He  was  treated  with  intravenous 
fluids,  digitalis  and  Peritrate.  Because  of 
the  history  of  episodes  of  flushing  and  the 
elevated  blood  pressure,  a 24  hour  urinary 

638 


V.M.A.  excretion  was  obtained,  which  was 
68.5  mg.  (normal  9 to  10  mg.)  He  was  then 
transferred  to  the  Veterans  Administration 
Research  Hospital  where  his  blood  pressure 
was  260/120.  He  had  marked  abdominal 
distention  and  absent  bowel  sounds. 
Neither  cafe-au-lait  spots  nor  neurofibro- 
mata were  present.  Each  flank  was  mas- 
saged without  elevation  of  the  blood  pres- 
sure. Past  history:  physical  examinations  in 
1966  and  1967  were  said  to  be  normal.  A 
familial  history  of  hypertension  was  not 
obtained. 

A naso-grastic  tube  was  inserted  and 
parenteral  fluid  was  administered.  The  pa- 
tient improved  with  this  conservative  ther- 
apy and  oral  feedings  were  taken  after  a 
week.  The  day  after  admission  a Regitine 
test  was  performed.  Approximately  two 
minutes  after  the  injection  of  Regitine,  his 
pressure  dropped  from  240/125  to  155/80, 
but  five  minutes  later  returned  to  the 
previous  abnormal  level.  The  day  after 
admission  24  hour  urinary  excretion  of 
catecholamines  was  determined  and  was 
5,900  micrograms  (normal  less  than  103 
micrograms).  His  blood  pressure  remained 
elevated  for  nine  days,  then  returned  to 

Illinois  Medical  Journal 


normal  levels.  A number  o£  radiologic 
studies  have  been  performed. 

Dr.  Hirsh  Handmaker : The  admis- 
sion films  were  four  views  of  the  abdomen 
and  showed  an  absence  of  dilation  of  the 
large  and  small  bowel,  but  some  separation 
of  the  loops  of  the  bowel,  suggesting  edema. 
The  picture  of  generalized  gas,  seen  in  the 
distal  colon  and  rectum,  as  well  as  stacked 
small  bowel,  is  compatible  with  an  obstruct- 
ing lesion  in  the  region  of  the  anus  as 
well  as  severe  ileus.  The  intravenous  pyelo- 
gram  showed  bilateral  symmetrical  filling 
of  the  upper  urinary  tract  without  any  ob- 
struction, and  good  calyceal  systems,  except 
for  the  upper  pole  of  the  right  kidney,  was 
not  well  visualized.  One  view  suggested  a 
mass  in  the  right  suprarenal  area.  The  per- 
fusion nephrotomogram,  performed  twice, 
failed  to  demonstrate  a mass  in  the  right 
suprarenal  region.  The  upper  calyceal  sys- 
tem was  not  well  seen.  This  is  considered 
to  be  a normal  perfusion  nephrotogram. 
Patient  enters. 

Dr.  Sherman:  Could  you  just  describe 
one  of  the  attacks  you  had?  How  would 
these  start  and  what  were  they  like? 

Patient:  Usually  when  I would  get  ex- 
cited or  worried,  I would  start  sweating 
and  coughing.  Then  I would  sit  down  for 
an  hour  or  an  hour  and  a half  and  would 
cool  down.  I could  feel  my  heart  going  real 
fast.  Also  I had  headaches  in  the  base  of 
my  head. 

Patient  leaves. 

Dr.  John  Colwell:  This  patient  had  a 
classical  history  for  pheochromocytoma. 
After  the  stress  of  his  knee  injury,  he  had 
a severe  attack  of  nervousness,  sweating, 
and  headache.  This  progressed  to  nausea, 
vomiting  and  paralytic  ileus.  This  latter 
complication  is  unusual  in  pheochromocy- 


toma and  represents  the  vasoconstrictive 
effects  of  catecholamine  excess  on  bowel 
vasculature.  This  is  an  important  complica- 
tion of  pheochromocytoma  to  recognize  and 
to  treat  medically.  Premature  surgical  in- 
tervention for  a surgical  abdomen  could 
have  been  lethal  in  this  case. 

The  internist  is  faced  with  the  evalu- 
ation of  large  numbers  of  patients  with 
hypertension.  Because  pheochromocytoma 
is  a remediable  cause  of  an  elevated  blood 
pressure,  it  must  be  ruled  out  in  all  cases 
of  hypertension.  This  may  be  screened  by 
indirect  tests  and  diagnosed  definitively  by 
direct  measurement  of  the  excretion  of  uri- 
nary catecholamines  and  their  metabolites. 
Of  the  indirect  tests,  the  use  of  intra- 
venous phentolamine  (5  mg.)  has  been  the 
most  valuable  in  hypertensive  subjects.  As 
in  this  case,  a fall  in  blood  pressure  greater 
that  35/25  mm.  of  mercury  shortly  after 
intraveneous  phentolamine  is  suggestive  of 
pheochromycytoma.  Falsely  positive  re- 
sponses may  occur  in  patients  who  are 
azotemic,  on  sedatives,  anti-hypertensive 
agents  or  tranquilizers.  There  are  several 
provocative  tests  for  pheochromocytoma, 
but  these  should  be  used  sparingly  because 
of  the  possibility  of  provoking  a hyper- 
tensive crisis. 

The  direct  tests  of  the  excretion  of  cate- 
cholamines or  their  metabolites  have  sup- 
planted the  indirect  tests  for  definitive 
diagnosis  because  of  the  improved  accuracy 
and  specificity.  There  are  biochemical 
methods  for  measuring  norepinephrine 
(NE),  epinephrine  (E),  normetanephrine 
(NMN),  metanephrine  (NE),  and  vanillyl- 
mandelic  acid  (VMA)  in  24  hour  urine 
specimens.  The  formulas  and  a simplified 
metabolic  scheme  for  these  compounds  are 
as  follows  (Fig.  1): 


NE (R=H) 

E(R=CH2)  (Normal: <103yg/day) 


NMN (R=H) 

MN (R=CH2)  (Normal: 300-900yg/day) 

VMA  (Normal : 3-6 . 8mg/day) 

Fig.  1. 


for  November,  1968 


639 


Although  an  occasional  patient  will  have 
an  elevated  urinary  excretion  of  VMA  or 
one  of  the  metanephrines  instead  of  total 
catecholamines,  the  measurement  of  any 
one  of  these  three  groups  of  compounds 
will  usually  provide  an  accurate  diagnosis. 
When  total  catecholamines  are  measured,  it 
is  important  that  the  patient  does  not  take 
antihypertensives  of  the  alphamethylilopa 
configuration,  tetracycline  antibiotics,  and 
adrenaline-like  drugs.  When  VMA  is  mea- 
sured, the  patient  must  be  off  all  coffee, 
fruits,  vanilla,  bananas,  and  asprin.  In  this 
patient,  total  urinary  catecholamines  were 
extremely  high  upon  admission  to  the  hos- 
pital (5.9  mg.)  and  fell  to  about  twice  nor- 
mal (274  uq.)  shortly  before  surgery.  Over 
approximately  the  same  time  interval,  uri- 
nary VMA  fell  from  65  mg.  to  19  mg./day. 
These  findings  indicate  that  the  tumor  was 
secreting  large  amounts  of  catecholamines 
concomitant  with  the  most  severe  clinical 
symptoms. 

Once  the  presence  of  a pheochromocy- 
toma  is  diagnosed  by  biochemical  means, 
an  attempt  must  be  made  to  localize  it.  Be- 
cause retroperitoneal  air  insufflation  and 
arteriography  may  precipitate  a hyperten- 
sive episode,  these  are  rarely  indicated.  Lo- 
calization is  usually  adequate  with  an  in- 
travenous pyelogram  and  nephrotomo- 
grams. In  this  subject,  the  upper  pose  of  the 
right  kidney  did  not  visualize  well  with 
these  procedures  and  suggested  the  pres- 
ence of  a right-sided  tumor.  Although 
measurement  of  plasma  catecholamines 
from  different  sites  has  been  used  for  loca- 
tion in  problem  cases,  procedures  for  mea- 
suring plasma  catecholamines  are  not  avail- 
able in  most  medical  centers. 

We  have  recently  been  interested  in  ex- 
ploring the  mechanism  of  the  abnormal 
glucose  tolerance  test  in  patients  with  pheo- 
chromocytoma.  According  to  most  series, 
diabetes  is  present  in  at  least  50  per  cent  of 
cases.  It  is  likely  that  this  figure  would  be 
increased  if  glucose  tolerance  testing  were 
done  in  all  subjects  with  this  tumor.  Until 
recently,  it  was  accepted  that  the  major 
reasons  for  blood  glucose  elevation  in  these 
subjects  were  the  mobilization  of  liver  gly- 
cogen by  epinephrine,  increased  glucose 
production  from  lactate  by  the  liver, 
and  an  inhibition  of  peripheral  glucose 
uptake  by  the  lipolytic  action  of  the 
catecholamines.  While  these  mechanisms 


are  contributory,  it  is  likely  that  a 
major  effect  of  the  catecholamines  on  glu- 
cose tolerance  is  mediated  through  an  in- 
hibition of  insulin  release  from  the  pan- 
creas. Studies  by  Porte  et  al.  have  shown 
that  this  effect  is  governed  by  alpha  adren- 
ergic receptors^’2.  Since  phentolamine  pro- 
duces alpha  receptor  blockade,  we  reasoned 
that  a phentolamine  drip  should  improve 
glucose  tolerance  and  insulin  secretion  in 
subjects  with  pheochromocytoma. 

Results  of  this  procedure  are  shown  in 
two  subjects  below: 


Subject  Subject  #2 


Max.  Ins. 

Max.  Ins. 

Rise 

Rise 

K* 

(uU/ml) 

K*(uU/ml) 

I.V. 

GTT 

s phen- 

tolamine 

.43 

18 

.74  21 

I.V. 

GTT 

c phen- 
tolamine 

1.21 

50 

1.05  58 

I.V. 

GTT 

post-op. 

1.18 

60 

*K  = rate  of  glucose  disappearance  (mg%/min) 
after  I.V.  glucose  (Normals  > 1.0,  diabetics  < 0.8). 

It  is  apparent  in  both  cases  that  phento- 
lamine restored  the  abnormal  glucose  tol- 
erence  and  insulin  secretion  to  normal.  Pat- 
ient No.  2 in  the  table  is  the  case  discussed 
today.  While  we  must  study  more  patients 
with  pheochromocytoma,  these  early  results 
indicate  that  the  diabetic  glucose  tolerance 
frequently  seen  in  this  disorder  is  due  to  a 
decrease  insulin  secretion  medicated  by 
alpha  adrenergic  receptor  stimulation  by 
catecholamines. 

It  is  also  apparent,  therefore,  that  this 
patient  illustrates  the  classical  clinical  and 
biochemical  findings  of  pheochromocytoma. 
In  addition  he  has  helped  provide  new  in- 
formation on  the  abnormalities  of  carbohy- 
drate metabolism  seen  in  this  syndrome. 

Dr.  Thomas  Shields:  These  patients 
present  a serious  anesthetic  problem  dur- 
ing the  removal  of  the  tumor.  Dr.  Homi  is 
the  anesthesiologist  in  charge  of  this  pa- 
tient and  will  comment  on  the  manage- 
ment of  the  patient  during  operation. 

Dr.  John  Homi:  Anesthetists  can  come 
across  a pheochromocytoma  in  two  ways:  as 
an  emergency  or  as  an  elective  procedure. 
The  patient  may  present  an  abdominal 
emergency,  not  usually  with  intestinal  ob- 
struction, because  that  is  indeed  rare.  They 
may  have  abdominal  pain  and  they  may  be 
rushed  into  the  operating  room  with  a diag- 
nosis of  acute  appendicitis,  for  example, 
and  if  the  blood  pressure  is  not  being  moni- 


640 


Illinois  Medical  Journal 


tored  carefully,  a catastrophe  can  occur.  In- 
deed, this  is  how  a number  of  these  patients 
die.  One  of  the  patients  I managed  in  Cleve- 
land had  a brother  who  succumbed  in 
this  way.  He  had  a cerebral  hemorrhage 
during  an  appendectomy.  It  is  worthwhile 
to  have  Regitine  available,  although  statis- 
tically the  chances  of  encountering  a tumor 
in  this  way  are  very  slight. 

There  are  many  ways  of  preparing  the 
patient  medically,  and  there  are  advan- 
tages and  disadvantages  to  all.  In  some 
centers  Phenoxybenzamine,  an  alpha  re- 
ceptor blocking  agent,  has  been  used 
to  prepare  the  patient  preoperatively.  This 
smooths  out  the  anesthetic  course  tre- 
mendously, but  it  has  one  drawback  in 
my  opinion.  If  multible  tumors  are  present, 
which  occurs  in  approximately  ten  per 
cent,  or  a small  tumor  in  an  unusual  site, 
you  may  miss  a tumor  at  operation.  An- 
other approach  to  preoperative  alpha 
blockade  is  to  use  a Phentolamine  (Regi- 
tine) drip,  the  blood  pressure  being  very 


carefully  monitored  at  all  times.  A partial 
block  of  the  beta  receptor  system  with  Pro- 
panalol  (Inderal)  can  be  used  in  cases 
where  tachycardia  or  arrhythmias  are  of 
concern. 

As  far  as  premedication  is  concerned,  I 
think  the  patient  should  be  premedicated 
rather  heavily,  because  anybody  who  is  hav- 
ing an  abnormal  operation  for  a rare  dis- 
ease is  apprehensive  and  will  secrete  cate- 
cholamines. Any  sort  of  stimulation  of  the 
patient,  such  as  the  introduction  of  tubes 
preoperatively,  adds  to  the  preoperative 
stress.  The  induction  of  anesthesia  should 
be  started  with  a small  needle.  You  should 
not  have  to  do  cut-downs  or  insert  large 
intravenous  catheters  into  the  patient. 
These  are  very  unpleasant  and  may  be  dan- 
gerous. A rather  slow  careful  induction  of 
anesthesia,  taking  frequent  pressure  mea- 
surements, is  needed.  I think  there  should 
be  two  anesthetists  on  the  case,  or  two  peo- 
ple concerned  with  anesthesia  in  the  opera- 
ting room,  one  of  whom  does  nothing  but 


Fig.  2.  Pheochromocytoma  of  right  adrenal  adja- 
cent to  lateral  border  of  the  inferior  vena  cava  and 
the  superior  edge  of  the  right  renal  vein. 


for  November,  1968 


641 


watch  the  pressure  at  this  stage,  using 
either  a standard  blood  pressure  cuff  or, 
preferably,  an  oscillotonometer.  Having  got 
the  patient  intubated  without  bucking  or 
straining  (and  this  is  very  important  be- 
cause putting  an  endotracheal  tube  into  the 
trachea  can  be  strong  stimulus  and  may 
trigger  a severe  bout  of  hypertension  or  ar- 
rhythmia in  these  patients),  steps  to  set  up 
suitable  monitoring  equipment  may  now 
be  taken.  At  this  time  a central  venous 
pressure  catheter  is  inserted  as  well  as  some 
form  of  intra-arterial  pressure  monitor. 

(The  one  described  by  Dr.  Hale  in  the 
Cleveland  Clinic  Quarterly  has  proven  very 
satisfactory  in  my  hands.)  The  accuracy  is 
not  as  important  as  the  record  of  change; 
what  you  want  to  know  is  if  the  blood  pres- 
sure is  going  up  or  if  it  is  coming  down. 
The  pressure  monitor  must  be  inserted 
when  the  patient  is  at  the  proper  depth  of 
anesthesia,  and  before  the  abdominal  pre- 
paration starts  stimulating  the  patient. 
These  points  are  most  important  because 
these  patients  tend  to  have  a fluctuating 
blood  volume  as  well  as  a fluctuant  blood 
pressure.  We  wish  to  insure  that  neither 
hypoxic  nor  hypercarbic  stimulation  of 
catecholamine  output  is  present.  The  ven- 
ous pressure,  blood  pressure,  pulse  rate, 
and  electrocardiogram  are  now  on  display. 
This  enables  the  anesthesiologist  to  replace 
fluid  and  blood  rationally,  or  to  give  alpha 
or  beta  blocking  drugs  as  indicated. 

I would  like  to  point  out  that  unfortun- 
ately each  case  is  different.  Some  have  pre- 
dominantly noradrenalin  excretion,  some 
may  secrete  a lot  of  adrenalin,  a few  will 
secrete  very  little  of  either.  Thus,  some  of 
these  tumors  give  very  little  trouble  during 
anesthesia,  general  anesthesia  alone  being 
enough  to  lower  their  blood  pressure. 
Others  can  cause  cardiac  arrhythmias,  spik- 
ing blood  pressures,  etc.  However,  when  the 
proper  monitors  are  used  and  the  appropri- 
ate drugs  are  available,  one  can  usually 
handle  these  exigencies.  I think  the  danger 
with  these  cases  is  to  underestimate  them. 
When  you  have  only  an  ordinary  blood 
pressure  cuff  and  do  not  have  an  estimate 
of  venous  pressure,  you  can  sometimes  mis- 
interpret the  blood  pressure  or  other  chan- 
ges. Either  excessive  or  inadequate  trans- 
fusion can  result.  Similarly,  important  ar- 
rhythmias can  go  undetected  without  suit- 
able recording  devices. 


The  choice  of  what  anesthetic  agent  to 
use,  which  is  stressed  in  some  of  the  litera- 
ture, is  not  nearly  so  important  as  you 
might  think,  because  actually  as  long  as 
the  patient  is  at  an  adequate  depth  of  an- 
esthesia, and  without  hypercapnia,  acidosis, 
or  hypoxia,  the  various  drugs  we  now  have 
on  hand  can  modify  the  catecholamine 
secretion  problem.  Needless  to  say,  how- 
ever, agents  which  are  known  to  signifi- 
cantly sensitize  the  myocardium  to  catecho- 
lamines such  as  cyclopropane  or  trichlore- 
thylene  are  best  avoided.  N2O  and  O2,  Halo- 
thane,  Methoxyflurane  and  ether  have  all 
been  used  successfully  in  these  patients. 

Personally,  in  the  case  of  small  tumors  of 
uncertain  situation  with  little  catechola- 
mine secretion  I jDiefer  to  use  an  agent  to 
lower  the  blood  pressure  by  a direct  action 
on  the  smooth  muscle  of  the  vessels.  Sodi- 
um nitraprusside  is  the  most  useful  agent 
of  this  type.  To  raise  the  blood  pressure  a 
vasoconstrictor  (which  is  not  related  to 
catecholamines,  but  has  a direct  action  on 
vessels,  namely,  angiotensin)  is  useful.  An- 
other non-specific  drug,  namely  Lidocaine 
(Xylocaine),  is  effective  for  controlling  ven- 
tricular arrhythmias  and  is  widely  used  in 
anesthesia.  In  the  case  of  tumors  of  known 
situation  which  are  known  to  be  affecting 
the  myocardium  and  blood  pressure  severe- 
ly, I think  there  is  a place  for  using  alpha 
and  beta  blocking  drugs  both  preoperative- 
ly  and  intraoperatively.  Postoperatively,  re- 
placement of  blood  and  fluid  as  dictated  by 
changes  in  central  venous  pressure,  pulse 
rate,  and  blood  pressure  will  often  render 
vasopressor  therapy  unnecessary. 

To  sum  up,  it  is  perfectly  possible  to 
manage  these  cases  with  many  different 
combinations  of  drugs.  What  I think  is  im- 
portant in  anesthetic  management  is  pro- 
per preoperative  preparation,  skillful  in- 
duction and  maintenance  of  anesthesia  to- 
gether with  setting  up  proper  monitoring 
systems  as  I described  and  thereby  keeping 
full  control  of  the  situation  during  the 
operative  and  sometimes  critical  postopera- 
tive period. 

Dr.  Shields:  Dr.  Conn,  will  you  com- 
ment on  the  surgical  approach  to  pheochro- 
mocytoma? 

Dr.  Julius  Conn:  Since  99  per  cent  of 
pheochromocytomas  will  be  found  in  the 
abdominal  cavity,  arteriographic  studies 
add  very  little  considering  the  risk  that 


642 


Illinois  Medical  Journal 


they  add.  From  five  to  ten  per  cent  of  them 
will  be  multiple,  so  both  adrenal  glands, 
periaortic  areas,  and  anywhere  chromaffin 
tissues  are  present  must  be  carefully  ex- 
plored, We  prefer  to  explore  these  patients 
utilizing  bilateral  transverse  upper  abdom- 
inal incision,  which  gives  access  to  both 
adrenal  areas  and  will  give  good  exposure 
of  the  entire  retroperitoneal  area  including 
the  pelvis.  I favor  exploring  the  left  adren- 
al using  the  approach  that  Brady  and  Flan- 
dreau  described  in  1958,  rather  than  re- 
flecting the  spleen  and  the  colon.  An  inci- 
sion is  made  in  the  base  of  the  medocolon 
to  the  left  of  the  inferior  mesenteric  vein. 
This  does  away  with  the  extensive  dissec- 
tion in  the  left  upper  quadrant  and  still 
gives  good  exposure  of  the  left  adrenal. 

Good  preoperative  preparation  and  anes- 
thetic management  turns  this  from  a very 
risky,  very  difficult  operation  into  just  a 
difficult  operation. 

The  patient’s  abdomen  was  explored 
through  a bilateral  transverse  upper  ab- 
dominal incision.  There  was  a vascular, 
firm,  4x6x8  cm.  mass  in  the  area  of  the 
right  adrenal.  The  mass  extended  along 


the  superior  border  of  the  right  renal  vein 
and  the  lateral  border  of  the  inferior  vena 
cava  (Fig.  2).  There  was  a prominent  thrill 
felt  over  the  inferior  vena  cava  adjacent  to 
the  tumor.  As  the  veins  draining  the  tu- 
mor were  individually  ligated,  the  thrill  di- 
minished in  intensity  and  then  disappeared. 
Careful  exploration  of  the  left  adrenal,  the 
periaortic  region,  and  the  pelvis  was  nega- 
tive for  an  additional  pheochromocytoma. 

The  pheochromocytoma  weighed  82  gms. 
and  was  cystic  in  one  area  (Fig.  3),  The 
cyst  contained  12  cc,  of  bloody  fluid  which 
was  assayed  for  catecholamine  activity. 

The  postoperative  course  was  uneventful 
with  the  patient  ready  for  discharge  on  the 
tenth  postoperative  day.  His  blood  pressure 
was  120/80  at  the  time  of  his  discharge 
from  the  surgical  service. 

References 

1.  Porte,  D.,  Jr,  Graber,  A.L.,  Kuzuya,  T.,  and  Wil- 
liams, R.H.:  “The  Effect  of  Epinephrine  on  Im- 
munoreactive  Insulin  Levels  in  Man.”  J.  Clin. 
Invest.  45:228,  1966. 

2.  Porte,  D.,  Jr.:  “A  Receptor  Mechanism  for  the 
Inhibition  of  Insulin  Release  by  Epinephrine  in 
Man.”  J.  Clin.  Invest.  46:86,  1967. 


Fig.  3.  Bisected  pheochromocytoma  showing  large 
cystic  area. 


for  November,  1968 


643 


THE  VIEW  BOX 


By  Leon  Love,  M-D. 

Director,  Department  of  Diagnostic  Radiology,  Cook  County  Hospital, 
and  Clinical  Professor  of  Radiology,  Chicago  Medical  School 


This  ten  year  old  boy  entered  with  a chief  complaint  of  vomiting  of  one 
day’s  duration  and  pain  which  was  generalized  throughout  the  abdomen. 
Physical  examination  revealed  diffuse  tenderness  throughout  the  abdomen. 
A white  blood  count  was  6,500. 

What’s  your  diagnosis? 

1)  Gastroenteritis 

2)  Acute  appendicitis 

3)  Intussusception 

4)  Gallstone  (Answer  on  page  684) 


644 


Illinois  Medical  Journal 


Medical  Progress 

Automotive  Injury 
and  the 

Practicing  Physician 

By  Eugene  F.  Desmond,  M.D. /Chicago  and 
Seymour  Charles,  M.D. /Newark,  N.J. 


Automobile  injuries,  an  unfortunate 
by-product  of  man’s  technology,  constitute 
an  ever-increasing  environmental  epidemic 
which  has  already  reached  staggering  pro- 
portions. Auto  accidents  now  cause  53,000 
deaths  and  over  4,000,000  injuries  annually 
in  the  United  States  to  rank  only  behind 
cancer  and  cardiovascular  disease  as  a 
cause  of  death  in  our  country.  Automotive 
injuries  are  the  number  one  cause  of  death 
for  those  between  15  and  24  years  of  age 
and  far  outstrip  Vietnam  and  all  wars  as  a 
killer  of  youth.  Before  1980,  one  out  of 
every  five  Americans  will  have  been  killed 
or  injured  in  an  auto  accident  and  half  of 
us  will  be  involved  in  an  injury-producing 
collision  in  our  lifetime. 

If  drastic  preventive  measures  are  not 
soon  undertaken  the  next  ten  years  will 
see  the  number  of  deaths  rise  to  100,000  an- 
nually and  the  cost  of  human  and  property 
damage  will  increase  from  the  current  8 
billion  to  15  billion  dollars  annually.  The 
magnitude  of  the  medical  problem  is  illus- 
trated in  Table  I. 

Until  the  recent  past,  physicians  have 


Medical  Progress 


Harvey  Kravitz,  M.D. 
Medical  Progress  Editor 


concentrated  their  clinical  attention  on 
medical  disabilities  which  compound  error 
and  compromise  driving  expertise.  Visual 
defects,  alcoholism,  convulsive  disorders, 
mental  illness,  and  other  chronic  illnesses 
have  been  considered  to  be  at  least  relative 
impediments  to  driver  licensure  but  meth- 


Table  I 

ESTIMATES  OF  THE  CURRENT  IMPACT  OF  MOVING  MOTOR 
VEHICLE  INJURIES  ON  MEDICAL  RESOURCES 


HOSPITAL  CARE 


Annual  number  of 

persons  hospitalized  502,000 

Annual  number  of 

days  of  care  8,534,000 

Average  length  of  stay 

per  person  hospitalized  17  days 

Number  of  hospital 

beds  required 23,000 


MEDICAL  ATTENTION  BECAUSE  OE  MOVING 
MOTOR  VEHICLE  INJURIES  (per  year) 


Hospitalized  persons  502,000 

Non-hospitalized  persons  2,803,000 


TOTAL  persons  receiving 

medical  care  3,305,000 


PHYSICIANS’  SERVICES 


In-hospital  physicians’ 

visits  8,534,000 

Out-of-hospital 

physicians’  visits  5,606,000 

TOTAL  physicians’ 

visits  14,140,000 


COSTS  OE  MEDICAL  SERVICES  (per  year) 


Hospital  expenditures  S354,844,000 

Physicians’  services  79,608,000 

Other  medical  services 

and  supplies  280,920,000 

TOTAL  costs  of  medical  services  5715,372,000 


for  November,  1968 


645 


ods  of  identifying  and  controlling  medical 
disabilities  prior  to  licensure  have  been 
largely  ineffectual  despite  physician  inter- 
est and  participation. 

A great  burden  of  responsibility  for  med- 
ical and  surgical  care  for  the  accident  vic- 
tims has  fallen  upon  the  medical  profession 
but  the  profession  has  yet  to  apply  its  pre- 
ventive medicine  skills  meaningfully  to 
this  huge  epidemic,  fn  these  days  of  over- 
crowded and  understaffed  hospitals,  it  is 
not  difficult  to  visualize  the  potential  of 
such  a preventive  program  in  reducing 
the  frequency  and  severity  of  injuries. 

American  safety  philosophy  has  tradition- 
ally emphasized  the  human  error  in  acci- 
dent causation  with  final  assignment  of  re- 
sponsibility to  the  “nut  behind  the  wheel.” 
Various  exhaustive  public  campaigns  have 
been  attempted  to  influence  driver  be- 
havior with  no  obvious  lowering  of  acci- 
dent statistics.  Recently  various  authors^’^ 
have  developed  an  epidemiological  ap- 
proach to  the  control  of  automobile  acci- 
dents, and  as  physicians  we  are  naturally 
oriented  to  this  approach.  The  host  is  our 
patient  in  his  capacity  as  driver,  passenger, 
or  pedestrian.  The  causative  agent  of  the 
bodily  injury  is  the  automobile. 

Two  Collisions  in  Every  Crash 

In  every  crash,  there  are  two  separate 
collisions.  The  first  is  the  impact  of  the  ve- 
hicle itself  with  another  car  or  obstruction. 
In  the  second  collision  the  driver  or  the 
passengers,  continuing  in  the  same  direc- 
tion of  travel  as  the  vehicle,  must  strike 
some  object  of  the  interior  or  exterior  to 
interrupt  that  course  of  travel.  It  is  this 
second  collision,  a fraction  of  a second  af- 
ter the  first  impact  which  is  responsible  for 
bodily  injury.  As  studies  are  directed  to 
the  forces  and  factors  involved  in  the  col- 
lision of  the  passenger  with  the  internal 
vehicle  structure  or  exterior,  specific  pat- 
terns of  injury  become  apparent.  These 
patterns  of  injury  repeat  themselves  with 
such  frequency  that  methods  of  prevention 
become  evident. 

Just  as  in  the  aircraft,  the  forces  trans- 
mitted to  the  occupants  of  the  automobile 
are  determined  by:  (1)  their  attenuation 

and  absorption  by  structures  intervening  be- 
tween the  occupant  and  the  point  of  colli- 
sion contact;  (2)  distance  and  direction  of 
displacement  of  the  occupant;  (3)  area  con- 
figuration and  resistance  of  objects  against 


which  the  occupant  is  decelerated;  (4)  at- 
tenuation and  absorption  of  forces  by  the 
body  of  the  occupant;  (5)  rate  of  application 
of  the  forces;  (6)  frequency  characteristics; 

(7)  duration. 

Investigations  Into  Crashes 

Two  early  pioneers  in  the  initiation  of 
studies  on  the  correlation  between  the 
forces  of  deceleration  and  the  tolerance  of 
the  human  being  were  Mr.  Hugh  DeHav- 
en,  founder  of  the  Cornell  Automotive 
Crash  Injury  Research  Project,  and  Col. 
John  Stapp  of  the  United  States  Air  Force. 

Mr.  DeHaven  first  became  interested  in 
the  mechanics  of  injury  and  safety  design 
when  he  escaped  serious  injury  while  in  the 
Royal  Air  Force  during  World  War  I.  His 
side  of  the  cockpit  had  remained  intact 
and  he  survived,  while  his  associates  were 
killed  in  the  crushed  contra-lateral  side  of 
the  plane.  As  he  began  his  studies,  he  noted 
that  “many  of  the  traumatic  results  of  both 
air  and  auto  accident  could  be  avoided. 
Structures  and  objects  by  placement  and 
design  created  an  inevitable  expectation  of 
injury  in  even  minor  accidents.” 

DeHaven^  established  that  the  apparent 
miraculous  survival  in  the  instances  of 
freefall  indicated  that  the  human  body  un- 
der the  conditions  of  extreme  force  was 
capable  of  unexpectedly  large  tolerances. 
He  maintained  that  “the  person  who  es- 
capes in  a high  speed  crash,  owes  his  life 
to  some  decelerative  interval  and  to  a fa- 
vorable distribution  of  pressure.”  The  basis 
for  the  modern  concept  of  occupant  and 
pedestrian  protection  is  that  structural  pro- 
visions to  reduce  impact  and  distribute 
pressure  can  enhance  survival  and  modify 
injury  within  wide  limits. 

About  twenty  years  ago.  Col.  Stapp^ 
realized  that  for  all  his  efforts  to  improve 
the  safety  of  pilot  and  passengers  in  air 


Eugene  F.  Diamond, 

M.D.,  (right)  is  Clin- 
ical Professor  and  Act- 
ing Chairman,  De- 
partment of  Pediat- 
rics, Stritch  School  of 
Medicine.  He  holds  his 
M.D.  from  Stritch  and 
has  served  a pediat- 
ric residency  at  the 
University  of  Chicago.  He  is  a member  of  the 
Accident  Prevention  Committee  of  the  Ameri- 
can Academy  of  Pediatrics. 

Seymour  Charles,  M.D.,  is  from  Newark,  New 
Jersey.  He  is  National  Chairman  of  the  Phy- 
sicians for  Automotive  Safety. 


646 


Illinois  Medical  Journal 


flight,  personnel  losses  were  larger  from 
automobile  accidents.  He  recognized  the 
similarity  of  crash  forces.  “Must  exposure 
to  mechanical  force  invariably  result  in  in- 
jury or  death?  How  much  mechanical  force 
can  a human  body  withstand  and  survive 
with  no  permanent  ill  effects?  'What  pro- 
tective measures  can  be  employed  to  insure 
survival  up  to  a limit  of  failure  of  the  hu- 
man body?” 

Using  himself  as  a subject,  Dr.  Stapp  un- 
dertook a series  of  courageous  experiments, 
propelling  himself  at  over  600  miles  per 
hour  and  then  coming  to  a sudden  stop. 
He  personally  recorded  the  limits  of  toler- 
ance of  the  human  body  to  the  force  of  de- 
celeration. He  became  convinced  that  the 
human  could  absorb  such  forces  that  a 
whole  car  could  be  designed  from  top  to 
bottom,  from  side  to  side,  from  bumper  to 
bumper  to  crash  safely  and  allow'  the  occu- 
pants to  w'alk  aw'ay  wdth  minimal  injuries. 

The  Safer  Automobile 

Substantial  evidence  has  now'  been  accu- 
mulated to  show'  how'  Stapp  and  DeHaven’s 
pioneer  research  can  be  brought  to  the 
draw’ing  board  in  the  design  of  a safer 
automobile; 

1.  Build  the  package,  that  is  the  car 
body,  strong  enough  so  that  it  will  not 
collapse,  crushing  the  contents  of  the 
car  (the  occupants). 

2.  Construct  the  door,  including  door 
locks,  so  that  doors  will  stay  closed  to 
prevent  the  occupants  from  being 
throwm  out  of  the  car  against  some 
solid  object.  Doors  should  open  easily 
after  a crash  so  that  the  occupants  can 
get  out. 

3.  Restrain  the  occupants  so  that  they 
w'ill  decelerate  w'ith  the  car  instead  of 
hitting  the  interior  of  the  car,  thus  re- 
ducing the  stopping  force. 

4.  Design  the  interior  of  the  car  so  that 
w'hen  the  occupants  are  throw'n  for- 
ward they  W'ill  come  in  contact  w'ith 
larger  and  energy-absorbing  areas, 
thus  reducing  the  stopping  force. 

These  engineering  principles  can  be  ef- 
fectively implemented  because  each  acci- 
dent is  not  just  another  isolated  tragedy  of 
human  error.  Non-industry  research  at 
Harvard,^  Cornell,®  UCLA,''  and  Michi- 
gan® Universities  show’s  specific  patterns  of 
bodily  injury. 


Injury  Causing  Facets 

There  is  repetition  of  injury  causation  in 
hundreds  of  automobile  accidents  every 
day  wTere  the  accident  causation  is  far  less 
uniform.  Specific  interior  and  structural  de- 
sign features  have  clear  relationship  in  fre- 
quency and  type  of  injury  in  study  after 
study.  The  steering  assembly,  the  w'ind- 
shield,  instrument  panel,  upper  part  of  the 
front  seat  back  rest,  door  structures,  lower 
part  of  the  front  seat  back  rest,  corner 
post,  headers,  sun  visors  and  hardware  are 
leading  sites  of  injury-producing  impact. 

In  both  the  Cornell  and  Michigan  stud- 
ies, the  steering  assembly  accounted  for 
about  20%  of  the  serious  injuries,  usually 
to  the  driver  as  he  is  throw'n  forw^ard, 
crushed  or  impaled.  Restraining  devices 
have  limited  protection  for  the  driver  as 
the  steering  assembly  invades  the  occupant 
area  in  ramrod  effect. 

The  instrument  panel  w'ith  its  assortment 
of  protrusive  knobs  accounted  for  12%  of 
the  deaths  in  the  Huelke-Gikas®  investiga- 
tions of  170  automobile  fatalities  in  'Wash- 
tenaw' County,  Mich.  Even  the  recently 
fashionable  superficial  padding  of  these 
panels  has  not  corrected  underlying  edges 
w'hich,  as  Mr.  DeHaven  observed  years  ago, 
act  as  a steel  beam  or  anvil  inflicting  head 
and  face  injuries. 

The  Cornell®  studies  show  over  11%  of 
the  injuries  are  caused  by  the  wdndshield, 
meaning  that  at  least  200,000  of  our  pa- 
tients are  disabled  or  disfigured  annually, 
often  W'ith  long,  expensive  convalescenses. 

Although  the  steering  assembly,  instru- 
ment panel  and  windshield— in  that  order 
— w'ere  the  most  dangerous,  the  most  ser- 
ious cause  of  injury  to  the  occupant  w'as 
ejection  from  the  car  itself.  Cornell  data 
show'ed  that  ejection  from  the  vehicle  ac- 
counted for  about  25%  of  serious  and  fatal 
injuries.  The  risk  of  fatal  injury  was  in- 
creased fivefold  if  the  occupant  w'as  throw'n 
from  the  car.  Ejection  occurs  w'hen  the 
doors  pop  open  after  crashes  and  the  oc- 
cupants are  hurled  free  of  the  vehicle. 

Ejection  Causes  Most  Serious  Injuries 

In  a Ford  Motor  Company  survey  in 
some  22  states,  the  reduction  in  injury  and 
death  to  those  wearing  seat  belts  was  sig- 
nificant, in  that  those  w’earing  seat  belts  in- 
curred 66%  fewer  injuries  and  80%  few’er 
deaths.  In  the  Huelke-Gikas  studies  of  the 


for  November,  1968 


647 


University  of  Michigan,  40%  of  the  deaths 
were  preventable  had  restraining  devices 
been  used.  Even  if  the  effectiveness  of  seat 
belts  at  high  speeds  is  questioned,  studies 
still  show  a large  measure  of  protection  can 
be  afforded  regardless  of  the  speed  of  im- 
pact. 

The  tragedy  of  ejection  is  that  even  a 
minor  accident  can  produce  a fatality  as 
the  person  is  likely  to  be  run  over  by  an- 
other car  or  seriously  strike  some  fixed  ob- 
ject. Cornell®  studies  also  showed  that 
roll-overs,  which  occur  in  one  out  of  every 
five  rural  accidents,  are  especially  lethal 
and  not  infrequently  result  in  the  ejected 
passengers  being  pinned  beneath  the  cars. 

For  the  past  20  years,  seat  belts  have 
been  the  most  effective  single  available  de- 
vice to  reduce  the  severity  of  injury  in  the 
second  collision.  Properly  designed,  tested 
and  installed  restraining  devices  for  the 
driver  and  his  passengers,  regardless  of  the 
individual  positions  in  the  car,  for  exam- 
ple, do: 

1.  Minimize  contact  of  the  vital  parts  of 
the  body  from  injurious  impact  with 
the  interior  of  the  car. 

2.  Secure  the  position  of  the  driver  and 
occupants  in  their  properly  seated  po- 
sitions in  order  to  prevent  loss  of  con- 
trol of  the  car. 

3.  Prevent  ejection  of  the  driver  and 
passengers  from  the  vehicle  and  injury 
producing  contact  with  outside  ob- 
jects, crushing  by  the  vehicle,  or  crush- 
ing by  other  vehicles. 

Although  these  facts  have  been  known 
for  two  decades,  the  simple  lap  belt  has 
yet  to  be  installed  in  more  than  1/3  of  the 
American  cars;  the  incidence  of  utilization 
is  even  less,  ft  is  already  evident  that  the 
shoulder  strap  harness  arrangement,  pre- 
ferably in  combination  with  a lap  belt  in 
a three  point  insertion,  would  be  much 
more  effective  in  preventing  severe  injuries 
for  the  front  seat  passengers.  Harness  type 
restraints  are  even  more  important  for  in- 
fants and  children,  as  they  habitually 
romp  and  jump  about  in  the  fast  moving 
car  and  not  only  are  a perilous  distraction 
to  the  driver  but  put  themselves  in  con- 
stant jeopardy  with  a sudden  collision. 

Other  studies  implicate  overall  construc- 
tion and  weight  of  automobiles.^^  Acci- 
dents were  studied  involving  cars  of  various 
weights,  classified  as  follows:  (1)  771  small 
foreign  cars  of  under  2,000  pounds;  (2) 


1,085  foreign  and  American  cars  of  be- 
tween 2,000  and  3,000  pounds;  (3)  10,979 
American  standard  size  autos  of  more  than 
3,000  pounds. 

fn  class  1 there  were  20%  more  severe 
accidents  and  50%  more  fatal  accidents 
than  in  class  3.  Class  2 with  75%  American 
and  25%  foreign  cars  fared  only  slightly 
better  than  the  light  weights.  The  major 
factor  in  the  poor  record  of  the  small  cars 
was  a 63%  higher  ejection  rate  than  class 
3,  and  25%  higher  ejection  than  class  2. 
Furthermore,  the  lightest  cars  were  more 
often  involved  in  roll-over  type  accidents: 
47.4%  for  the  small  cars,  26.9%  for  the 
medium-size  cars  and  20.6%  for  the  heavy 
cars. 

Release  of  Research  Data 

No  other  field  of  medicine  has  such  a 
restriction  of  publication  of  research  and 
investigation.  The  studies  of  human  toler- 
ances of  forces  of  deceleration,  the  patterns 
of  injury  determined  in  retrospective  and 
planned  crash  studies,  and  the  established 
means  of  occupant  and  pedestrian  protec- 
tion are  not  presented  and  discussed  in  the 
regular  medical  journals  of  this  country. 
U.S.  government  subsidies  have  paid  for 
most  of  the  research  done  by  the  superb 
organization  of  the  Cornell  Crash  Injury 
Research  project.  The  public  release  of 
much  of  this  valuable  investigation  is  con- 
trolled not  by  the  Public  Health  Service 
but  by  the  Automobile  Industry. ini- 
portant  research  reported  at  the  annual 
Stapp  Crash  Conferences  and  meetings  of 
the  American  Association  of  Automotive 
Medicine  is  seldom  circulated  in  the  popu- 
lar lay  press  although  the  most  intricate 
details  of  virology,  cancer  therapy  and 
genetic  research  are  regularly  presented. 
When  the  medical  profession  understands 
the  available  means  of  injury  prevention, 
there  will  be  a sharpening  of  clinical  cor- 
relation in  practice  and  reporting  of  new 
experiences.  The  present  grim  acceptance 
of  accident  pathology  from  the  automobile 
can  be  replaced  with  inquisitive  evaluation 
of  each  patient’s  bodily  injury  and  dis- 
ability in  terms  of  how  this  experience 
might  be  applied  to  prevention.  This  is 
the  same  rationale  which  permeates  all 
other  aspects  of  medical  practice. 

One  of  the  most  serious  and  chronic  bod- 
ily injuries,  especially  to  the  front  seat  pas- 
senger and  driver,  is  that  called  the  whip- 


648 


Illinois  Medical  Journal 


Summary 


lash.  Here,  tlie  forces  of  deceleration  throw 
the  neck  and  head  into  extreme  extension  to 
produce  severe  hemorrhage  and  tearing  of 
the  miisulo-skeletal  structures  in  the  pos- 
terior neck.  A properly  positioned  head- 
rest would  prevent  this  injury  or  reduce 
its  severity. 

A gamut  of  design  deficiencies  show  lack 
of  attention  to  problems  of  driver  and  pe- 
destrian visibility.  Automobiles  can  and  do 
become  invisible  day  and  night  with  ob- 
vious implications  in  accident  causation. 
\fisual  obstructions  are  caused  by  wind- 
shield glare  and  distortions,  cornerposts, 
rearvie^v  mirrors,  rear  corner  blind  spots, 
and  glare  off  of  the  vehicle  surface.  A^ehicle 
signal  systems  aie  inadequate  and  hazard- 
ous. Corection  of  most  visual  defects  in- 
volves application  of  knotvn  technological 
means.i^ 

Representative  Kenneth  A.  Roberts, 
former  chairman  of  the  Subcommittee  on 
Health  and  Safety  of  the  House  Interstate 
Commerce  Committee  spent  more  than  ten 
years  studying  the  problem  of  hightvay 
safety.  In  August  of  1964  the  Roberts’  Bill 
tvas  passed  which  requires  the  Congress  to 
establish  safety  standards  for  automobiles 
to  make  it  illegal  for  any  car  to  be  shipped 
in  interstate  commerce  that  does  not  meet 
these  standards.  In  effect,  the  legislation  re- 
quires the  General  Services  Administration 
to  establish  safety  standards  for  cars  which 
the  government  tcill  purchase.  Although 
the  government  purchases  less  than  60,000 
vehicles  per  yeai',  it  was  believed  that,  by 
using  the  level  of  federal  supply  standards, 
the  automobile  indusm-  might  be  encour- 
aged to  extend  the  same  safety  features  re- 
quired in  government  cars  to  those  sold  to 
the  general  public. 

A\4th  the  recognition  of  automotive  in- 
jury and  death  in  an  epidemiological  con- 
text as  preventable  disorders,  at  least  in 
part,  the  medical  profession  can  assume  a 
more  meaningful  role  in  their  control.  The 
physician  can  join  with  automotive  en- 
gineers, highway  safety  technicians  and 
other  members  of  an  aroused  and  anxious 
citizenry.  Hopefully,  such  a conjoint  effort 
might  reverse  the  trend  of  this  runaway 
epidemic  of  trauma  and  death. 


1.  Automotive  injury  and  death  consti- 
tute a huge  public  health  problem 
which  is  on  the  increase. 

2.  Epidemiological  approaches  to  this 
problem  would  seem  to  offer  the 
chief  hope  of  success  in  effecting  re- 
duction. 

3.  “Second  collision’’  type  injuries  could 
be  favorably  influenced  by  improved 
automobile  exterior  and  interior  de- 
sign. 

4.  Passenger  restraint  systems  are  also 
important  in  reducing  various  types 
of  injury  including  those  due  to  ejec- 
tion. 

5.  Greater  professional  and  public 
atvareness  of  the  problem  and  its  pre- 
ventable aspects  are  needed. 

References 

1.  Severv,  D.  M.,  Mathewson,  J.  H.,  Siegel,  A. 
\V.;  Automobile  Head-On  Collisions.  Series 
II  SAE  Trans.  67:238,  1959. 

2.  Haddon,  ^V.,  Klein,  D.,  and  Suchman,  E.  A.; 
Accident  Research,  Methods  and  Approaches, 
Xew  York,  Harper  & Row  Publishers,  Inc. 
1965. 

3.  DeHaven,  H.;  Mechanical  .\nalysis  in  Falls 
of  Fifty  to  One  Hundred  and  Fifty  Feet. 
^Far  Medicine  2:586,  1942. 

4.  Stapp,  J.  P.;  Human  Tolerance  to  Decelera- 
tion; Am.  J.  Surg.  93:734,  1957. 

5.  Moseley,  A.  L.;  Research  on  Fatal  Hightvay 
Collisions;  Boston,  Harvard  University  Press, 
1962. 

6.  Moore,  J.  D.,  et  al;  Child  Injuries  in  .Auto- 
mobile -Accidents;  Xew  A’ork,  Cornell  .Auto- 
motive Injuiy  Research,  1960. 

7.  Mathewson,  J.  H.,  et  al;  .Automobile  Head- 
On  Collisions,  Series  III  S.AE  Reprint  211  D, 
.August  1960. 

8.  Gikas,  P.  AV.  and  Huelke,  D.  F.;  How  Do 
They  Die?;  S.AE  Publication  1003  .A,  1965. 

9.  .Automobile  Crash  Safety  Research;  Buffalo, 
X’ew  A'ork:  Cornell  .Aeronautical  Faboratoiy, 
Inc.  1955. 

10.  Study  of  Human  Kinematics  in  a Rolled- 
Over  .Automobile;  Buffalo,  X'ew  A'ork:  Cor- 
nell .Aeronautical  Laboratory,  Inc.  1959. 

11.  McFarland,  R.  .A.,  Moore,  R.  C..  and  AVar- 
ren,  .A.  B.;  Human  A’ariables  in  Motor  A'e- 
hicle  -Accidents,  Review  of  the  Literature; 
Harvard  School  of  Public  Health,  Boston 
1955. 

12.  X'ader,  R.;  Unsafe  .At  .Any  Speed;  Xew  A’ork, 
Grossman  1965. 

13.  -Allen,  M.  J.;  Certain  A'isual  .Aspects  of  the 
-Average  Modern  .American  .Automobile;  J. 
-Amer.  Optometry  .Association  5:380,1962. 


Faith  may  be  defined  briefly  as  an  illogical  belief  in  the  occurence  of  the  im- 
probable.—H.  L.  Mencken 


]or  November,  1968 


649 


Tragic  Deaths  Of  The  Lincoln  Sons 

By  Emmet  F.  Pearson,  M.D. /Springfield 


The  essential  elements  of  early  Greek 
tragedies  rested  on  an  inner  triumph  in 
spite  of  outward  defeat.  The  Lincoln  trag- 
edy is  quite  the  opposite,  with  outward  tri- 
umphs that  have  favorably  influenced  the 
entire  human  race  but  brought  complete 
inner  defeat  and  demise  to  the  Lincoln 
family  itself.  The  sublime  tragedy  of  the 
Lincoln  family  story  reaches  its  full  impact 
when  we  recall  the  lamentable  early  deaths 
of  four  of  the  five  Lincoln  sons.  The  final 
pathos  of  this  true-life  drama  of  a once 
happy  Springfield  family  comes  with  the 
extinction  of  the  family  lineage. 

Nearly  everything  that  even  remotely  in- 
volved Abraham  Lincoln  is  of  great  inter- 
est around  the  world.  More  has  been  writ- 
ten about  Lincoln  than  any  other  person 
who  has  lived  on  this  planet  with  the  pos- 
sible exception  of  Jesus  Christ.  The  per- 
sonal tragedies  of  Abe  and  his  wife  Mary 
are  known  to  most,  but  the  terrible  an- 
guish caused  by  the  illness  and  deaths  of 
their  sons  deserves  to  be  retold. 

Abe  was  a strong  young  man,  but  be- 
came a self-styled  hypochondriac  and  had 
several  fits  of  deep  depression.  He  was  an 
indulgent  father  who  suffered  greatly  with 
each  of  his  children’s  illnesses  and  deaths. 
Mary  was  a vivacious,  gracious  and  extra- 
ordinarily ambitious  young  woman.  She 
was  forced  to  watch  three  of  her  four  sons 
die  and  to  see  her  husband  murdered. 
These  bombardments  of  psychic  trauma 
completely  broke  her.  She  was  committed 
for  a while  to  a mental  hospital  and  her 
last  years  were  most  unhappy. 

The  health  problem  of  the  Lincoln  fam- 
ily encompassed  the  amazing  period  of 


Emmet  F.  Pear- 
son, M.D.,  is  an  in- 
ternist. He  is  a 
graduate  of  Wash- 
ington Univ.,  St. 
Louis,  and  served 
his  residenee  at 
Barnes  Hospital. 
Dr.  Pearson  is 
a member  of  the 
ISMS  Archives 
Committee  and  this 
article  is  another 
in  a continuing 
series  commemor- 
ating Illinois’  Ses- 
quicentennial. 


transition  in  medicine  from  the  backwoods 
of  Kentucky  and  the  rugged  frontier  town 
of  New  Salem,  through  the  rising  status  of 
medicine  and  increasingly  well  educated 
doctors  in  Springfield,  on  to  contact  with 
sophisticated  19th  Century  medicine  in 
Europe  and  vigorous  young  Chicago. 

Lincoln’s  Purchases  of  Drugs 

Lincoln  himself  had  close  personal  re- 


lationships with  many  doctors  of  strong 
personality,  and  the  family,  while  living  in 
Springfield,  had  reason  to  call  on  several 
prominent  doctors  as  family  physicians.  It 
appears  that  the  most  frequent  prescriber 
for  the  Lincoln  family  was  amateur  Abe 
himself.  He  made  frequent  purchases  at 
the  Diller  Drug  Store,  the  accounts  of 
which  have  been  preserved.  (Photograph 
of  ledger  page).  Among  the  medicines  that 
Lincoln  purchased  were  castor  oil.  Calo- 
mel, Dr.  Jaynes’  carminative.  Brown’s  mix- 
ture, cough  candy,  spirits  of  camphor,  gly- 
cerine, ipecac,  paregoric,  Wright’s  pills, 
pennyroyal  and  much  brandy.  It  is  reason- 
ably safe  to  assume  that  the  castor  oil  and 
calomel  were  for  the  boys. 

Of  Abe’s  and  Mary’s  four  sons,  only  Ro- 
bert reached  maturity.  Robert’s  only  son, 
Abraham  Lincoln  II,  died  at  the  age  of  16. 
There  were  many  unknown  aspects  of  the 
lives,  health  and  deaths  of  all  the  Lincoln 
male  heirs.  Many  letters  are  extant  that 
pertain  to  the  sicknesses  of  the  boys.  News- 


650 


Illinois  Medical  Journal 


A page  from  the  ledger  of  Diller  Drug  Store, 
Springfield,  showing  purchases  bv  Lincoln  in 
1853. 

paper  reports  are  available,  and  docu- 
ments, county  records  and  the  research  of 
early  historians  are  sufficient  to  fill  in 
many  details.  Some  personal  communica- 
tions of  the  late  Dr.  Clarion  Pratt  and  Dr. 
^Vayne  Temple,  Springfield  historians,  are 
included. 

Robert  Lincoln,  the  fust  child,  Avas  born 
in  the  Globe  Tavern  in  Springfield  exactly 
nine  months  after  the  hectic  marriage  of 
his  parents.  At  that  time.  Dr.  Anson  G. 
Hemy  -^vas  probably  the  family  doctor.  Dr. 
Hemy  had  been  a student  of  the  great  Dr. 
Daniel  Drake  of  Cincinnati.  Mrs.  Lincoln 
tvTote  that  Dr.  Henry  was  her  dearest 
friend.  Mrs.  A.  T.  Bledsoe,  a friend  of  Mrs. 
Lincoln’s,  whose  husband  became  Assist- 
ant-Secretary of  AVar  in  the  Confederacy, 
later  t\Tote  that  she  was  in  attendance  at 
the  birth  of  Robert. 

Lincoln  Sons  Described 

Robert  was  an  introspective,  undemon 
strative,  shy  youth,  who  had  a divergent 
eye.  He  appears  to  have  been  quite  in- 
telligent and  graduated  easily  from  Har- 
vard College.  'When  he  was  fifteen  years 


old,  he  tvas  bitten  by  a dog  presumed  to 
be  mad.  His  father  took  him  to  Terre 
Haute,  Ind.,  to  have  a mad  stone  applied 
to  the  "wound,  to  dra"^\"  out  the  green 
poison  and  prevent  hydrophobia.  (There 
N\ill  be  more  about  Robert’s  family,  after 
discussion  of  his  brothers.) 

AMien  the  next  son,  Edwaid  Baker  (Lit- 
tle Eddie)  came  along,  the  Lincolns  -^s  ere 
becoming  prosperous  and  o^s  ned  the  home 
on  Eighth  Street  in  Springfield.  Only  a fe^v 
letters  refer  to  Eddie,  "vvho  T\as  said  to  be 
a “s'vv’eet”  boy.  His  death,  "which  occurred 
in  1850,  ^\*as  perpetually  lamented  by  his 
parents.  In  Lincoln’s  fare^\'ell  address  to  his 
friends  in  Springfield,  he  said,  “Here  I have 
lived  a quarter  of  a century— and  here  one 
child  lies  buried.’’  Early  historians  said  that 
Eddie  died  of  diphtheria  but  that  diagnosis 
seems  unlikely.  Lincoln  himself  "^aote  that 
the  boy  ^\*as  sick  fifty-nvo  days  and  the 
mortality  schedule  of  the  1850  Eederal  Cen- 
sus reported  that  he  died  from  “consump- 
tion.” One  wonders  if,  indeed,  there  was 
tuberculosis  in  the  family.  Brother  Tad 
probably  died  from  TB  and  ^Eillie,  the 
other  brother,  died  from  some  tvpe  of 
respfratory  infection.  It  seems  probable  that 
Robert’s  son,  Abraham  II,  might  have  had 
tuberculous  empyema.  Eddie’s  body  was 
removed  from  an  old  cemetery  many  yeais 
ago  to  lie  in  his  father’s  tomb.  Only  a fe"w 
years  past,  his  original  tombstone  was  found 
lying  face  down,  and  the  follo"wing  in- 
scription was  noted  on  it:  “Of  such  is  the 
Kingdom  of  Heaven.”  This  is  a line  of  a 
verse  tshich  appeared  anonymously  in  a 
Springfield  paper  after  Eddie’s  death  prob- 
ably "vaitten  by  Mary  Lincoln: 

“The  angel  death  "^s’as  hovering  nigh 
and  the  lovely  boy  "^\*as  caused  to  die. 
Bright  is  the  home  to  him  no"^\*  given 
for  such  is  the  Kingdom  of  Heaven.” 
The  thu  d son,  'Ullliam  'Wallace  Lincoln, 
“"Willie,”  was  born  in  1S50,  not  long  after 
the  death  of  Eddie.  He  "was  named  after 
Dr.  ^Villiam  "Wallace,  "whose  "^vife,  Erances, 
was  a sister  of  Marv  Todd  Lincoln.  Dr. 
"Wallace  was  by  this  time  the  family  doc- 
tor. He  probably  officiated  at  "Wilhe’s 
birth.  "Willie  was  a handsome,  precocious, 
energetic  and  lovable  boy  by  all  accounts. 
He  suffered  repeatedly  ^vith  spells  of  fever. 
One  very  severe  spell  came  on  after  Lin- 
coln’s election  to  the  presidency,  before  the 
family  moved  from  Springfield.  This  epi- 
sode ^s'as  diagnosed  as  scarlet  fever  and  his 


for  November,  1968 


651 


younger  brother,  Tad,  was  sick  at  the  same 
time.  The  occasion  of  this  illness  is  de- 
picted in  the  accompanying  picture  which 
was  made  when  the  sickroom  in  the  Lin- 
coln Home  was  reenacted,  showing  the  two 
boys  sick  in  bed.  Drs.  Henry  and  Wallace 
are  in  attendance,  and  the  distraught  par- 
ents are  looking  on. 

Willie’s  Death 

About  a year  after  the  Lincolns  were 
settled  in  the  White  House,  Willie  con- 
tracted a cold  while  he  was  riding  horse- 
back. Dr.  Robert  Stone,  Professor  of  Medi- 
cine in  what  is  now  George  Washington 
University,  was  the  Lincoln  family  doctor. 
Willie  became  progressively  worse  and  died 
17  days  later.  Dr.  Stone  said  his  fever  was 
“intermittent  and  assumed  a typhoid  char- 
acter.” It  would  appear  to  us  more  prob- 
ably that  he  died  from  pneumonia,  and 
that  he  had  been  weakened  by  preceding, 
recurrent  respiratory  infections.  Willie’s 
body  was  temporarily  buried  in  Washing- 
ton but  it  accompanied  his  father’s  on  the 
funeral  train,  when  the  President’s  body 
was  returned  to  Springfield  in  1865. 

Much  more  has  been  written  about 
Thomas  (Tad)  Lincoln  than  any  of  the 
other  brothers.  Dr.  Wallace  probably  also 
officiated  at  his  birth  in  1853.  “Tad’s” 
father  said  that  he  had  “a  head  like  a tad- 
pole.” He  had  a mild  cleft  palate  and 
talked  with  a lisp.  He  was  mischievous,  in- 
corrigible and  would  not  study.  At  age  12, 
he  could  not  read.  Like  Willie,  he  had  fre- 
quent bouts  of  fever.  He  was  sick  when 
Willie  died  in  Washington  and  he  was 
scheduled  to  accompany  his  father  to 
Gettysburg  on  the  day  of  the  famous  speech, 
but  became  ill  and  could  not  go.  On  one 
occasion,  Mary  Lincoln  wrote  a friend,  who 
was  going  to  Chicago  where  Mr,  Lincoln 
was  “politicking,”  asking  the  friend  to  “tell 
Mr.  Lincoln  that  Tad  is  sick  with  high 
fever  and  I do  not  like  his  symptoms  and 
I will  be  glad  if  he  will  come  home,” 

Mary  Lincoln  Returns  to  Chicago 

After  the  President’s  death,  Mary  Lin- 
coln was  distraught,  restless  and  generally 
mixed-up.  She  sailed  for  Europe  in  1867 
to  place  Tad  under  English  and  German 
tutors.  He  appeared  to  take  more  interest 
in  learning  then,  and  once  told  a reporter 
that  he  hoped  to  study  medicine.  Tad  was 
sickly  most  of  the  time  and  developed 


signs  of  pulmonary  tuberculosis  while  he 
was  in  Europe.  He  and  his  mother  re- 
turned to  Chicago  in  1871.  Tad  was  un- 
der the  care  of  several  famous  Chicago 
physicians,  including  Dr.  N.  S.  Davis,  one 
of  the  founders  of  the  AMA  as  well  as  of 
Northwestern  University  Medical  School. 
Dr.  H.  A.  Johnson  and  Dr.  Charles  Smith 
also  attended  Tad.  When  Tad  died  in  July 
of  1871,  at  the  age  of  18,  the  official  diag- 
nosis was  “pleurisy  and  dropsy  of  the 
chest,”  but  there  seems  little  doubt  today 
that  he  had  tuberculosis.  “Tad’s”  death 
later  precipitated  a complete  nervous  break- 
down in  his  mother,  causing  her  to  be 
committed  to  a private  sanitarium,  Belle- 
vue Place,  at  Batavia.  She  was  successfully 
treated  by  the  kindly  Dr.  R.  }.  Patterson, 
pioneer  Illinois  psychiatrist. 

Robert  Lincoln,  the  oldest  son,  lived  to 
the  ripe  age  of  83.  He  was  eminently  suc- 
cessful as  a lawyer  in  Chicago  and  as  a 
businessman,  becoming  president  of  the 
Pullman  Company.  He  remained  aloof,  was 
considered  somewhat  eccentric,  and  is  said 
to  have  been  embarrassed  by  his  father’s 
backwoods  background.  Although  Robert 
Lincoln  had  no  known  major  illnesses  in 
Chicago,  he  had  contact  with  some  of  the 
great  names  in  Chicago  medicine,  such  as 
Billings,  Bevan  and  Murphy. 

Robert’s  Life  Recounted 

Robert  married  Mary  Harlan,  daughter 
of  wealthy  Senator  Harlan  of  Iowa.  Their 
eldest  daughter,  Mary,  married  Mr.  Lin- 
coln’s secretary,  Charles  Isham,  and  they 
had  one  child,  Lincoln  Isham,  who  never 
married,  and  now  lives  secluded  in  retire- 
ment in  Vermont.  The  second  daughter  of 
Robert  Lincoln,  Jessie,  caused  her  father 
great  anguish  by  eloping  with  a baseball 
and  football  player  named  'U'^arren  Beck- 
wdth.  The  Beckwiths  had  one  son,  Robert 
Todd  Lincoln  Beckw’ith,  wdio  lives  quietly 
in  Washington.  He  married  late  and  has  no 
children.  He  visited  Springfield  for  the  first 
time  in  1965  on  an  occasion  honoring  his 
great  grandfather.  Observers  thought  he 
was  not  in  good  health.  Mary  Lincoln 
Beckwdth,  the  only  other  child  of  Jessie 
Lincoln,  never  married  and  lives  a secluded 
life  in  Vermont. 

One  of  the  most  lamentable  premature 
deaths  w^as  that  of  Abraham  Lincoln  II, 
called  “Jack,”  son  of  Robert.  Jack  w^as  said 
to  have  been  a truly  gifted,  precocious 


652 


Illinois  Medical  Journal 


child,  the  reincarnation  of  his  grandfather 
and  namesake.  AVhile  his  father  was  serving 
as  Ambassador  to  the  Court  of  St.  James 
in  London,  Jack  was  sent  to  Versailles  in 
order  to  study  French  and  to  prepare  for 
Harvard.  He  became  ill  with  fever  in  France 
and  a large  carbuncle  developed  in  his 
right  armpit.  This  tumor  was  incised  and 
drained  by  two  French  doctors  named  Peau 
and  Villon.  The  abscess  would  not  heal, 
and  the  boy  became  progressively  worse.  He 
was  moved  across  the  English  Channel  by 
special  boat  to  London.  There  he  was  at- 
tended by  several  famous  London  doctors, 
including  Sir  James  Paget.  Dr.  Webster 
Jones  of  Chicago,  who  was  in  London,  was 
called  in  consultation.  The  boy  gradually 
became  cachectic  and  a Dr.  J.  MacLagan 
said  the  cause  of  death  was  “carbuncle  with 
pleurisy.”  At  this  late  date,  the  course  of 
the  disease  sounds  to  us  now  like  tuber- 
cular empyema.  Jack’s  body  was  taken  to 
Springfield  for  burial,  but  on  his  father’s 
request,  it  was  later  removed  to  Arling- 
ton Cemetery,  where  it  rests  near  those  of 
his  father  and  mother.  How  much  this 
extraordinary  person  might  have  contrib- 
uted to  the  welfare  of  the  world  if  his  life 
might  have  been  saved  by  drugs  like  Pen- 


icillin and  Streptomycin  is  anyone’s  con- 
jecture; the  same  may  be  said  of  his  Uncle 
Willie. 

After  Jack’s  death,  Robert  Lincoln  was 
despondent  much  of  the  time,  and  a man- 
servant was  constantly  at  his  side  to  pre- 
vent a possible  suicide.  In  1909,  on  the 
100th  anniversary  of  the  birth  of  his  father, 
Robert  came  to  Springfield  in  his  special 
Pullman  car.  I was  told  by  my  uncle,  Mr. 
William  Pavey,  who  was  on  the  Greeting 
Committee,  that  they  could  not  get  Mr. 
Lincoln  off  his  car  and  that  the  commit- 
tee thought  that  he  was  not  sober.  He  died 
at  age  83  at  his  summer  home  in  New 
Hampshire,  of  a cerebral  hemorrhage. 

Aristotle  said,  in  effect,  that  the  reason 
why  people  enjoy  tragedies  is  that  the 
painful  actions  and  problems  of  others, 
which  excite  pity  and  fear  in  the  observer, 
may  purge  him  of  these  emotions:  Perhaps 
the  great  popularity  of  the  Lincoln  family 
story  may  in  part  be  explained  by  this 
Aristotelian  hypothesis.  Certainly  no  fam- 
ily has  suffered  and  died  more  sadly  than 
did  the  Lincolns,  and  none  seem  less  to 
have  deserved  such  a fate.  Perhaps  griev- 
ance for  the  Lincolns  may  challenge  us 
all  to  increased  sympathy,  ruth  and  com- 
passion. 


Reenactment  of  sickbed  scene  in  the  Lincoln 
Home  showing  Willy  and  Tad  in  bed  with 
severe  scarlet  fever.  Doctor  Anson  G.  Henry 
and  Doctor  William  Wallace  are  in  attendance. 


for  November,  1968 


653 


FELDSHERISM 


shortage”  by  developing  a semi-professional 
body  of  medium-grade  medical  workers 
(MMW)  with  a role  between  that  of  the 
current  physician  and  nurse.  Before  doing 
so,  they  should  investigate  the  Russian 
feldsher,  often  described  as  a “second-class 
doctor  for  peasants.”  He  (or  she,  since  90 
per  cent  are  women)  is  a physician’s  assis- 
tant, taking  over  tasks  that  are  delegated 
to  him. 

History  is  a wonderful  teacher.  Peter  the 
Great  introduced  semi-professional  medical 
workers  into  the  Russian  armies  in  the  sev- 
enteenth century.  According  to  Dr.  Victor 
W.  SideP’2,  the  Tsar  lacked  trained  physi- 
cians for  his  large  army.  They  were  called 
feldshers  and  the  group  was  active  for  two 
centuries  until  replaced  by  better  trained 
medics. 

On  retirement,  many  became  civilian 
feldshers;  they  practiced  mainly  in  the 
country  caring  for  the  peasant  population. 
Local  Russian  governments  started  special 
schools  for  the  group,  and  by  1913  there 
were  30,000  feldshers  who  outnumbered 
regular  physicians  two  to  one. 

During  revolutions  the  feldshers  were 
used  politically  to  make  the  regular  phy- 
sicians toe  the  mark.  After  the  revolutions, 
the  Soviets  decided  to  abandon  feldsherism 
because  it  was  considered  second-class  rural 
medicine.  A long  battle  ensued  and  the 
struggle  ended  by  making  them  a part  of 
the  medium-grade  medical  workers  (MMW) 
that  includes  midwives,  nurses,  pharmacists, 
and  dental  and  X-ray  technicians.  Approxi- 


from  a Technicum,  a secondary  vocational 
school,  rather  than  an  institute  or  univer- 
sity. The  majority  are  women.  They  prac- 
tice mainly  in  rural  areas  and  give  emer- 
gency medical  treatment  and  first  aid. 
Soviet  writers  describe  them  as  doctor’s 
helpers.  They  are  part  of  the  medical  team. 

Many  physicians  admit  that  they  could 
not  practice  complicated  Soviet  medicine 
without  the  help  of  middle  medical  workers. 
This  is  true,  especially  of  the  86,000  feld- 
sher-midwife stations  that  dot  the  country- 
side and  mountainous  areas.  At  the  present 
time,  there  are  538  MMW  schools  with  an 
enrollment  of  250,000  students.  Career 
choices  must  be  made  at  the  very  beginning 
because  the  student  is  trained  as  a feldsher, 
midwife,  sanitarian-feldsher,  pharmacist,  or 
a laboratory-feldsher.  All  technical  subjects 
are  taught  by  physicians.  Professional  teach- 
ers supply  theoretical  or  general  education 
subjects  (68  per  cent).  Students  having  un- 
satisfactory grades  may  repeat  the  courses 
once,  and  if  the  performance  is  still  unsat- 
isfactory, are  dropped.  Those  in  the  top  5 
per  cent  of  the  classes  are  permitted  to  take 
entrance  examinations  for  the  medical  in- 
stitutes. Other  graduates  may  apply  for 
evening  medical  school  after  two  years,  pro- 
vided they  work  as  feldshers  during  the 
day.  Still  others  can  apply  after  three  years 
of  obligatory  service  to  become  full-time 
medical  students. 

Do  we  want  this?  There  are  wide  cultural 
differences  between  our  heritage  and  that 
of  the  Russians.  The  feldsher  developed  in 


654 


Illinois  Medical  Journal 


Russia  when  communications  were  primi- 
tive. Originally  he  supplied  the  medical 
needs  of  a rural  community.  Today  Soviet 
policy-makers  have  him  as  part  of  the  med- 
ical team  guided  by  a physician.  In  other 
words,  feldsherism  is  a lesson  in  compre- 
hensive health  care. 

On  the  other  hand,  American  medicine 
has  fought  against  the  second-class  doctor 
for  more  than  a century.  The  feldsher  is 
just  that,  except  that  he  is  trained  by  physi- 
cians. In  this  respect,  he  is  an  improvement 
over  the  American  chiropracter,  naturo- 


path, or  Christian  Science  practitioner.  We 
firmly  believe  that  all  medical  treatment 
should  be  given  by  licensed  physicians  of 
the  highest  caliber.  Conversely,  if  helpers 
are  needed,  we  should  take  the  initiative  in 
supplying  the  demand. 

T.  R.  Van  Dellen,  M.D. 

References 

1.  Feldshers  and  “Feldsherism.”  Victor  W.  Sidel, 
The  New  England  Jl.  of  Med.,  (Apr.  25)  1968, 
278:17,  pgs.  934-939. 

2.  Ibid.  The  New  England  II.  of  Medicine  (May  2) 
1968,  275:18,  pgs.  987-992 


CHILDREN’S  ACCIDENTS  AND  MEDICAL  EDUCATION 


An  important  paper  was  reported  at  the 
recent  meetings  of  the  National  Childhood 
Injury  Symposium  in  June,  1968.  Dr.  Roger 
Meyer,  the  founder  of  this  symposium  and 
a recognized  authority  on  children’s  acci- 
dents, reported  on  the  results  of  a survey 
of  the  teaching  of  children’s  accidents  in 
the  pediatric  departments  of  seventy-seven 
medical  schools  in  this  country.^  The  sur- 
vey clearly  showed  that  the  teaching  about 
accidents  in  childhood  was  grossly  inade- 
quate. This  study  confirms  a previous 
study  by  Top  in  1960,  who  reported  that 
departments  of  preventive  medicine  of  a 
number  of  medical  schools  gave  less  than 
three  hours  of  instruction  per  school  year.^ 

Dr.  Meyer  contrasted  the  lack  of  instruc- 
tion in  our  medical  schools  with  the  stag- 
gering morbidity  and  mortality  due  to  ac- 
cidents. He  stated  that  one  out  of  three 
children  in  the  course  of  a year  will  re- 
quire medical  attention  for  injuries.  Trau- 
ma continues  to  be  the  leading  cause  of 
death,  taking  a larger  toll  than  the  next 
four  diseases  combined  from  the  ages  of 
one  to  twenty-one  years. 

Why  is  the  medical  student  given  so 
little  exposure  to  such  an  important  sub- 


ject? The  apparent  answer  is  that  medi- 
cal education  has  not  been  modified  suf- 
ficiently to  meet  the  pressing  national 
problem  of  accident  prevention  in  children. 
The  lack  of  qualified  specialists  in  acci- 
dent prevention  to  teach  the  subject  is 
also  a serious  handicap  to  progress  in  this 
area. 

Featured  in  the  medical  progress  sec- 
tion of  this  issue  is  an  excellent  paper  on 
automobile  accident  study  and  injury  pre- 
vention by  Eugene  Diamond,  M.D.,  and 
Seymour  Charles,  M.D.,  recognized  authori- 
ties in  this  field.  It  is  hoped  that  more  phy- 
sicians will  become  actively  interested  in 
research  in  the  prevention  of  the  huge 
number  of  accidents  which  afflict  almost 
all  of  us.  Your  attention  is  also  directed  to 
Dr.  Pachman’s  article  on  children  and 
smoking. 

Harvey  Kravitz,  M.D. 

References 

1.  Meyer,  R.  I-,  Childhood  Injury  and  Pediatric 
Education:  A Critique.  Proceeding,  National 
Childhood  Injury  Symposium,  June  30,  1968, 
Charlottesville,  Virginia. 

2.  Top,  F.  H.:  A Survey  of  the  Teaching  of 
Accident  Prevention  in  Departments  of  Pre- 
ventive Medicine,  J.  Med.  Ed.  35:  1152-53,  1960. 


FILM  REVIEW 


’’Seven  for  Susie,”  a film  available  from 
the  National  Easter  Seal  Society,  is  the 
dramatic  and  true  story  of  a little  girl  who 
seems  hopelessly  crippled.  The  film  is  an 
attempt  to  overcome  the  lack  of  knowledge 
about  professional  career  opportunities  in 
rehabilitation  open  to  young  people.  It  de- 
picts a child’s  struggle  to  overcome  her 
problems  with  the  help  of  seven  dedicated 
rehabilitation  professionals  including  a 


physical  therapist,  occupational  therapist, 
social  worker,  speech  pathologist,  psychol- 
ogist, recreation  specialist  and  special  edu- 
cational teacher.  Aimed  primarily  at  junior 
and  senior  high  school  and  college  students, 
the  13’/2  minute  16mm.  color  sound  film 
is  available  through  state  Easter  Seal  Socie- 
ties or  may  be  purchased  at  $50.00  from 
Careers  in  Rehabilitation,  National  Easter 
Seal  Society,  2023  W.  Ogden  Ave.,  Chi- 
cago, III.  6061  2. 


for  November,  1968 


655 


Diagnostic  Procedures  in  Gastroenter- 
ology^ Edited  by  Charles  H.  Brown,  M.D., 

438  pages,  illustrated,  C.  V.  Mosby  Co., 

St.  Louis.  1967,  $19.50. 

The  present  volume  began  as  a manual 
for  the  Fellows  in  Gastroenterology  at  the 
Cleveland  Clinic  to  describe  the  various 
diagnostic  procedures  along  with  their  in- 
dications and  contraindications.  The  pur- 
pose of  these  procedures  is  to  enhance  the 
diagnostic  ability  of  the  clinician.  Many  of 
the  sections  are  followed  by  nurses’  notes 
outlining  the  equipment  necessary  for  the 
procedure,  the  preparation  and  post-pro- 
cedural routines. 

Especially  valuable  is  the  introductory 
section  on  general  topics,  wherein  the  diag- 
nostic procedures  as  a group  are  discussed 
in  relationship  to  the  other  aspects  of  diag- 
nosis. The  procedures,  including  gastric 
analysis,  endoscopy,  liver  and  small  bowel 
biopsy,  specialized  roentgen  techniques 
and  pancreatic  scanning,  are  discussed.  The 
sections  include  the  Esophagus  and  Stom- 
ach, the  Pancreas,  Intestinal  Absorption, 
the  Liver,  the  Rectum  and  Colon,  Miscel- 
laneous Procedures  and  Specialized  Treat- 
ment. These  sections  are  followed  by  two 
supplements:— Special  Instructions  to  Pa- 
tients and  Diets. 

The  approach  is  a highly  personal  one, 
reflecting  the  experience  of  the  Cleveland 
Clinic.  Practical  aspects  are  emphasized. 
The  book  collects  much  information  not 
previously  available  in  one  place.  As  such, 
it  should  be  a useful  reference  work  for 
interested  physicians  and  paramedical  per- 
sonnel. 

E.  Clinton  Texter,  Jr.,  M.D. 


Clinical  Pathology /Interpretation  and 
Application,  Benjamin  B.  Wells,  M.D., 
Ph.D.  and  James  A.  Halsted,  M.D.,  W.  B. 
Saunders  Company,  Philadelphia,  1967, 
708  pp. 

This  book  attempts  to  narrow  the  gap 
between  research  knowledge  derived  from 
basic  science  and  the  everyday  practice  of 
medicine.  It  describes  laboratory  medicine 
from  the  point  of  view  of  the  practicing 
pathologist,  and  is  organized  around  clini- 
cal situations  in  which  laboratory  tests  yield 
valuable  information. 

After  an  introductory  chapter  in  which 
statistical  considerations  are  reviewed,  the 
book  is  divided  into  sections,  including: 
metabolic  disorders,  diseases  of  the  gastro- 
intestinal tract,  kidney,  blood,  heart  and 
lungs,  and  infectious  diseases.  The  last 
chapter  gives  the  details  of  certain  labora- 
tory procedures  selected  on  the  basis  of 
physician  involvement,  including  proced- 
ures which  the  physician  performs  himself 
or  which  require  physican  participation. 

As  in  previous  editions,  this  book  fulfills 
its  purpose  and  should  maintain  its  well- 
earned  place  in  the  library  of  medical  stu- 
dent or  practitioner. 

Joseph  C.  Sherrick,  M.D. 


There  is  now  a single,  strong,  na- 
tional organization  working  to  bring 
a better  life  to  two  million  Americans 
with  epilepsy.  Epilepsy  Foundation 
of  America— a union  of  The  Epilepsy 
Foundation  and  Epilepsy  Association 
of  America— offers  the  great  promise 
of  hope  to  all  these  forgotten  people. 
To  find  out  what  you  can  do  to  help, 
write  to  Epilepsy  Foundation  of 
America,  Washington,  D.C.  20005. 


656 


Illinois  Medical  Journal 


MEMBERSHIP  SURVEY  RESULTS 


What  You  Said 
What  ISMS  Is  Doing 


Part  I:  LEGISLATIVE  and  LEGAL  Issues 

TURN  THESE  PAGES  to  find  your  collective  viewpoint  on 
liberalizing  the  Illinois  abortion  law  . . . reducing  LSD  and  marijuana 
penalties  . . . and  three  other  key  issues. 

In  this  and  the  next  two  issues  of  the  Illinois  Medical  Journal,  we  will 
tell  you  what  you  told  us  in  the  membership  survey  last  August. 

And  we  shall  state— in  these  issues— what  actions  ISMS  intends  to  take 
in  response  to  your  opinions.  Indeed,  a primary  aim  of  the  survey  was  to 
achieve  a greater  harmony  between  your  wishes  and  society  endeavor. 

Our  reason  for  dividing  the  report  into  three  extensive  installments  is 
that  never  before  had  ISMS  conducted  a membership  survey  of  such 
breadth,  depth— and  significance. 

This  first  installment  is  devoted  to  issues  that  are  essentially  Legislative 
and  Legal.  It  thus  can  serve  as  a curtain-raiser  for  ISMS  activity  in  the 
General  Assembly  session  that  convenes  two  months  hence.  As  these  pages 
show,  your  responses  already  are  influencing  our  legislative  positions. 

In  the  December  issue,  we  shall  report  on  the  Socio-Economic  questions. 
Your  responses  on  these  will  be  guiding  us  in  many  areas— including  steps 
to  relieve  the  physician  shortage,  care  of  the  medically  deprived  and  deal- 
ings with  state  welfare  agencies. 

In  January,  we’ll  cover  issues  involving  Professional  Practice.  Your  re- 
actions on  these  will  be  guiding  us  on  such  matters  as  midweek  off-day 
schedules  ...  a 7-day  hospital  week  . . . health-care  costs  . . . and  our 
relations  with  hospitals  and  paramedical  groups. 

In  addition  to  giving  the  general  results  on  all  major  questions,  we  are 
including  responses  by  category— such  as  age,  area  and  field  of  practice— 
wherever  they  seem  meaningful. 

While  elated  by  the  over  3,000  replies  you  sent  us  in  a hot  month 
of  over-work  or  vacations,  we  realize  that  any  survey— regardless  how  care- 
fully prepared  or  well  received— has  certain  limitations. 

We  are  aware  that  on  such  complex  topics,  our  questions— and  your 
checkmarks— could  not  always  convey  the  full  message.  Indeed,  some  of 
you  volunteered  comments  alongside  your  answers,  and  for  these  we  are 
especially  grateful. 

Such  qualifications  aside,  w^e  believe  the  survey— and  your  response— 
represents  a valuable  exchange  of  ideas  between  the  officers  and  you  mem- 
bers ...  a splendid  act  of  cooperation  for  the  good  of  us  all. 


MATTHE^Y  B.  EISELE,  M.D. 
CHAIRMAN,  COMMITTEE 
ON  PUBLIC  RELATIONS 


for  November,  1968 


657 


ivicfviDCKdnir  ^ukvet  kcdulid 


LEQALIZEP  THERAPEUTIC  ABORTION 

ILLINOIS  MD's  FAVOR  MODERNIZED  LAW  IN  THESE  INSTANCES: 


QUESTION  AND  GENERAL  RESPONSE; 

The  ISMS  House  of  Delegates  last  May  left  open  the 
question  of  liberalizing  the  Illinois  abortion  law.  Do  you 
favor  an  amendment  that  would  legalize  therapeutic  abor- 
tion in  well-substantiated  cases  of: 


% of  M.D.s 
IN  FAVOR: 


a.  Expected  deformity  of  the  fetus?  79% 

b.  Risk  of  suicide  by  the  mother?  72% 

c.  Severe  risk  to  mother’s  mental  health?  76% 

d.  Grave  threats  to  her  physical  health?  86% 

e.  Forcible  rape?  87% 

f.  Statutory  rape?  73% 

g.  Incest?  82% 


- - * 


658 


Illinois  Medical  Journal 


IVIEIVtDEKOmr  9UKVEI  KE9ULI9 


While  a majority  favored  legalized  abortion  in  all  the 
circumstances  specified  above,  only  45  per  cent  said  “yes” 
to  the  question:  “Would  you  favor  an  amendment  setting 
no  conditions,  and  leaving  the  abortion  decision  to  the 
physician’s  discretion?” 

BREAKDOWN: 

Although  the  different  age  groups  were  in  fundamental 
agreement,  the  percentage  of  favorable  responses  generally 
was  higher  among  older  physicians. 

In  each  membership  category,  here  were  the  lowest  and 
highest  percentages  of  favorable  answers  on  the  seven  types 
of  therapeutic  abortions: 


By  age: 

Under  40 

63%  on  “f”-80%  on  “d’ 

40-55 

70%  on  “b”-86%  on  “e’ 

Over  55 

77%  on  “b”-92%  on  “e’ 

By  area: 

Chicago  Medical  Soc. 

75%  on  “b”— 89%  on  “e’ 

Downstate 

67%  on  “f”-86%  on  “d’ 

By  field 

of  practice: 

General  practitioners 

70%  on  “b”-88%  on  “e’ 

Specialists 

72%  on  “b”-87%  on  “e’ 

BACKGROUND: 

Illinois— like  most  other  states— outlaws  abortion  except 
to  preserve  the  mother’s  life.  In  all  other  circumstances  it 
is  a felony  subject  to  one-  to  ten-years  imprisonment. 

The  ISMS  House  of  Delegates— at  its  last  two  annual 
meetings— debated  proposals  to  modernize  the  Illinois  law, 
but  reached  no  decision. 

At  this  year’s  meeting  it  referred  the  issues  back  to  the 
Committee  on  Maternal  Welfare— for  development  of  any 
information  that  would  warrant  a changed  position.  The 
committee  has  favored  modifying  the  law. 

The  ISMS  supported  a General  Assembly  bill  to  create 
a special  study  commission  on  the  abortion  issue,  but  the 
bill  was  vetoed  by  former  Governor  Otto  Kerner. 

The  AMA  in  June,  1967,  held  that  certain  types  of 
therapeutic  abortions  were  consistent  with  medical  ethics.  A 
recent  Gallup  Poll  showed  that  77  per  cent  of  the  public 
—including  63  percent  of  the  Catholic  population— favored 
such  abortions.  Colorado,  Georgia,  Maryland,  North  Caro- 
lina, Mississippi— and  last  November,  California— have  re- 
laxed their  laws. 

ACTION  TO  BE  TAKEN: 

The  Board  of  Trustees,  at  its  October  5 meeting,  referred 
the  survey  results  to  the  Maternal  Welfare  and  Religion 
8c  Medicine  Committees  as  evidence  for  consideration  by 
the  House  of  Delegates. 


for  November,  1968 


659 


mcmDEK^mr  9UKVE  I ke^ulis 


j REDUCED  LSD  AND  “POT”  PENALTIES?  | 

■ ■ ■ - ■ — 
QUESTION  AND  GENERAL  RESPONSE: 

Some  observers— while  endorsing  stiff  punishment  for 
manufacture  and  distribution  of  psychedelic  drugs  and 
marijuana— believe  the  penalties  for  possession  exceed  the 
crime.  Present  Illinois  penalties  for  first  offenses  are:  Mari- 
juana, two-  to  ten-years  imprisonment  for  possession,  90 
days  to  one  year  for  use;  psychedelic  drugs,  up  to  one 
year  for  possession  or  obtainment. 

Should  ISMS  seek  amendments  reducing  the  Illinois  pen- 
alties for  first  offenses  in  cases  of: 

% of  M.D.s 
OPPOSED 

a.  Possession  or  use  of  marijuana?  52% 

b.  Possession  or  obtainment  of  psychedelic  drugs?  64% 

BREAKDOWN; 

In  addition  to  the  other  membership  categories,  the 
breakdown  by  “type  of  practice”  is  included  below  be- 
cause of  the  interesting  comparisons  it  presents. 


Marijuana 

Psychedelic  Drugs 

By  age: 

Under  40 

51% 

63% 

40-55 

53% 

65% 

Over  55 

51% 

62% 

By  area: 

Chicago  Medical  Society 

49% 

60% 

Downstate 

54% 

68% 

By  Field  of  Practice: 

General  practitioners 

56% 

67% 

Specialists 

50% 

62% 

By  Type  of  Practice: 

Solo  practice 

53% 

64% 

Partnership  or  group 

53% 

67% 

Hospital-based 

41% 

54% 

BACKGROUND; 

The  ISMS  has  taken  the  position  that  psychedelic  drugs 
and  marijuana  are  hazardous  under  any  conditions  and 
must  be  controlled. 

Last  year  the  society  was  instrumental  in  the  enactment 
of  the  state  law  banning  and  penalizing  the  manufacture, 
sale  and  possession  of  LSD  and  other  psychedelic  drugs. 

The  society’s  concern  with  the  problem  has  abided.  Its 
Committee  on  Narcotics  and  Hazardous  Substances  spon- 
sored a National  Symposium  last  spring  in  Chicago  to 
present  varied  opinions  on  the  legal,  moral  and  medical 
implications  of  psychedelics  and  “pot.” 

ACTION  TO  BE  TAKEN; 

The  Committee  on  Narcotics  and  Hazardous  Substances 
may  resume  its  study  of  the  issue  this  month,  said  its  chair- 
man, Dr.  Joseph  H.  Skom.  He  expressed  deep  interest  in 
the  survey  rsults. 

ISMS  officers  interpret  the  survey  results  as  an  endorse- 
ment of  present  law. 


660 


Illinois  Medical  Journal 


MEMBERSHIP  SURVEY  RESULTS 


QUESTION  AND  GENERAL  RESPONSE; 

New  Jersey’s  Supreme  Court  has  established  a voluntary 
procedure  designed  to  (a)  assist  plaintiffs  in  well  founded 
malpractice  suits,  (b)  discourage  potential  plaintiffs  in  un- 
founded and  false  claims,  and  (c)  restrain  adverse  publicity 
against  the  physician,  A panel  composed  of  two  physicians, 
two  attorneys  and  a judge  hears  evidence  and  re- 
views the  claim  on  a closed-door  basis  before  litigation  is 
pursued.  If  the  evidence  indicates  a reasonable  claim, 
either  a settlement  is  recommended  and  made  ...  or  the 
state  medical  society  provides  expert  medical  witnesses  for 
a trial.  If  the  evidence  shows  the  claim  to  be  unfounded 
or  false,  the  recommendation  is  that  no  suit  be  filed;  if 
a suit  is  filed,  the  plaintiff  must  retain  a new  attorney. 

Should  ISMS  encourage  adoption  of  such  a program  in 
Illinois? 


% of  M.D.s 
IN  FAVOR: 
96% 


BREAKDOWN; 


The  “yes”  vote  was  almost  identical  among  all  categories. 


BACKGROUND; 

Malpractice  claims,  like  personal-injury  cases,  are  a grow- 
ing hazard  in  this  “easy  money”  era.  The  Board  of  Trus- 
tees decided  that  Illinois  physicians  needed  further  pro- 
tection. 

Last  June  an  ISMS-sponsored  professional-liability  pro- 
gram took  effect.  In  addition  to  providing  insurance  cov- 
erage, it  is  designed  to  fight  nuisance  claims  and  brighten 
the  legal  climate. 

The  New  Jersey  panel  plan  is  a possible  further  way 
to  bring  legal  stability. 


ACTION  TO  BE  TAKEN; 

.Armed  with  the  survey  results,  the  ISMS  Medical-Legal 
Council  has  begun  meeting  with  representatives  of  the  Illi- 
nois and  Chicago  bar  associations  to  assess  the  panel  plan 
in  detail.  Finding  that  nuisance  claimants  apparently  are 
ignoring  New  Jersey’s  voluntary  setup,  some  council  mem- 
bers believe  any  Illinois  panel  should  have  a mandate  to 
review  all  claims. 

Any  final  proposal  would  be  submitted  to  the  Illinois 
Supreme  Court,  which— like  New  Jersey’s— can  make  rules 
for  the  entire  state-court  system. 


for  November,  1968 


661 


MEMBERSHIP  SURVEY  RESULTS 


WAYS  TO  RAISE  STATE  REVENUE? 


o 


-f- 

Q, 


%\ 

\ 


”•4- 


\ 


■V 


QUESTION  AND  GENERAL  RESPONSE: 


\ 

\ 


%% 

-7  o 


The  ISMS  House  of  Delegates  last  May  called  for  state 
legislation  to  provide  per  student  subsidies  to  medical 
schools.  Sources  of  revenue  will  have  to  be  considered. 

Would  you  regard  any  of  the  steps  as  acceptable  to  ex- 
pand medical  training  AND  meet  other  Illinois  needs? 

% of  M.D.s 
IN  FAVOR 


a.  A tax  on  all  services,  including  medical  services?  8% 

b.  A state  income  tax?  32% 

c.  A sales  tax  increase?  31% 

d.  Increased  earmarked  federal  grants  to  the  state?  62% 

BREAKDOWN: 


In  the  one  question  approved  by  a majority— increased 
earmarked  federal  grants  to  the  state— the  division  was: 


By  age: 

Under  40 

57% 

40-55 

64% 

Over  55 

63% 

By  area: 

Chicago  Medical  Soc. 

70% 

Downstate 

54% 

By  type  of  practice: 

General  practitioners 

55% 

Specialists 

66% 

662 


Illinois  Medical  Journal 


MEMBERSHIP  SURVEY  RESULTS 


BACKGROUND: 

The  ISMS  has  attacked  levies  on  medical  services  and 
drugs  as  “taxes  on  illness.”  It  has  taken  no  stand  on  a sales 
tax  per  se,  or  on  a state  income  tax. 

“Increased  earmarked  federal  grants  to  the  state”  would 
not  conflict  with  ISMS  policy,  provided  they  entail  no  fed- 
eral control  over  medical  education  and  practice. 

Nor  has  the  society  expressed  any  objection  to  a com- 
parable idea— rebate  of  federal  income  tax  moneys  to  the 
states. 

The  society  endorsed  the  calling  of  an  Illinois  Consti- 
tutional Convention,  partly  in  the  belief  that  the  state 
needs  a more  realistic  pattern  of  taxation. 

ACTION  TO  BE  TAKEN: 


The  ISMS  Council  on  Medical  Education  is  studying 
the  question  of  revenue  for  the  proposed  per-student  sub- 
sidies, and  will  have  the  benefit  of  the  survey  results. 


PRE-PAROLE  PSYCHIATRIC  TESTINQ? 


QUESTION  AND  GENERAL  RESPONSE: 

Many  major  crimes  of  recent  years  have  been  linked  to 
brain  tumor,  mental  health  and  other  medical  factors.  And 
many  such  crimes  are  caused  by  ex-convicts.  Should  ISMS 
encourage  legislation  requiring  neuropsychiatric  examina- 
tion of  all  criminals  prior  to  parole? 

% of  M.D.s 
IN  FAVOR: 
90% 


for  November,  1968 


663 


BREAKDOWN: 


By  age: 

Under  40 

83% 

40-55 

89% 

Over  55 

95% 

By  area: 

Chicago  Medical  Society 

91% 

Downstate 

89% 

By  field 

of  practice: 

General  Practitioners 

91% 

Specialists 

89% 

BACKGROUND: 

The  proposal  would  strengthen  and  broaden  present 
Illinois  law— giving  special  emphasis  to  uncovering  any 
murderous  and  violent  tendencies  in  parole  candidates. 

As  the  law  now  stands,  the  Parole  and  Pardon  Board 
may  request  psychiatric  examination  of  sex  offenders  prior 
to  parole.  Usually  at  the  request  of  the  prison  sociologist, 
such  examination  may  be  given  in  other  cases.  But  there 
is  no  uniform  requirement. 

ACTION  TO  BE  TAKEN: 

Study  by  the  Committee  on  Mental  Health  could  lead 
to  development  of  legislation  to  implement  the  pre-parole 
proposal. 

In  addition  to  pre-parole  examination,  some  observers 
urge  fuller  use  of  psychiatry  in  earlier  stages  of  confinement. 

This,  they  argue,  would  help  convicts  attain  the  emo- 
tional health  that  would  make  them  fit  candidates  for 
release. 

IN  THE  DECEMBER  ISSUE  OF  !MJ: 

Membership  Survey  Analysis  on  SOCIO-ECONOMIC  ISSUES 


FILM  REVIEWS 


A medical  motion  picture  that  shows  in- 
side views  of  the  stomach  has  just  been 
completed  at  Long  Beach  Veterans  Admin- 
istration Hospital.  The  viewer  sees  just  what 
a physician  sees  when  he  looks  inside  the 
stomach  with  an  instrument  called  a fiber- 
optic gastroscope  or  fiberscope.  The  new 
film  shows  among  other  things:  a benign 
ulcer,  a malignant  stomach  ulcer,  a duode- 
nal ulcer  and  the  stomach  after  gastric  sur- 
gery. For  more  information  write:  Veterans 
Administration,  Information  Service,  Wash- 
ington D.C.  20420. 


The  National  Medical  Audiovisual  Cen- 
ter has  announced  the  release  of  several 
new  slide  sets  and  audiotapes  including, 
S-1558-X,  "Questions  to  Answer  in  Pathol- 
ogy;" S-1559-X,  "Hemoglobin;"  S-1560-X, 
"Disorders  of  Cardiac  Rate  and  Rhythm;" 
S-1561-X,  "The  Acutely  III  Baby;"  S-1562-X, 
"Acute  Renal  Failures."  Audiotapes  include: 
A-1 565-X,  "Headaches;"  A-1556-X,  "Al- 
lergy;" and  A-1 567-X  "Bowel  Sounds."  Re- 
quests for  loans  should  be  sent  to:  Na- 
tional Medical  Audiovisual  Center  (Annex), 
Chamblee,  Georgia  30005. 


664 


Illinois  Medical  Journal 


ILLINOIS  ASSOCIATION 

OF  THE  PROFESSIONS 


Interprofessional 

Ralph  G.  Michael,  P.E.  and  a charter 
member  of  lAP,  recently  spoke  at  a joint 
meeting  of  the  Chicago  Chapter  of  the 
American  Institute  of  Architects  and  the 
Chicago  Chapter  of  the  Illinois  Society  of 
Professional  Engineers.  Excerpts  of  his  talk 
will  be  recognized  as  pertinent  to  the  in- 
terprofessional relationships  existing  be- 
tween other  professions. 

“It  is  imperative  that  architects  and  en- 
gineers rise  above  their  professional  dif- 
ferences and  work  together. 

1.  To  oppose  legislation  which  would 
compromise  professional  practice  as 
we  know  it. 

2.  To  combat  the  efforts  of  those  groups 
that  would  encroach  into  our  areas  of 
practice. 

3.  To  mutually  contribute  to  the  solu- 
tion of  the  problems  of  society,  solu- 
tions that  only  the  design  professions 
can  provide. 

We  have  all  witnessed  the  imposition  of 
Medicare,  with  the  resultant  control,  by 
legislation  and  administration,  of  the  pro- 
fessional and  business  practice  of  a sister 
profession.  Experimentation  is  being  con- 
ducted at  the  local  level  in  some  areas 
with  “judicare”  and  it  is  not  a difficult 
step  from  there  to  “Archicare”  or  “Engi- 
care.” 

I can  assure  you  that  a Society  that  is 
told: 

1.  It  will  suffocate  from  air  pollution 

2.  It  will  strangle  from  water  pollution 

3.  It  is  burying  itself  in  refuse  and  gar- 
bage 

4.  It  finds  itself  taking  longer  and  long- 
er to  go  shorter  and  shorter  distances, 
and 

5.  It  has  forty-five  million  of  its  people 
living  in— near— or  on  the  brink  of 
poverty, 

will  not  continue  to  tolerate  parochial  dif- 


The  average  American  housewife  con- 
trols about  65  horsepower  around  her 
house  just  by  flicking  switches.  Figuring  22 
men  to  one  horse,  that’s  equal  to  1,450 
men  (including  her  husband)  being  helpful 
around  the  house. 

ferences  between  the  professionals— particu- 
larly, those  professions  that  must  bear  the 
burden  of  the  solution  for  these  problems. 

Unless  we  are  willing  to  establish  the 
necessary  dialogue  and  develop  a true  co- 
operative interdisciplinary  approach  to  our 
relations,  we  will  find  ourselves  attempting 
to  practice  in  a hostile  framework  dictated 
by  others. 


Will  the  Professionals  Last  the 
Cultural  Revolution? 

Luncheon  speaker  at  the  Fifth  Annual 
Meeting  of  the  Illinois  Association  of  the 
Professions  on  October  11  at  the  Ambas- 
sador East  Hotel  in  Chicago  was  Dr.  Thom- 
as R.  Bennett,  Professor  of  Administration 
and  Director  of  Graduate  Studies  at  George 
Williams  College;  Downers  Grove.  His 
topic  was  entitled  as  above. 

Honored  guests  at  the  luncheon  meet- 
ing were  the  deans  of  the  professional  col- 
leges in  Illinois  and  members  of  the  Board 
of  Directors  of  lAP  member  organizations. 


Spoon  River  Drug  Store 

The  primary  public  relations  project  of 
the  Illinois  Pharmaceutical  Association  for 
1968  was  the  sponsorship  and  restoration 
of  an  1890  pharmacy  at  the  Sesquicenten- 
nial  State  Fair  in  Springfield. 

A highlight  of  the  ten  day  Fair,  between 
800  and  1000  persons  passed  through  the 
pharmacy  each  hour,  with  over  100,000 
visitors  exposed  to  the  pharmacy. 

A permanent  installation  is  being  con- 
sidered. 


for  November,  1968 


665 


SOCIO 


ECONOMIC 

news 


A service  of  the  Public  Relations  and  Economics  Division 


IDPA  Finds  M.  D.  Errors 
on  Some  13,200 
Bills  A Month 


The  data-processing  machinery  of  the  Illinois  Depart- 
ment of  Public  Aid  rejects  about  14,500  of  the  100,000  phy- 
sicians’ bills  fed  into  it  monthly.  Some  13,200  of  the  rejec- 
tions are  due  to  erroneous  information  on  the  bill.  The 
rest  result  from  complications  that  require  individual  con- 
sideration. These  figures  were  given  by  Robert  G.  Wessel, 
chief  of  the  IDPA  division  of  medical  administration,  at 
ISMS  workshops  on  government  health  programs  in  Car- 
bondale  and  Alton.  The  workshops— scheduled  for  all  areas 
of  the  state— are  making  physicians  and  medical  assistants 
more  expert  in  claims  procedures. 


ISMS  To  Be  Friend  The  ISMS  Board  of  Trustees  has  approved  society  inter- 

of  Court  in  vention  as  amicus  curiae  (friend  of  the  court)  in  the  first 

Anti-Fluoridation  Case  challenge  Illinois’  new  Fluoridation  Act.  A group 

known  as  the  “Illinois  pure  water  committee”  filed  the 
suit  in  Madison  County.  Dr.  Franklin  D.  Yoder,  state  pub- 
lic health  director,  asked  ISMS  to  intervene  in  cooperation 
with  the  Illinois  State  Dental  Society.  The  1967  act,  backed 
by  ISMS  and  ISDS,  provides  for  addition  of  0.9  to  1.2  milli- 
grams of  fluoride  per  liter  to  public  water  supplies  “to  pro- 
tect the  dental  health  of  all  citizens,  particularly  children.” 


State  ''Health  Guides" 
Serve  East  St.  Louis 
Poor  Area 


East  St.  Louis  is  a pilot  area  for  a State  program  of 
“health  guides”  who  spread  health  information  among  the 
poor.  The  guides  are  recruited  from  disadvantaged  neigh- 
borhoods and  thus  gain  ready  acceptance  in  them.  In  addi- 
tion to  familiarizing  the  poor  with  available  services  and 
facilities,  they  are  to  report  to  service  agencies  on  the  con- 
ditions and  needs  they  encounter.  Lynford  Keyes,  chief  of 
the  Bureau  of  Health  Education,  Illinois  Department  of 
Public  Health,  described  the  project  at  the  ISMS  Leader- 
ship Conference  last  month  in  Springfield.  He  said  it  soon 
would  be  extended  to  other  areas.  The  Kerner  Commission 
report— to  which  Keyes  referred— said  the  relative  lack  of 
health  in  urban  ghettos  springs  partly  from  “lower  utiliza- 
tion of  medical  services.” 


New  Emphasis  Planned 
in  Chicago  Health 
Centers 


The  Chicago  Board  of  Health  plans  to  establish  neigh- 
borhood health  centers  in  conjunction  with  small  commun- 
ity hospitals  and  neighborhood  physicians.  Dr.  Jack  Zackler 
of  that  agency  told  the  ISMS  Leadership  Conference.  This 
step,  he  said,  would  have  an  all-around  favorable  effect  on 


666 


Illinois  Medical  Journal 


Major  Medical  Plan 
Renewals  Hold  Steady 
After  Rate  Hike 


ISMS  Malpractice 
Program  Untouched 
By  Rate  Trend 


Advisory  Committee 
to  IDPA  Proposes 
Podiatry  Policy 


Health  Care  Now 
Receiving  74%  of  U.S. 
Grants  to  States 


Governor  Announces 
Boost  in  Alcoholism 
Agency  Grants 


the  community  health  pattern.  The  first  center  is  program- 
med for  the  Englewood  district.  The  plans.  Dr.  Zackler 
noted,  are  not  conditional  on  Office  of  Economic  Oppor- 
tunity grants,  which  helped  finance  a center  connected 
with  Presbyterian-St.  Luke’s  Hospital. 

Subscribers  to  the  ISMS-sponsored  Group  Major  Medical 
Program  have  responded  agreeably  to  the  premium  rate  in- 
creases that  took  effect  August  1.  For  the  policy  year  which 
began  then,  the  number  of  non-renewals  is  only  3 per  cent, 
the  same  as  in  previous  years.  Ernest  T.  Luehr,  president 
of  Parker,  Aleshire  8c  Co.,  which  administers  the  program, 
gave  this  report  to  the  ISMS  Committee  on  Economics  8c 
Insurance.  He  also  noted  that  the  program  paid  out  more 
than  $150,000  in  claims  from  August  1,  1967  to  last  July  31. 

Stock  insurance  companies  belonging  and  subscribing  to 
the  Insurance  Rating  Board  raised  their  premium  rates  on 
malpractice  coverage  October  2 in  28  states.  Their  increase 
on  the  basic  limits  ($5,000  each  claim/$  15,000  aggregate 
claims)  was  20  percent  in  Illinois;  the  range  was 
from  10  per  cent  in  Maine  and  Oklahoma  to  100 
percent  in  Vermont.  In  Illinois  and  the  other  states,  there 
was  a 50  per  cent  increase  on  coverage  above  the  $5,000/$  15,- 
000  limits.  Not  affected  is  the  ISMS  professional-liability 
insurance  program,  which  took  effect  in  June;  its  rates 
cannot  be  raised  without  society  approval. 

The  ISMS  Advisory  Committee  to  the  Illinois  Depart- 
ment of  Public  Aid  has  proposed  a policy  for  the  recogni- 
tion and  reimbursement  of  podiatrist  services  in  public-aid 
cases.  Under  the  proposal,  payments  would  be  made  for  all 
Illinois-licensed  services  of  the  podiatrist  EXCEPT  routine 
foot  care,  routine  hygienic  foot  care,  flat  foot  conditions, 
subluxations  of  the  foot,  plastic  operations  (unless  neces- 
sary to  correct  traumatic  injury  or  congenital  deformity 
evidenced  in  infancy),  home  calls  if  for  other  then  surgical 
service,  and  services  provided  as  surgical  consultant  or  as- 
sistant. The  committee  asked  IDPA  to  implement  the  pro- 
posal, which  calls  for  payment  on  a usual-and-customary 
fee  basis. 

More  than  $11  billion  of  the  $15  billion  in  Federal 
grants  to  states  and  localities  last  year  was  for  health  care, 
the  Health  Insurance  Institute  reported.  The  health  grants 
are  for  public  aid,  research,  air  polluion,  sanitation  proj- 
ects, hospital  and  medical  construction,  and  the  like.  In 
1960  these  accounted  for  only  $3  billion  of  the  $11  billion 
grant  total. 

Governor  Samuel  H.  Shapiro  has  announced  the  award 
of  $197,000  in  State  grants  to  community  alcoholism  agen- 
cies for  the  fiscal  year  that  started  July  1.  The  money— 
$27,000  more  than  last  year— will  go  to  17  alcoholism  agen- 
cies for  development  of  new  programs  and  techniques  in 
treatment  and  care,  and  for  community  education.  Localit- 
ies will  provide  $178,561  in  matching  funds. 

— By  DON  B.  FREEMAN 


for  November,  1968 


667 


To  All  ISMS  Members: 

YOU  are  the  most  important  member  of 
professional  medicine  in  the  state  of  Illinois. 
Your  opinion  is  of  vital  interest  to  your  fel- 
low practitioners.  The  ultimate  objective  of 
the  Illinois  State  Medical  Society  and  the 
Illinois  Medical  Journal  is  to  serve  you. 

With  this  in  mind,  the  ISMS  Publications 
Committee  has  established  this  “Membership 
Forum”  as  a medium  through  which  you  may 
express  your  opinion  and  comment. 

This  Forum  may  include  communications 
pertaining  to  any  topic  and  will  not  be 
strictly  a “letters  to  the  editor”  section.  If, 
for  example,  you  would  like  to  express  an 
opinion  regarding  pending  legislation,  this 
might  be  published  here.  Or,  if  you  disagree 
with  the  substance  of  a Journal  article,  this 
will  afford  the  opportunity  of  stating  your 
view  or  experience.  Socio-economic  factors 
being  of  such  importance  today,  you  may 
want  to  ask  what  others  are  thinking  or 
postulate  on  solutions. 


Of  course,  not  every  communication  can 
be  published.  Certain  of  them  may  not  war- 
rant publication.  Others  may  not  be  usable 
for  professional  or  legal  reasons.  But  we  do 
invite  your  communication.  You  need  not 
have  your  name  published,  if  such  is  your 
desire  and  it  is  so  stated;  but  anonymous 
letters  will  not  be  accepted.  Communications 
should  not  exceed  300  words  in  length.  The 
right  of  editing  or  condensing  is  reserved. 
If  the  matter  is  of  sufficient  magnitude  to 
warrant  referral  to  an  ISMS  committee  or 
some  official  agency,  such  will  be  done  and 
the  inquiry  and  answer  will  both  be  pub- 
lished. 

This  new  section  in  the  IMJ  is  being  estab- 
lished as  a service  to  you,  the  physician 
reader.  Send  your  communications  to;  Mem- 
bership Forum,  Illinois  State  Medical  Society, 
360  N.  Michigan  Ave.,  Chicago,  60601. 

Jacob  E.  Reisch,  M.D. 
Secretary-Treasurer,  ISMS 
Chrm.,  Publications  Committee 


What  the  Student  Should  Know 

''It  is  the  responsibility  of  a Faculty  of  Medicine  to  instruct  its  students  in 
the  pharmacology  and  therapeutic  uses  of  narcotics,  amphetamines,  and 
barbiturates  and  to  impress  upon  them  their  addictive  and  habit  forming 
properties.  The  student  should  be  made  fully  aware  of  the  particular  risks 
to  which  the  physician  is  exposed  by  being  legally  permitted  to  have  these 
drugs  in  his  possession.  He  should  be  repeatedly  cautioned  that,  when  licens- 
ed, he  should  never  self-prescribe  or  self-administer  these  drugs  but  should 
rely  on  another  physician  for  these  services.  He  should  be  instructed  that  the 
abuse  of  these  drugs  is  considered  to  be  an  offence  which  could  result  in 
the  loss  of  his  license." 

The  public  is  becoming  aware  of  the  harmful  effects  of  excessive  use  of 
alcohol  and  tobacco,  both  of  which  are  available  for  purchase  without  spe- 
cial permission.  Federal  and  provincial  governments  tax  the  consumer  heav- 
ily for  his  fun  or  folly.  But  the  same  governments  reserve  to  Doctors  of 
Medicine  the  responsibility  of  placing  in  the  hands  of  their  citizens  the 
narcotic  and  controlled  drugs  which,  if  used  wisely,  may  promote  health, 
but  which,  issued  without  discrimination,  may  induce  unhealthy  depend- 
ence. The  medical  profession  must  respect  this  responsibility  if  it  is  to  con- 
tinue to  hold  the  respect  of  governments  and  of  the  community.  To  teach  this 
responsibility  is  the  duty  of  the  medical  school.  (G.  H.  Ettinger,  The  Problem 
of  Overprescription.  Addictions  (Addiction  Research  Foundation  of  Ontario) 
[Summer]  1 968;  1 5:2;  pgs.  9-11). 


668 


Illinois  Medical  Journal 


solved  by 

Mylanta 

aluminum  and  gg  magnesium  hydroxides  p/us  simethicone 

''will  it  ease  the  pain?'' 

Mylanta  helps  relieve  ulcer  pain  \A/ith  the  two  most  widely 
prescribed  antacids:  aluminum  and  magnesium  hydroxides. 

will  it  help  "my  gassy  stomach"? 

Mylanta  a/so  contains  simethicone:  for  concomitant  relief 
of  G.l.  gas  distress. 

"will  this  one  taste  O.  K»?" 

The  prolonged  acceptance  of  Mylanta  was  recently 
confirmed  in  87.5%  of  104  patients -after  a total  of  20,459 
documented  days  of  therapy.*  *Danhof,  I.  E.:  Report  on  file. 


In 

peptic 

ulcer: 


the 
antacid 


Composition:  Each  Mylanta  chewable  tablet  or  teaspoonful 

(5  ml.)  contains:  magnesium  hydroxide,  200  mg.;  aluminum  hydroxide, 

dried  gel,  200  mg.;  simethicone,  20  mg.  Dosage:  One  or  two  tablets  (well 

chewed  or  allowed  to  dissolve  in  the  mouth)  or  one 

or  two  teaspoonfuls  to  be  taken  between  meals  and  at  bedtime. 


Division/Pasadena,  Calif. 
ATLAS  CHEMICAL  INDUSTRIES,  INC. 


for  November,  1968 


669 


Clinics  for  Crippled  Children 


Twenty  three  clinics  for  Illinois’  physi- 
cally handicapped  children  have  been 
scheduled  for  December  by  the  University 
of  Illinois,  Division  of  Services  for  Crippled 
Children.  There  will  be  fifteen  general 
clinics  providing  diagnostic  orthopedic,  pe- 
diatric, speech  and  hearing  examination 
along  with  medical,  social,  and  nursing 
service.  There  will  be  six  special  clinics 
for  children  with  cardiac  conditions  and 
rheumatic  fever,  and  two  for  children  with 
cerebral  palsy.  Clinicians  are  selected  from 
among  private  physicians  who  are  certified 
Board  members.  Any  private  physician  may 
refer  to  bring  to  a convenient  clinic  any 
child  or  children  for  whom  he  may  want 
examination  or  consultative  services. 

Dec.  4— Rock  Island  Cerebral  Palsy— Foun- 
dation for  Crippled  Children  & Adults, 
3808  Eighth  Avenue 

Dec.  4— Carmi— Carmi  Township  Hospital 
Dec.  4— Alton  Rheumatic  Fever  8c  Cardiac 
—Alton  Memorial  Hospital 
Dec.  4— Hinsdale— Hinsdale  Sanitarium 
Dec.  5— Effingham  General— St.  Anthony 
Memorial  Hospital 

Dec.  5— Springfield  General— St.  John’s 

Hospital 

Dec.  5— Lake  County  Cardiac— Victory  Me- 
morial Hospital 

Dec.  10— East  St.  Louis— Christian  Welfare 
Hospital 

Dec.  10— Peoria  General— Children’s  Hos- 
pital 


Dec.  11— Champaign  - Urbana— McKinley 
Hospital 

Dec.  12— Litchfield— Madison  Park  School 
Dec.  12— Bloomington— St.  Joseph’s  Hos- 
pital 

Dec.  13— Chicago  Heights  Cardiac— St. 

James  Hospital 

Dec.  13— Evanston— St.  Francis  Hospital 
Dec.  17— Belleville— St.  Elizabeth’s  Hos- 
pital 

Dec.  17— Peoria  General— Children’s  Hos- 
pital 

Dec.  1 8— Springfield  Cerebral  Palsy  (P.M.) 
—Diocesan  Center 

Dec.  18— Aurora— Copley  Memorial  Hospi- 
tal 

Dec.  18— Chicago  Heights  General— St. 

James  Hospital 

Dec.  19— R o c k f o r d— Rockford  Memor- 
ial Hospital 

Dec.  19— Effingham  Rheumatic  Eever  & 
Cardiac— St.  Anthony  Memorial  Hospital 
Dec.  19— Elmhurst  Cardiac— Memorial  Hos- 
pital 

Dec.  20— Chicago  Heights  Cardiac— St. 

James  Hospital 

The  Division  of  Services  for  Crippled 
Children  is  the  official  state  agency  estab- 
lished to  provide  medical,  surgical,  correc- 
tive, and  other  services  and  facilities  for 
diagnosis,  hospitalization  and  after-care  for 
children  with  crippling  conditions  or  who 
are  suffering  from  conditions  that  may 
lead  to  crippling. 


Crerar  Library  Designated 
Regional  Medical  Library 


The  John  Crerar  Library,  Chicago,  has 
been  designated  the  Midwest  Regional 
Medical  Library  by  the  National  Library  of 
Medicine,  National  Institutes  of  Health.  It 
will  serve  medical  practitioners,  research- 
ers, and  educators  throughout  the  five-state 
area  of  Illinois,  Indiana,  Iowa,  Minnesota, 
and  Wisconsin.  Announcement  of  a $150,- 
000  grant  for  the  new  Regional  Medical  Li- 
brary was  made  jointly  by  Martin  M.  Cum- 
mings, M.D.,  Director,  National  Library  of 
Medicine,  and  Oliver  W.  Tuthill,  President 
of  the  Crerar  Library. 

The  grant,  made  under  authority  of  the 
Medical  Library  Assistance  Act  of  1965 
(Public  Law  89-291),  will  allow  the  Crerar 
Library  to  serve  as  part  of  a proposed  na- 
tional medical  library  network.  This  net- 
work is  designed  to  make  information  serv- 


ices for  activities  related  to  practice,  educa- 
tion, and  research  available  to  health  pro- 
fessionals in  all  areas  of  the  country. 

Crerar's  Regional  Medical  Library  serv- 
ices will  include  the  loan  of  books  and,  in 
the  case  of  journal  articles,  single  cost-free 
copies  in  lieu  of  original  material;  refer- 
ence and  bibliographic  services;  production 
of  a Union  Catalog  of  books  and  a Union 
List  of  Periodicals  in  the  biomedical  collec- 
tions of  libraries  in  the  region  served.  In 
addition,  Crerar  will  formulate  computer 
searches  of  the  biomedical  journal  litera- 
ture to  be  processed  by  MEDLARS  (Medical 
Literature  Analysis  and  Retrieval  System) 
at  the  National  Library  of  Medicine.  The 
Midwest  Regional  Medical  Library  is  the 
fourth  of  a proposed  network  of  nine  or 
ten  to  be  operational  by  1970. 


670 


Illinois  Medical  Journal 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  an  effort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  phy- 
sicians, the  Journal  is  publishing  synopses 
submitted  to  the  Physicians  Placement  Serv- 
ice concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  who  know  of  any  out-of-state 
physicians  seeking  an  Illinois  residence  are 
asked  to  notify  the  placement  service. 

Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addi- 
tional physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave., 
Chicago  60601. 

K.\XE  COUNTY:  Carpentersville;  pop- 
ulation: 22,000.  One  physician.  Nearest  hos- 
pital at  Elgin,  7 miles;  population:  52,000. 
T^vo  prescription  drug  stores.  Office  space 
and  housing  available.  Agiicultural  and  in- 
dustrial area:  17  churches.  Grade  and  high 
schools.  Recreational  facilities  include  golf 
course  and  large  community  swimming 
pool.  Eor  further  information  contact:  Mr. 
John  W.  Eranzen,  Carpentersville.  Phone: 
426-4881. 

K-\NE  COUNTY:  North  Aurora;  popu- 
lation: 3,500.  East  growing  community. 
Nearest  physicians  at  Batavia  and  Aurora,  4 
miles.  Nearest  hospitals  at  Aurora  and 
Geneva,  6 miles.  One  prescription  store. 
Available  physician’s  office  on  ground  floor. 
Predominant  nationalities:  German  and 
Swedish.  Many  residents  commute  to  Chi- 
cago and  Aurora.  Two  small  industries. 
Churches:  Lutheran  and  Presbyterian. 

Nearest  golf  course  and  swimming  pool,  10 
minute  drive.  East  gi'owing  residential  area; 
very  small  business  district.  For  further  in- 
formation contact:  Mr.  AVilliam  Rachielles, 
12  E.  AVilson,  Batavia.  Phone:  879-1400. 

IL\NIC\KEE  COUNTY:  Bradley;  popu- 
lation: 7,000.  Trade  area,  40,000.  Hospitals 
2 miles— 300  beds.  Agricultural  and  indus- 
trial area.  Churches:  Protestant,  Catholic 
and  Jewish.  Grade  and  high  schools.  Busi- 
ness college  and  Nazarene  College.  Kanka- 
kee Country  Club  and  Elks  County  Club 


nearby.  Kankakee,  population,  28,000, 
adjoins  Bradley  on  the  south.  For  further 
information  contact:  Dr.  Klein,  371  AV. 
Broadway,  Bradley. 

R\NIC\KEE  COUNTY:  St.  Anne;  popu- 
lation: 1,700.  Two  physicians  until  recent- 
ly; oldest  doctor  now  deceased.  Urgent  need 
for  replacement.  Remaining  doctor  limits 
practice  due  to  heart  condition.  Two  hos- 
pitals at  Kankakee,  14  miles;  60  miles  from 
Chicago.  One  prescription  drug  store;  10 
year  old  building  available.  Equipment  for 
rent  or  for  sale.  Predominant  nationalities: 
Dutch,  French.  Agricultural  area.  Four 
Protestant  and  Catholic  churches.  Grade 
and  high  schools.  For  further  information 
contact:  Mrs.  Lesley  Hayes,  Dixie  High- 
way, St.  Anne.  Phone:  427-6574. 

KENDALL  COUNTY:  Yorkville;  popu- 
lation: 1,800.  Trade  area,  6,000.  Nearest 
physicians  at  Plano,  Oswego  and  Aurora. 
Nearest  hospitals  at  Aurora,  12  miles.  Popu- 
lation of  Aurora,  70,000.  Two  prescription 
stores.  Completely  equipped  medical  fa- 
cility available.  Financial  assistance  if  de- 
sired. Sources  of  income:  light  industry  and 
agTiculture.  Churches:  Protestant  and  Cath- 
olic. Grade  and  high  schools.  Nearby  recre- 
ational facilities:  golf,  swimming,  fishing 
and  boating.  County  medical  society  anx- 
ious for  1 or  more  physicians  to  locate  here. 
For  further  information  contact:  Mr.  Laur- 
ence Henning,  President,  Yorkville  Nation- 
al Bank,  Yorkville.  Phone:  553-1621. 

The  following  towns  in  the  above-listed 
counties  are  also  reported  to  be  in  need  of 
additional  general  practitioners.  For  de- 
tailed information  contact  the  county  so- 
ciety secretaries  shown  below: 

Kane  County:  Aurora,  Dundee,  St.  Char- 
les, Geneva  and  Batavia 
Robert  G.  Stone,  M.D. 

860  Summit  Street 
Elgin. 

Kendall  County:  Oswego,  NeAvark  and 
Plano 

Joseph  L.  DaAV,  M.D. 

OsAvego. 


Returning  Viet-Nam  era  servicemen  Avill 
SAvell  the  nation’s  veterans  population 
850,000  by  1969. 


for  Xovember,  1968 


673 


Help  the  Needy! 


A patient  of  advancing  years  may  appear  to  “have  everything,”  but  may  well 
be  in  need— medically . You  know  the  symptoms.  She’s  tired  most  of  the  time. 
Though  there’s  nothing  wrong  with  her  organically,  she  suffers  from  general 
malaise.  Lassitude  has  become  her  way  of  life  . . . vague  aches  and  pains  her 
major  concern. 

Such  a patient  has  entered  the  “Mediatric  Age”— that  stage  of  her  life  in 
which  she’s  an  ideal  candidate  for  MEDIATRIC.  This  preparation  provides 
the  anabolic  benefits  of  gonadal  steroids,  plus  a gentle  mood  uplift  and  the 
nutritional  support  she’s  apt  to  need.  MEDIATRIC  is  intended  to  help  keep 
her  more  alert  and  active,  and  relieve  general  malaise  ...  to  help  restore  that 
sense  of  physical  and  emotional  well-being  that  the  elderly  deserve  to  enjoy. 


674 


Illinois  Medical  Joxirnal 


when  cough 

is  not 


the 


OMNI 

. . . because  OMNI-TUSS  is  indicated  for  cough 
associated  with  upper  respiratory  tract  infections, 
bronchitis,  bronchiectasis,  bronchial  asthma,  emphy- 
sema, sinusitis  and  rhinitis,  hay  fever,  or  other  allergic 
conditions.  Any  of  these  conditions  may  exhibit  the 
general  symptom  syndrome — coughing,  wheezing, 
bronchospasm,  and  tenacious  mucus — which  may 
benefit  from  the  antitussive,  bronchodilative,  antihis- 
taminic,  and  expectorant  action  of  Omni-Tuss. 

The  therapeutic  usefulness  of  Omni-Tuss  is  enhanced 
by  a unique  resin  complex  formulation  providing  the 
clinically  desirable  advantages  of:  (1)  uniform  drug 
availability  throughout  an  extended  period,  (2)  8 to  12 
hours  of  symptomatic  control,  (3)  minimal  dosage 
requirement,  (4)  minimal  side  effects. 

Economical,  efficient  b.i.d.  dosage — extremely  well- 
tolerated  by  children,  6-12,  and  adults. 


only  sound 
you  hear . . . 


TUSS*  b.i.d. 

‘Omni  Tuss’  Suspension:  Each  teaspoonful  (5  cc.)  contains 
10  mg.  codeine  (Warning:  May  be  habit-forming),  5 mg. 
phenyltoloxamine,  3 mg.  chlorpheniramine,  25  mg.  ephe- 
drine,  all  as  cation  exchange  resin  complexes  of  sulfonated 
polystyrene,  and  20  mg.  guaiacol  carbonate. 

Available  on  prescription  only.  Class  X exempt  narcotic. 
Permissible  on  oral  prescription. 

Dosage:  Adults:  1 teaspoonful  (5  cc.)  ql2h. 

Children  (6-12 years):  Vi  teaspoonful  ql2h. 

Side  Effects:  Minimal,  but  when  encountered  may  include 
jitteriness,  nausea,  drying  of  mouth,  insomnia,  constipa- 
tion, which  disappear  upon  adjustment  of  the  dose  or  dis- 
continuance of  treatment. 

Precautions  and  Contraindications:  For  complete  detailed 
information,  refer  to  package  insert  or  official  brochure. 

Strasenburgh 

Strasenburgh  Laboratories  Division 
Wallace  & Tieman  Inc.,  Rochester,  N.Y. 


— Medicine  and  Religion 

To  Better  Understand  Your  Protestant  Patient 

By  Rev.  Carl  Nighswonger,  S.T.M./Chicago 


The  Protestant  patient  is  first  of  all  a 
person,  and  as  such,  manifests  three  dimen- 
sions of  religious  need  which  should  be 
distinguished  during  any  crisis  experience. 

1)  Spiritual  Needs:  There  is  a growing 
appreciation  of  the  spiritual  dimension  of 
the  “whole”  person  which  represents  the 
individual’s  need  to  have  a sense  of  mean- 
ing and  purpose  to  his  life.  One  becomes 
spiritually  sick  when  he  has  been  unable 
to  experience  this  sense  of  meaning  and 
purpose  in  his  life. 

The  level  to  which  an  individual  has 
achieved  a meaningful  and  worthwhile  life 
will  be  reflected  in  his  ability  to  cope  with 
the  crisis  of  illness.  An  illness  may  reach 
tragic  proportions  for  one  whose  life  is 
yet  “unfulfilled;”  or  it  may  be  welcomed 
by  the  patient  whose  life  has  become  “emp- 
ty” of  any  real  meaning. 

Sometimes  the  physician  will  observe 
such  spiritual  conflict,  or  sickness,  through 
physical  and  emotional  symptomatology. 
In  such  instances  he  should  be  encouraged 
to  help  the  patient  recognize  and  deal  with 
the  problems  of  an  unfulfilled  or  meaning- 
less life. 

2)  Religious  Behavior:  The  patient’s  re- 
ligious behavior  will  reflect  the  unique 
function  his  religion  serves  in  his  person- 
ality structure.  An  intrinsic  religious  faith 
reflects  an  internalized  trust  and  confi- 
dence which  enables  an  individual  to  cope 
with  life  situations  realistically  and  hon- 
estly. His  religious  beliefs  will  symbolize 
what  he  feels  and  experiences  in  life. 

The  individual  with  such  an  intrinsic  re- 
ligion usually  experiences  personal  growth 
and  maturity  in  the  process  of  coping  with 
his  illness,  even  though  it  be  painful  and 
difficult  for  him.  The  physician  of  such  a 
patient  should  be  careful  that  he  does  not 
underestimate  the  therapeutic  resources  of 
the  patient’s  religious  faith  and  practices 
which  will  aid  in  his  responsiveness  to  ill- 
ness and  the  treatment  program. 

On  the  other  hand,  the  patient  whose 
religion  is  basically  extrinsic  will  find  it 
difficult  to  experience  any  personal  growth 
from  his  illness.  Extrinsic  religion  usually 
represents  a defense  against  reality  rather 


than  any  genuine  acceptance  of  his  life  sit- 
uation. 

Few  physicians  have  been  spared  the  ex- 
posure to  such  defensive  religious  behavior. 
The  incongruence  between  feelings  and  ac- 
tions is  usually  quite  prominent  and  some- 
times leads  the  physician  to  either  ignore 
the  patient’s  religious  concerns,  or  to 
“neutralize”  them  through  a referral  to 
the  patient’s  clergyman. 

The  physician  who  recognizes  the  pa- 
tient’s use  of  religion,  as  a defense,  gains  a 
further  understanding  of  the  personal  con- 
cerns of  his  patient  and  will  usually  find 
a sensitive  clergyman  very  helpful  in  the 
treatment  process. 

3)  Theological  concerns:  The  third  di- 
mension of  religious  need  represents  the 
patient’s  own  theological  perspective  which 
determines  how  he  interprets  the  purpose 
of  life  as  well  as  the  meaning  of  his  illness. 

Often  an  individual’s  theological  de- 
velopment has  been  hampered  by  irrele- 
vant or  inadequate  doctrines  and  teach- 
ings which  sometimes  contribute  to  his 
lack  of  meaning  and  purpose  in  life  as 
well  as  his  religious  defensiveness.  (The 
current  “God  is  Dead”  controversy  reflects 
the  manner  in  which  theological  irrelevance 
exists  for  many  persons.) 

Although  most  physicians  wisely  avoid 
theological  issues  and  discussion  with 
their  patients,  they  should,  nevertheless,  be 
aware  that  the  patient’s  response  to  his  ill- 
ness and  the  prescribed  treatment  program 
may  very  well  be  handicapped  by  constric- 
tive or  conflictual  theological  beliefs 
which  might  very  well  be  based  on  distor- 
tion or  misunderstanding. 

The  physician’s  respect  for  the  patient 
as  a person  demands  that  he  respect  the 
theological  perspective  of  his  patient  even 
though  it  might  be  personally  unacceptable 
to  himself.  Such  differences  need  not  im- 
pede the  physician-patient  relationship, 
particularly  if  the  physician  has  called  upon 
the  professional  cooperation  of  an  informed 
clergyman  to  assist  him  in  the  care  of  the 
patient. 

(Continued  on  page  706) 


682 


Illinois  Medical  Journal 


II I cvGr 
catch  up  on 
my  work?” 


w^^rnmSmm^ 


HS 


'^m 


Mebaral®  usuaUy  calms  the  anx- 
ious patient  without  the  degree 
of  languor,  or  decrease  in  alert- 
ness often  caused  by  other  bar- 
bituratesJ  Mebarai  is  particularly 
valuable  in  treating  anxiety-ten- 
sion states  when  minimal  hypnot- 
ic action  is  desired.^  Its  sedative 
action  is  prolonged^  and  pre- 
dictable. 


Contraindication:  Large  doses  are 
contraindicated  In  patients  with 
nephritis. 

Warning:  May  be  habit  forming. 

Precautions:  As  with  other  barbi- 
turates, caution  is  advisabie  dur- 
ing use  in  debilitated  and  senile 
patients  and  in  patients  with  pul- 
monary disease. 

Adverse  reactions:  Although 
Mebarai  is  generally  well  tolerated 
over  long  periods,  the  possibility 
of  idiosyncrasy  to  barbiturates  {as 
manifested  by  drowsiness,  ver- 
tigo, and  cutaneous  eruptions) 
should  be  considered. 

Dosage:  Adults,  for  daytime  seda- 
tion—Va  gr.  (32  mg.),  % gr.  {50  mg.) 
and,  at  times,  IV2  gr.  {100  mg.), 
three  or  four  times  daily. 

References:  1,  Musser.  Ruth  D.,  and  Shub* 
kaget,  Betty  L.:  Pharmacology  and  Therapeu- 
tics, ed.  3,  New  York,  Macmillan  Company, 
1965,  p.  363.  2,  Council  on  Drugs,  American 
Medical  Association:  New  Drugs  1965,  Chi- 
cago, American  Medical  Association,  1965, 
p.  157,  3.  Modell,  Walter  (Ed.):  Drugs  in  Cur- 
rent Use  1966,  New  York,  Springer  Publishing 
Company,  1966,  p.  77. 

Winthrop  Laboratories  rzi7.  ,«> i 

New  York,  N . Y.  1 001 6 


THE  VIEW  BOX 

( Continued  from  page  644 ) 

Diagnosis:  Acute  appendicitis. 

The  striking  feature  is  the  presence  of  a 
calculus  immediately  above  the  right  iliac 
crest.  You  will  also  note  that  there  is  a 
vaguely  defined  mass  in  the  right  lower 
quadrant  with  absence  of  gas  around  the 
cecum.  The  presence  of  a calcification  in 
the  region  of  the  appendix  in  a patient 
with  an  acute  abdomen  is  appendicitis  un- 
til proven  otherwise.  Usually  the  presence 
of  a calculus  indicates  that  there  is  either 
gangrenous  appendix  or  perforation  of  the 
appendix.  Other  roentgen  signs  which  can 
be  present  in  acute  appendicitis  are  1)  ob- 
literation of  the  psoas  on  the  right  side; 
2)  a loss  of  properitoneal  fat  line,  particu- 
larly if  there  is  a laterally  placed  appen- 
dix; 3)  an  air  fluid  level  will  be  seen  in 
the  right  colon  in  about  85%  of  the  cases 
on  the  decubitus  film;  4)  occasionally  scol- 
iosis with  retraction  of  the  lumbar  spine 
away  from  the  right  lower  quadrant  will 
be  noted.  A barium  enema  is  a very  help- 
ful examination  in  the  diagnosis  and  has 
been  shown  to  be  without  apparent  dan- 
ger. The  presence  of  a pressure  defect  in 
the  cecum  with  an  inverted  three  pattern 
has  been  diagnostic  of  acute  appendicitis. 
At  surgery  this  patient  had  a ruptured 
gangrenous  appendix. 


Film  Review 

"The  Problem  of  Chest  Pain,"  an  im- 
portant new  medical  education  film,  is  now 
available  for  loan  without  charge.  Pro- 
duced in  cooperation  with  Tinsley  R.  Har- 
rison, M.D.,  Birmingham,  Ala.  and  the 
American  College  of  Cardiology,  it  is  being 
released  in  conjunction  with  the  publica- 
tion of  Dr.  Harrison's  book.  Principles  and 
Problems  of  Ischemic  Heart  Disease.  The 
mode  of  presentation  is  unique,  employ- 
ing a film-within-a-film  technique.  Through 
this  method,  the  audience  is  able  to  view 
a motion  picture,  along  with  Dr.  Harrison 
and  a colleague,  and  at  the  same  time 
listen  to  an  exchange  of  pertinent  ques- 
tions and  answers  between  the  two.  Pre- 
sented by  the  Pharmaceuticals  Division  of 
Geigy  Chemical  Corp.,  the  film  may  be  se- 
cured by  contacting  either  Geigy's  Profes- 
sional Service  Representatives  or  its  Medi- 
cal Service  Department. 


Preludin  is  indicated  only  as  an 
anorexigenic  agent  in  the  treatment 
of  obesity.  It  may  be  used  in  simple 
obesity  and  in  obesity  complicated 
by  diabetes,  moderate  hypertension 
(see  Precautions),  or  pregnancy 
(see  Warning). 

Contraindications:  Severe  coronary 
artery  disease,  hyperthyroidism, 
severe  hypertension,  nervous  insta- 
bility, and  agitated  prepsychotic 
states.  Do  not  use  with  other  CNS 
stimulants, including  MAO  inhibitors. 
Warning:  Do  not  use  during  the  first 
trimester  of  pregnancy  unless  |do- 
tential  benefits  outweigh  possible 
risks.  There  have  been  clinical 
reports  of  congenital  malformation, 
but  causal  relationship  has  not  been 
proved.  Animal  teratogenic  studies 
have  been  inconclusive. 
Precautions:  Use  with  caution  in 
moderate  hypertension  and  cardiac 
decompensation.  Cases  involving 
abuse  of  or  dependence  on  phen- 
metrazine  hydrochloride  have  been 
reported.  In  general,  these  cases 
were  characterized  by  excessive 
consumption  of  the  drug  for  its  cen- 
tral stimulant  effect,  and  have 
resulted  in  a psychotic  illness 
manifested  by  restlessness,  mood  or 
behavior  changes,  hallucinations  or 
delusions.  Do  not  exceed  recom- 
mended dosage. 

Adverse  Reactions:  Dryness  or  un- 
pleasant taste  inthe  mouth, urticaria,, 
overstimulation,  insomnia,  urinary 
frequency  or  nocturia,  dizziness, 
nausea,  or  headache. 

Dosage:  One  25  mg.  tablet  b.i.d.  or 
t.i.d.  Or  one  75  mg.  Endurets  tablet 
a day,  taken  by  midmorning. 
Availability:  Pink,  square,  scored 
tablets  of  25  mg.  for  b.i.d.  or  t.i.d. 
administration,  in  bottles  of  100  and 
1000. 

Pink,  round  Endurets®  prolonged- 
action  tablets  of  75  mg.  for  once-a- 
day  administration,  in  bottles  of 
100  and  1000. 

Under  license  from 
Boehringer  Ingelheim  G.m.b.H. 

(B)R3-46-560-B 

For  complete  details,  please  see 
full  prescribing  information. 

Preludin’ 

phenmetrazine 

hydrochloride 

Geigy  Pharmaceuticals 
Division  of 

Geigy  Chemical  Corporation 
Ardsley,  New  York  10502 


684 


Illinois  Medical  Journal 


ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 

“Your  Best  Foot  Forward” 


By  Susan  Piszczek 

Medical  assistants  today  are  witnessing 
a growing  profession!  Sure  sounds  familiar, 
doesn’t  it!  Actually,  medical  assistants  form 
a new  profession  and  even  have  their  own 
professional  organization. 

But  a medical  assistant  is  a difficult  per- 
son to  describe  and  define.  The  American 
Medical  Association’s  career  handbook— 
Horizons  Unlimited— says  that  “the  wom- 
en who  staff  physicians’  offices,  whatever 
the  nature  of  their  duties,  are  properly 
called  medical  assistants.”  That’s  right,  a 
medical  assistant  is  a secretary,  nurse,  lab 
assistant,  housekeeper,  bookkeeper  . . . and 
performs  numerous  other  tasks. 

Another  definition  says  that  a medical 
assistant  is  “an  individual  who  is  super- 
vised by  a physician  and  who  performs 
those  administrative  and/or  clinical  duties 
delegated  to  her  in  relation  to  her  specific 
training  and  in  accord  with  the  respective 
state  laws  governing  such  actions  and  ac- 
tivities.” 

The  medical  assistant  meets  the  chal- 
lenges posed  by  the  relentlessly-ringing  tele- 
phone, soothes  worried  patients,  entertains 
rambunctious  or  frightened  children,  con- 
quers the  multitude  of  insurance  forms  and 
possibly  even  assists  her  boss  in  the  ex- 
amining room. 

Nevertheless,  the  main  job  of  this  medi- 
cal assistant  is  to  see  that  the  physician’s 
office  is  managed  efficiently.  She  helps  the 
physician  in  every  way  possible  so  that  he 
is  free  to  concentrate  on  diagnosing  and 
treating  patients. 

The  AMA  realizes  that  a medical  assis- 
tant is  invaluable  to  the  physician,  for  a 
trained  office  assistant  can  relieve  the  phy- 
sician of  needless  duties.  If  she  places  serv- 
ice above  self  . . . she  is  truly  a pro- 
fessional . . . and  professional  individuals 
find  great  satisfaction  in  the  dedication 
and  service  to  others. 


It  is  in  this  service  to  others  that  pro- 
fessionals must  strive  to  meet  the  accept- 
able standards  of  high  moral  character. 

Because  of  the  importance  of  the  job 
and  the  relationship  with  the  physician  and 
patient,  the  assistant  at  all  times  must  re- 
member to  put  the  best  foot  forward. 

And  putting  your  best  foot  forward 
means  one  must  have  a pleasing  per- 
sonality, be  adept  at  dealing  with  people, 
be  neat  and  accurate  . . . and  yes,  use  dis- 
cretion and  good  judgment.  One  must  be 
guided  by  a code  of  ethics. 

What  is  ethics?  Well,  ethics  is  the  study 
of  right  and  wrong  in  human  conduct.  It 
deals  with  moral  conduct,  duty  and  judg- 
ment. Ethics  comes  from  the  Greek  word 
ethos,  and  has  come  to  be  associated  with 
human  customs.  Some  of  these  customs  are 
mere  conventions  such  as  table  manners, 
modes  of  dress,  forms  of  speech  and  eti- 
quette. 

The  earliest  written  code  of  ethical  prin- 
ciples for  medical  practice  was  conceived 
by  the  Babylonians  around  2500  B.C.  That 
document,  the  Code  of  Hammurabi,  was 
a code  of  conduct  setting  forth  in  con- 
siderable detail  for  that  era  of  history 
the  nature  of  conduct  demanded  of  the 
physician.  The  Oath  of  Hippocrates— a 
brief  statement  of  principles— has  come 
down  through  history  as  a living  and  even 
workable  statement  of  ideals  to  be  cher- 
ished by  the  physician.  This  Oath  was  con- 
ceived some  time  during  the  period  of 
Grecian  greatness,  probably  around  the 
fifth  century  B.C.  It  has  remained  in  West- 
ern Civilization  as  an  expression  of  ideal 
conduct  for  the  physician.  And  in  1803,  a 
physician,  philosopher  and  writer,  known 
as  Thomas  Percival,  published  his  code  of 
medical  ethics.  Medical  ethics  serves  as  a 

(Continued  on  page  702) 


for  November,  1968 


689 


Now  Continental  Bank 
will  give  your 
$20y000  investment 
the  million  dollar 
treatment. 


' 

RTL 

MCI 

— 



5»&33 

3*48 

338  2=' 

^11  336 

690 


Illinois  Medical  Journal 


Washing  Machine 
Dialysis 


Use  of  a domestic  washing  machine  in 
conjunction  with  an  improved  version  of 
the  Twin  Coil  dialyzer  constitutes  a simple 
and  inexpensive  system  for  hemodialysis. 
Since  installation  costs  are  very  low,  this 
method  is  particularly  useful  for  commun- 
ity hospitals  where  only  a small  number  of 
dialyses  are  anticipated. 


Hemodialysis  with  the  disposable  Twin 
Coil  artificial  kidney  is  currently  done  with 
standard  equipment  specifically  designed 
for  this  purpose.  This  consists  essentially 
of  a large  tank  fitted  with  pumps,  a heater 
and  several  other  devices.  The  acquisition 
of  such  expensive  equipment  is  outside  the 


Antonio  A.  Versaci, 
M.D.  (top)  is  Director 
of  the  Renal  Division, 
Memorial  Hospital, 
Springfield  and  was  the 
Director  of  Hemodialy- 
sis at  Mt.  Sinai  Hospi- 
tal, Chicago.  He  was 
also  Assistant  Professor 
of  Medicine  at  the  Chi- 
cago Medical  School. 

Robert  V.  Soriano, 
M.D.  (center)  is  a Fel- 
low in  Renal  Diseases, 
Mt.  Sinai  Hospital,  Chi- 
cago. He  holds  his  M.D. 
from  the  XJniv.  of  Santo 
Tomas,  Philippines  and 
served  an  interneship 
at  Mt.  St.  Francis  hos- 
pital in  Pittsburgh. 

George  Dunea,  M.D. 
(lower)  is  Director  of 
the  Chicago  Medical 
School  Medicine  Sec- 
tion as  well  as  Assistant 
Professor  at  Chicago 
Medical  School.  His 
p r e - m e d training  is 
from  the  University  of 
Sydney,  Australia  and 
he  holds  the  M.R.C.P, 
from  London. 


With  A 

New  Twin  Coil 
Kidney 

By  Antonio  A.  Versaci,  M.D., 
Robert  V.  Soriano,  M.D. 
and  George  Dunea,  M.B., 
M.R.C.P. /Chicago 

means  of  many  institutions,  and  may  be 
difficult  to  justify  if  only  a limited  number 
of  dialyses  are  anticipated.  It  is  our  pur- 
pose to  present  a simple  and  inexpensive 
method  of  dialysis,  which  utilizes  a domes- 
tic washing  machine  in  conjunction  with 
an  improved  type  of  Twin  Coil  artificial 
kidney,  the  “Ultra-Flo  145”.  This  method 
significantly  reduces  the  cost  of  hemodialy- 
sis and  places  this  procedure  within  the 
reach  of  any  community  hospital. 

Description 

A standard  tub  type  washing  machine 
is  employed.  The  agitator  is  removed.  The 
coil  kidney  is  inserted  into  a standard  Tra- 
venol  cannister  which  is  suspended  in  the 
machine  (Fig.  1).  The  machine  is  filled 
with  warm  water  (38-39  °C.)  through  a 
“fill”  hose.  For  convenience  this  may  be 
connected  to  the  drain  pipe,  so  that  filling 
occurs  by  retrograde  flow  through  the  drain 
system.  The  “fill”  hose  is  then  disconnected 
from  the  drain  pipe:  2.64  liters  of  Dialy- 
sate  Salt  Concentrate  is  added  and  the  to- 
tal volume  of  dialysate  solution  is  made  up 
to  70  liters.  The  drain  pump  is  used  as  a 
dialysate  circulating  pump  during  dialysis 
by  attaching  to  the  drain  pipe  a rubber 
hose  which  is  connected  to  the  coil-cannis- 
ter  (Fig.  2).  The  dialysate  is  circulated  at 
a rate  of  approximately  50  liters  per  min- 

Ultra-Flo  145,  Dialysate  Salt  Concentrate,  and 
Travenol  are  products  of  Travenol  Laboratories, 
Inc.,  Morton  Grove,  Illinois. 


'for  November,  1968 


693 


TABLE 


Fig.  1 — ^Washing  machine  dialyzer 

ute.  Although  no  heater  is  used,  heat  loss 
from  the  dialysis  fluid  is  not  significant. 
The  bath  is  changed  every  1 1/2  to  2 hours 
by  disconnecting  the  circulation  hose  lead- 
ing from  the  cannister  and  attaching  the 
“fill”  hose  to  the  drain  pipe  for  draining 
and  refilling.  The  coil  is  used  with  a blood 
pump,  standard  connecting  sets  and  ma- 
nometer, and  is  primed  with  saline. 

The  “Ultra-Flo  145”,  an  improved  ver- 
sion of  the  original  Twin  Coil  artificial 
kidney,  employs  a new  plastic  membrane 
support  and  an  external  compression  cuff. 
It  has  a high  dialysance  and  ultra-filtration 
capacity  and  a reduced  blood  volume  and 
surface  area  (See  Table).  Patients  are  easily 
managed  by  twice  weekly  six  hour  dialysis. 
A further  reduction  in  blood  requirements 
may  be  achieved  by  use  of  a single  coil, 
either  alone  or  by  simultaneous  dialysis 
of  two  patients  on  one  “Ultra-Flo  145” 
dialyzer;  a six  hour  dialysis  is  adequate  if 
blood  flow  rates  are  high  or  if  the  patient 
is  small,  otherwise  eight  to  ten  hours  of 
dialysis  are  needed. 

Discussion 

The  concept  of  utilizing  domestic  wash- 
ing machines  for  dialysis  was  originated  by 
Nose  in  1961,^  and  more  recently  adapted 


Original  Ultra-Flo  Ultra-Flo  145” 


Twin  Coil 
Surface  Area 

(KO)  1.9 

Priming  Volume 
(c  tubing)  1100 

Urea  Dialysance 
Blood  flow 
200  ml /min.  125 
250  145 

300  160 

350  170 

400  185 


145” 

Single- Coil 

1.45 

0.725 

500-600 

350-400 

135 

85 

160 

105 

180 

120 

200 

135 

215 

150 

for  use  with  four  home  made  coils.^-^  In 
these  systems,  adequate  circulation  of  dia- 
lysis fluid  was  promoted  by  the  washing 
machine  agitator.  The  use  of  disposable 
coil  artificial  kidneys  is  more  convenient, 
and  at  present  only  slightly  more  expensive. 
However,  the  larger  size  and  winding  of 
the  “Ultra-Flo  145”  coil  requires  a blood 
pump  as  well  as  a pump  for  adequate  cir- 
culation of  the  dialysis  fluid.  The  latter  is 
easily  achieved  by  use  of  a rubber  hose 
from  the  drain  pump.^ 

In  our  experience,  dialysis  with  a wash- 
ing machine  is  as  effective  and  convenient 
as  the  standard  methods.  In  fact,  the  ab- 
sence of  multiple  switches  makes  it  easier 
to  operate.  While  dialysis  with  the  corn- 


694 


Illinois  Medical  Journal 


References 


plete  “Ultra-Flo  145”  is  rapid  and  efficient, 
further  reduction  in  cost  may  be  achieved 
by  use  of  a single  coil  only,  or  by  simultan- 
eous dialysis  of  two  patients  on  one  Twin 
Coil.® 

The  principal  initial  equipment  cost  of 
this  system  is  for  the  blood  pump,  since 
used  washing  machines  are  inexpensive.  At 
a time  when  dialysis  equipment  is  becom- 
ing increasingly  complex  and  expensive, 
we  hope  that  this  approach  will  seiv^e  as  a 
stimulus  toward  the  development  of  less 
expensive  methods  of  treatment  for  the 
many  who  continue  to  die  from  uremia. 


1.  Nose,  Y.:  On  a Portable  T\^)e  Artificial  Kid- 
nev  Set,  J.  Japanese  Med.  Instrument.  31:40-42, 
1961. 

2.  Kolff,  'W.  J.:  Introduction  of  a Simple  Artifi- 
cial Kidney  in  the  United  States,  Clev.  Clin. 
Quart.  34:151-158,  1967. 

3.  Khastagir,  B.,  Erben,  J.,  Shimizu,  A.,  Rose,  F., 
Nose,  Y.,  Van  Dura,  D.  and  Kolff,  'W.  J.:  The 
Four-Coil  Artificial  Kidney  for  Home  Dialysis, 
Trans.  Amer.  Soc.  Artif.  Org.  13:14-18,  1967. 

4.  Simon,  X.  M.,  Blondell,  X*.  J.  and  del  Greco, 
F.:  A Xew  Technique  for  Simultaneous  Dialy- 
sis of  Two  Patients  with  The  Twin  Coil  Kid- 
nev,  Trans.  Amer.  Soc.  Art.  Int.  Org.  10:183- 
185,  1964. 

5.  Ragde,  H.,  Xakamoto,  S.  and  Kolff,  W.  J.: 
Simultaneous  Hemodialvses  with  Twin  Coil 
Artificial  Kidney,  JAMA  176:668-669,  1961. 


Emphysema  Second  to  Heart  Disease 
As  Cause  of  Adult  Disability 


Emphysema  is  now  second  only  to  heart 
disease  as  a cause  of  adult  disability— and 
its  prevalence  is  still  increasing,  reports  Dr. 
Benjamin  Burrows,  Associate  Professor  of 
Medicine  at  The  University  of  Chicago. 

Although  the  precise  cause  of  the  di- 
sease is  still  uncertain.  Dr.  Burrows  points 
out  that  there  is  a clear  association  with 
cigarette  smoking  and  a very  suggestive 
relationship  to  air  pollution. 

In  addition,  genetic  factors,  respiratory 
infections,  and  socio-economic  conditions 
have  been  implicated  in  the  disease. 

Dr.  Bunows  believes  it  is  more  accurate 
to  refer  to  the  condition  which  often  leads 
to  irreversible  airways  obstruction  as  the 
emphysema-bronchitis  syndrome. 

In  the  past,  chronic  bronchitis  has  been 
a clinical  condition  characterized  by  chronic 
cough  and  expectoration  of  uncertain 
cause.  Emphysema,  on  the  other  hand,  has 
been  characterized  by  dilation  of  the 
lung’s  terminal  air  spaces  A\dth  destruction 
of  their  walls. 

Many  patients  have  features  suggesting 
a mixture  of  the  two  conditions.  Because 
of  the  uncertainty  of  cause,  the  two  may 
well  be  manifestations  of  the  same  or  re- 
lated problems. 

Reported  deaths  from  the  condition, 
whatever  its  cause,  have  doubled  every  five 
years  since  1945.  The  true  death  rate,  ac- 
cording to  Dr.  Burrows,  undoubtedly  ex- 
ceeds that  of  lung  cancer. 

Dr.  Burrows  has  been  conducting  ex- 
tensive research  on  the  emphysema-bron- 
chitis syndrome  for  six  years. 


In  the  U.S.,  the  more  common  pattern 
involves  a slowly  developing  airway  ob- 
struction which  begins  in  early  adult  life 
and  becomes  recognizable  on  physiological 
testing  by  the  age  of  30  or  40.  In  these 
individuals,  expiratory  flow  rates  fall  two 
to  four  times  as  fast  as  in  the  general 
population.  However,  it  takes  20  to  40 
yeai's  for  these  individuals  to  develop  suf- 
ficient airways  obstruction  to  produce 
chronic  labored  breathing. 

Patients  with  this  pattern  of  the  disease 
generally  complain  of  weakness  and  dysp- 
nea (labored  breathing).  A mild  cough 
often  begins  after  the  onset  of  measurable 
ventilatory  impairment,  but  it  may  come 
before  clinical  dyspnea. 

The  second  pattern  of  the  disease  seems 
to  begin  earlier,  often  in  childhood.  It  is 
characterized  by  recurrent  respiratory  in- 
fections, recurrent  airway  obstruction,  and 
early  chronic  bronchitis. 

Dr.  Burrows  cautions  that  once  chronic 
obstructive  lung  disease  has  developed, 
there  is  a distressing  tendency  to  regard  it 
as  untreatable.  WTien  this  critical  obstruc- 
tion has  developed,  there  should  be  a vig- 
orous and  prolonged  medical  program  to 
be  certain  the  disorder  is  irreversible. 

The  major  principles  in  treating  these 
patients  are  to  take  an  active  approach  to 
therapy,  discourage  premature  invalidism, 
and  avoid  dependence  on  expensive  gad- 
gets or  treatments  of  unproven  value,  es- 
pecially when  these  are  used  in  place  of 
simpler  and  more  easily  administered  ther- 
apeutic measures.  Dr.  Burrows  added. 


for  November,  1968 


695 


IDPA 


Illinois  Department  of  Public  Aid 
Payment  Procedures  and  Policies  Explained 


Harold  O.  Swank,  Director 
Illinois  Department  of  Public  Aid 

Part  I of  a Series 


On  Jan.  1,  1967,  the  Illinois  Department 
of  Public  Aid  adopted  a new  procedure  for 
paying  physicians  for  medical  care  ren- 
dered to  recipients  of  public  assistance. 
Arrived  at  jointly  with  the  Illinois  Medical 
Society,  the  procedure  called  for  physicians 
to  bill  IDPA’s  Springfield  Office  directly, 
charging  usual,  customary  and  reasonable 
fees. 

The  then  new  procedure  was  discussed 
in  principle  by  Public  Aid  Director  Harold 
O.  Swank  in  the  February,  1967,  issue  of 
the  Illinois  Medical  Journal.  At  that  time 
it  was  pointed  out  that  the  procedure,  be- 
ing new,  would  be  subject  to  evaluation 
and  refinement  once  sufficient  experience 
had  accrued  to  assure  proper  judgment. 
Consequently,  formal  and  informal  discus- 
sions have  taken  place  periodically  between 
IDPA  staff  and  members  of  the  ISMS  Com- 
mittee on  Usual  and  Customary  Fees.  And 
now,  some  eighteen  months  later,  it  is  apro- 
pos to  discuss  areas  where  problems  con- 
tinue to  occur  and,  for  the  benefit  of  all, 
to  answer  those  questions  most  frequently 
asked  by  individual  doctors.  But  before 
doing  that,  a brief  history  of  the  procedure 
and  a resume  of  public  aid  programs  are 
essential  for  overall  perspective  and  un- 
derstanding. 

Prior  to  Jan,  1,  1967,  physicians  sent  their 
bills  to  the  appropriate  county  department 
of  public  aid  where  they  were  reviewed  for 
such  factors  as  eligibility  of  the  patient, 
presence  of  needed  case  data,  and  charges 
not  to  exceed  the  flat  rates  mutually  agreed 
upon  in  1958  by  ISMS  and  IDPA.  The 
counties  then  forwarded  the  screened  bills 
to  Springfield  for  final  review,  compila- 
tion, and  payment.  Fees  to  fit  unusual 
cases,  errors  in  billing,  and  other  admin- 
istrative problems  were  usually  settled  at 
the  local  level  in  conjunction  with  the 
County  Medical  Advisory  Committee.  The 
more  difficult  problems— especially  those 
involving  fees— were  taken  up  with  ISMS 
for  discussion  with  IDPA  at  the  state  level. 


The  procedure  now  in  effect  offers  sig- 
nificant improvements.  By  adopting  “usual, 
customary,  and  reasonable”  fees,  doctors 
are  assured  of  a more  realistic  return  for 
their  services  as  the  former,  flat  rates  were 
obsolescent  and  were  generally  less  than 
the  fees  charged  patients  in  the  private 
economy.  Also,  as  part  of  the  payment  im- 
provement, IDPA  lifted  the  restrictions 
which  limited,  under  certain  conditions, 
the  amount  of  services— number  of  office 
calls  or  visits— for  which  it  would  pay.  The 
new  fee  rates  closely  approximate  those 
governed  by  Title  XVIII  (Medicare)  which 
became  effective  July  1,  1966,  under  the 
U,  S.  Social  Security  Act. 

Also,  direct  billing  plus  computer  proc- 
essing can  promote  faster  handling  and 
prompt  payment.  However,  the  speed  fac- 
tor is  provisional,  depending  on  whether 
or  not  bills  reflect  precisely  all  case  identi- 
fication data  (recorded  at  the  top  of  Form 
132)  and  whether  or  not  all  medical  serv- 
ices are  properly  coded  and,  if  necessary, 
explained.  Bills  which  do  not  fulfill 
these  requirements  cannot  be  computer 
processed.  Some  of  them— those  with  er- 
rors which  can  be  detected  visually— are 
screened  out  during  the  initial  clerical  re- 
view which  all  bills  undergo,  and  those 
not  so  detected  are  later  rejected  by  the 
computer. 

Bills  having  errors  involving  medical 
procedures  receive  individual  consideration 
by  professional  staff.  Those  with  errors  of 
case  identification  receive  manual  process- 
ing by  IDPA  clerical  or  technical  staff,  after 
which  most  can  be  machine  processed.  But 
all  manual  or  individually  considered  ac- 
tions cause  delay.  Throughout  this  article 
—to  be  serialized  in  several  consecutive  is- 
sues of  the  Illinois  Medical  J ournal—thext 
will  be  emphasis  and  detail  on  how  to 
achieve  the  desired  accuracy  in  billing  for 
physicians’  services  and  dispensed  drugs. 
The  objective  is  mutual— doctors  want  to 
be  paid  accurately  and  promptly  and  the 


696 


Illinois  Medical  Journal 


IDPA  wants  to  pay  them  accurately  and 
promptly. 

For  the  benefit  of  all  physicians— particu- 
larly those  who  have  just  entered  into 
practice  in  the  state— a brief  resume  of 
IDPA  programs  follows.  There  are  two 
broad  classes  of  needy  people  who  are 
entitled  to  care  under  the  Medical  As- 
sistance (Title  XIX)  program.  First,  there 
are  people  who  lack  the  income  and  assets 
to  meet  basic  living  costs  and  medical  care 
when  they  get  sick.  These  cases  are  known 
as  grant  cases  because  during  eligibility 
they  receive  a monthly  financial  grant. 
Such  cases  include  recipients  of  Old  Age 
Assistance,  Blind  Assistance,  Disabled  As- 
sistance or  Aid  to  Dependent  Children. 
The  other  broad  classification  is  termed 
Medical  Assistance-No  Grant  and  refers  to 
people  who  have  sufficient  income  or  assets 
to  pay  for  regular  living  costs  but  lack 
the  means  to  pay  for  medical  care,  includ- 
ing drugs,  when  they  become  ill. 

These  five  categories— OAA,  BA,  DA, 
ADC  and  MA-NG— are  funded  50/50  with 
federal  and  state  money.  They  are  not  to 
be  confused  with  General  Assistance  or 
Aid  to  the  Medically  Indigent  (also  under 
General  Assistance).  The  latter  two  are 
locally  administered  programs  using  either 
local  revenue  or  a combination  of  state 
and  local  funds.  Eligibility  for  GA  or  AMI 
is  determined  by  the  local  township  su- 
pervisor or  the  commissioner  in  commis- 
sion type  counties. 

How  Does  One  Define  Usual, 
Customary,  and  Reasonable  Fees? 

The  basic  definitions  of  usual,  custom- 
ary, and  reasonable  fees  are  contained  in 
the  Medicare  Act.  The  definitions  were 
reviewed  and  accepted  for  implementation 
by  ISMS  in  its  meeting  on  Jan.  16,  1966. 
The  “usual”  fee  is  that  fee  usually  charged 
for  a given  service  by  an  individual  physi- 
cian to  his  private  patient  (i.e.,  his  own 
usual  fee).  A fee  is  “customary”  when  it 
is  within  the  range  of  usual  fees  charged 
by  physicians  of  similar  training  and  ex- 
perience, for  the  same  service  within  the 
same  specific  and  limited  geographical  area 
(socio-economic  area  of  a metropolitan 
area  or  socio-economic  area  of  a county). 
And  a fee  is  “reasonable”  when  it  meets 
the  usual  and  customary  criteria  or— in  the 
opinion  of  the  responsible  local,  district. 


or  state  medical  society  review  committee 
—is  justifiable  considering  the  special  cir- 
cumstances of  the  particular  case  in  ques- 
tion. 

How  Were  These  Fees  Determined? 

The  Society’s  Committee  on  Usual  and 
Customary  Fees  surveyed  Illinois  doctors 
in  the  fall  of  1966,  asking  them  to  list  their 
usual,  customary  and  reasonable  fees  for 
a wide  range  of  medical  services  corres- 
ponding to  the  services  listed  in  the  first 
edition  of  the  “Current  Procedural  Termi- 
nology” booklet  published  by  the  Ameri- 
can Medical  Association.  Not  all  the  doc- 
tors queried  answered  the  survey  but  there 
was  sufficient  response  for  ISMS’s  commit- 
tee to  negotiate  with  the  IDPA  to  estab- 
lish the  usual,  customary  and  reasonable 
fees  prevailing  in  each  county  and  for  the 
state  as  a whole.  Fees  varied  by  doctor  and 
by  geographical  area  and  thus  it  is  possible 
for  adjoining  counties  to  differ  on  prevail- 
ing fees. 

Are  The  Fee  Schedules  Obtained  In  The 
1966  Survey  of  Illinois  Doctors  Still 
In  Effect?  May  Fees  Be  Revised? 

Yes,  for  the  most  part  the  fees  found  by 
survey  are  still  in  effect.  However,  fees  on 
some  individual  procedures  have  been  re- 
vised upward.  Complicated  or  very  unusual 
procedures  receive  individual  consideration 
and  are  decided  on  after  thorough  profes- 
sional medical  consultation. 

Should  a doctor  be  dissatisfied  with  the 
amount  he  has  received  for  a service  he 
may  communicate  his  thoughts  to  the  IDPA 
in  Springfield.  The  IDPA  first  checks  the 
bill  to  see  if  it  was  coded  and  computed 
properly.  If  a coding  error  was  made  the 
original  payment  is  revised.  If  the  pay- 
ment was  correct  by  IDPA  standards  the 
doctor  is  so  notified.  If  still  dissatisfied  he 
may  consult  ISMS’s  local  county  or  regional 
committee  which  deals  with  government 
agencies.  Such  appeals  are  now  rare  and 
seldom  if  ever  involve  the  frequently  used 
procedures. 

Then  A Doctor  May  Not  Be  Paid 
The  Full  Amount  He  Bills  IDPA? 

The  IDPA  currently  pays  doctors  at 
about  93.6  percent  of  charges  as  billed. 


for  November,  1968 


697 


Each  bill  is  considered  in  light  of  three 
factors— the  doctor’s  usual,  customary  and 
reasonable  fee,  the  prevailing  fee  for  the 
county,  and  the  prevailing  fee  for  the  state. 
IDPA  pays  the  lowest  of  the  three  rates. 

Is  There  Any  Value  In  A Doctor 
Continuing  To  Bill  At  His  Usual 
And  Customary  Fees  Even  Though 
Experience  Shows  That  Some 
Charges  Will  Be  Reduced? 

Yes,  As  already  mentioned,  payments 
have  averaged  93.6  percent  of  charges. 
Also,  the  computer  records  fee  profiles  on 
individual  doctors  and  are  the  basis  for 
fee  analysis.  The  accumulated  medical 
trends  together  with  the  medical  charac- 
teristics of  recipients  are  invaluable  in 
planning  long  range  medical  programs  and 
securing  the  necessary  appropriations. 

What  Questions  Are  Asked  Most 
Frequently  By  Doctors? 

Understandably,  doctors  have  questions 
from  time  to  time  due,  if  nothing  else,  to 
the  sheer  magnitude  of  the  Medical  Assist- 
ance program.  Then,  too,  doctors  must 
keep  abreast  of  the  entitlements,  fees  and 
procedures  of  other  programs  to  include 
Medicare,  Blue  Cross/Blue  Shield,  and  a 
host  of  private  health  insurance  programs, 
both  group  and  individual. 

This  serialized  article  is  one  way  to  help 
assure  two-way  communications  channels 
between  IDPA  and  doctors  and  between 
doctors  and  the  IDPA. 


There  are  several  broad  categories  of 
questions  asked  and  each  has  its  own 
group  of  auxiliary  questions.  One  is:  why 
are  payments  sometimes  less  than  the  bill- 
ing? The  principal  reason,  already  ex- 
plained, is  that  IDPA  considers  payment 
in  light  of  the  doctor’s  usual  and  custom- 
ary fee,  the  prevailing  county  fee,  and  the 
prevailing  state  fee— as  previously  defined 
and  determined  by  survey.  Other  questions 
bear  on  billings:  Why  is  payment  some- 
times denied  or  delayed?  Why  does  the 
computer  reject  bills?  What  is  the  role  of 
the  doctor  in  the  patient’s  eligibility  for 
medical  care?  What  is  the  procedure  for 
billing  IDPA  when  the  patient  is  also  eli- 
gible for  Medicare?  Under  what  circum- 
stances are  payments  reduced  or  denied 
on  billings  by  the  doctor  for  dispensed 
drugs  or  billings  by  the  pharmacist  for 
prescribed  drugs?  What  is  the  proper  way 
to  bill  for  services  when  the  physician  uses 
one  or  more  assistants?  May  a general  prac^ 
tioner  or  internist  bill  for  hospital  calls 
while  his  patient  is  in  the  hospital  under 
a surgeon’s  care?  May  a doctor  bill  for 
services  rendered  a year  or  more  ago?  Is 
the  “Current  Procedural  Terminology” 
code  book  undergoing  revision  to  better 
define  terms  and  to  provide  more  alterna- 
tives for  coding  complicated  cases?  Why  is 
there  a difference  in  billing  procedure  for 
tests  performed  by  an  Independent  Certi- 
fied Laboratory  and  tests  performed  by  a 
hospital  pathologist? 

These  and  other  questions  will  be  an- 
swered in  detail  in  later  installments. 


Immunity  In  Cancer 

Increasingly,  research  interest  in  cancer  is  centering  on  attempts  to  un- 
ravel the  relationship  between  the  immune  progess  and  protection  from  or 
induction  of  malignant  change.  The  coincidence  of  abnormalities  in  the 
defense  systems  of  the  body  and  malignant  disease  is  not  random.  It  has 
been  recognized  for  a long  time  that  various  neoplasms,  particularly  lymph- 
omas, appear  to  induce  immunologic  abnormalities  including  'autoimmune' 
disease.  On  the  other  hand,  the  possibility  that  defense  mechanisms  result 
in  the  appearance  of  malignancy  seems  logically  remote.  There  are,  how- 
ever, recent  experiments  in  mice  and  observations  in  man  which  suggest 
both  that  immune  mechanisms  can  result  in  changes  leading  to  malignancy 
and  that  some  initial  stress  (a  virus,  for  example)  may  initiate  a chain  of 
events  leading  through  'autoimmune'  disease  into  malignancy.  (John  R.  Du- 
rant, ''Immunity  In  Cancer''  Highlights,  Delaware  Med.  Jl.  [Mar.]  1968;  pg. 
84.) 


698 


Illinois  Medical  Journal 


Medical-Legal  Problems 

of  Illinois  Physicians 


Liability  of  Physicians  in  Committing 
Patients  to  Mental  Hospitals 

By  Frank  M.  Pfeifer,  Legal  Council,  ISMS 


The  present  Mental  Health  Code  (Para- 
graph 1-1  through  427,  Chapter  911/2,  Illi- 
nois Revised  Statutes,  1967),  which  was 
adopted  by  the  Illinois  Legislature  in  1967 
covers  the  commitment,  care  and  treatment 
of  persons  who  are  in  need  of  mental  treat- 
ment or  who  are  mentally  retarded  and 
follows  very  closely  the  Mental  Health  Act 
of  1963. 

LFnder  the  Mental  Act,  or  Code  as  it 
now  exists,  there  are  several  different  ways 
in  which  individuals  in  need  of  treatment 
may  be  admitted  to  a mental  hospital; 
namely,  informal  admission,  voluntary  ad- 
mission, admission  on  certificate  of  physi- 
cian, emergency  admission  and  admission 
by  order  of  court.  Under  several  of  the 
types  of  admission,  a certificate  of  a phy- 
sician licensed  to  practice  medicine  in  all 
of  its  branches  is  a necessary  requirement. 

There  seems  to  be  a feeling  on  the  part 
of  some  physicians  in  Illinois  that  they 
are  not  qualified  to  make  an  examination 
of  the  patient  and,  thereafter,  to  sign  a 
certificate  of  need  for  hospitalization  unless 
they  are  either  psychologists  or  psychia- 
trists, and  further  feel  that  to  sign  such 
a certificate  might  subject  them  to  liability 
and  damage  suits.  While  the  Mental  Code 
does  mention  both  psychologists  and  psy- 
chiatrists, there  is  no  requirement  that  the 
physician  making  the  examination  and 
signing  the  certificate  need  specifically  be 
trained  in  either  of  these  fields  of  medi- 
cine; but  instead,  all  physicians  authorized 
to  practice  medicine  in  all  of  its  branches 


The  IMJ,  in  attempting  to  bring  to  the 
physicians  of  Illinois  information  that 
is  of  importance  and  concern  to  them, 
will  carry  in  future  issues  medical-legal 
articles  written  by  the  legal  counsel  of 
the  Illinois  State  Medical  Society.  These 
articles  will  he  based  upon  actual  experi- 
ences, questions  and  problems  as  they 
arise  from  time  to  time  throughout  the 
State.  Answers  to  individual  queries  and 
specific  problems  cannot  be  answered  in 
these  columns. 


are  specifically  authorized  to  perform  this 
necessary  service. 

The  certificate  needed  for  hospitaliza- 
tion which  the  physician  signs  after  ex- 
amining the  patient  (Form  68-MHC-4) 
contains  a box  indicating  whether  he  is 
licensed  to  practice  medicine  in  all  of  its 
branches  or  whether  he  is  a psychologist 
or  psychiatrist.  This  information  is  for  the 
use  of  the  mental  hospital  after  the  pa- 
tient has  been  admitted  and  in  no  way 
qualifies  the  right  of  the  physician  to  make 
the  examination  and  sign  the  certificate. 
Perhaps  it  is  due  to  this  language  of  the 
certificate;  perhaps  it  is  due  to  the  fact 
that  psychologists  and  psychiatrists  are 
mentioned  in  the  Act;  but  for  some  rea- 
son, many  physicians  are  fearful  of  signing 
the  certificate  and  are  refusing  to  perform 
this  very  necessary  service. 

The  word  physician  is  used  throughout 
the  Act  and  such  an  individual  is  author- 


/or  November,  1968 


699 


ized  to  make  the  necessary  examinations 
and  sign  the  certificate.  Under  Section  1-14 
of  the  Act,  a physician  is  defined  as  fol- 
lows: “Physician”  means  any  person  li- 
censed by  the  State  of  Illinois  to  practice 
medicine  in  all  its  branches  and  includes 
any  person  holding  a state  hospital  permit 
or  temporary  certificate  of  registration  as 
provided  in  the  Medical  Practice  Act. 

We  find  from  reading  the  entire  Mental 
Health  Code  that  physicians,  as  defined 
above,  are  authorized  to  make  the  neces- 
sary examinations  and  to  sign  the  certi- 
ficates and  this  being  the  case,  there  could 
be  no  liability  upon  a physician  so  doing 
unless  it  could  be  shown  that  he  was  act- 
ing with  malice  for  some  ulterior  purpose 
of  his  own.  We  have  had  mental  institu- 
tions in  Illinois  for  many  years  and  over 
this  period  of  time,  have  had  many  dif- 
ferent acts  pertaining  to  the  admission  of 
patients  into  mental  hospitals;  all  of  which 
have  had  provisions  for  physicians’  certi- 
ficates when  the  admission  was  not  upon 
a voluntary  basis.  A review  of  the  decisions 
of  the  Appellate  Courts  and  the  Supreme 
Court  of  Illinois  does  not  reveal  a single 
case  of  a physician  ever  being  held  liable 
for  committing  an  individual  to  a mental 
hospital. 

Over  and  beyond  everything  said  above. 
Section  12-11  of  the  present  Mental  Health 
Code  provides  as  follows:  “All  persons  act- 
ing in  good  faith  and  without  negligence 
in  connection  with  the  preparation  of  ap- 
plications, petitions,  certificates  or  other 
documents  for  the  apprehension,  transpor- 
tation, examination,  treatment,  detention 
or  discharge  of  an  individual  under  the 
provisions  of  this  Act  incur  no  liability, 
civil  or  criminal,  by  reason  of  such  Acts.” 
If  there  was  any  possibility  of  liability,  it 
has  clearly  and  definitely  been  removed 
by  the  immunity  provision  quoted  next 
above. 

While  it  is  true  in  Illinois  that  physicians 
have  the  legal  right  to  pick  and  choose 
their  patients  and  do  not  have  to  provide 
medical  services  for  a given  individual  if 
they  do  not  desire  to  do  so,  wholesale  re- 
fusal to  examine  individuals  for  determi- 
nation of  their  mental  condition  might 
cause  the  Legislature  to  change  the  law  in 
a manner  which  would  not  be  to  the  lik- 
ing of  the  physicians.  It  is  the  recommen- 


dation of  this  writer  that  the  physicians 
in  Illinois  cooperate  with  the  public  au- 
thorities in  this  most  important  and  neces- 
sary medical  service.  Lest  anyone  be  con- 
fused, let  it  be  said  that  while  a physician 
in  Illinois  has  the  right  to  pick  and  choose 
his  patients,  once  a physician  accepts  the 
patient,  this  patient  cannot  be  abandoned 
by  him  until  a suitable  replacement  has 
been  obtained.  This  means  that  a physi- 
cian treating  a mental  patient  is  under  a 
duty  to  sign  the  certificate  if  admission 
to  a state  mental  hospital  becomes  neces- 
sary. 

A copy  of  the  certificate  needed  for  hos- 
pitalization, which  the  examining  physi- 
cian is  called  upon  to  sign,  is  set  forth  be- 
low. You  will  note  that  under  No.  1 you 
indicate  whether  you  are  a physician  li- 
censed to  practice  medicine  in  all  of  its 
branches  or  whether  you  are  a psychologist 
under  the  Illinois  Psychologist  Registration 
Act  or  whether  you  are  a psychiatrist.  (Def- 
inition of  psychiatrist  in  Section  1-15  is: 
“psychiatrist”  means  a physician  as  defined 
in  Section  1-14,  who  devotes  a substantial 
portion  of  his  time  to  the  practice  of  psy- 
chiatry and  has  practiced  psychiatry  for 
one  year  immediately  proceeding  the  cer- 
tification of  any  patient.”)  Under  No.  2 
the  physician  states  the  name  of  the  per- 
son examined,  the  time  and  date  and  the 
results  of  the  examination.  Under  No.  3 
the  physician  states  the  type  of  care  which 
should  be  received  by  the  patient  and  then 
indicates,  in  the  appropriate  box,  the  type 
of  admission  for  which  the  certificate  is 
used.  This  last  item  is  not  of  any  real 
consequence  to  the  physician  and  would 
not  need  to  be  checked  by  him;  for  his 
duty  ends  when  he  reports  his  findings 
from  the  examination  and  indicates  the 
type  of  treatment  he  feels  is  appropriate. 

The  physician,  in  signing,  names  his  de- 
gree which  in  the  case  of  a physician  li- 
censed to  practice  medicine  in  all  its 
branches,  should  be  “M.D.” 

Circuit  and  Associate  Judges  in  Illinois 
have  the  power  to  order  a physician  to 
make  an  examination,  to  report  his  findings 
and  to  testify;  and  in  those  rare  situations 
where  a physician  is  so  ordered,  he  of 
course  must  comply,  even  though  he  would 
prefer  otherwise  for  to  refuse  would  sub- 
ject him  to  contempt  of  court  which  can 
carry  a jail  sentence. 


700 


Illinois  Medical  Journal 


CERTIFICATE  OF  NEED  FOR  HOSPITALIZATION 


I CERTIFY; 

1.  (Check  appropriate  box) 

□ I am  licensed  to  practice  medicine  in  all  its  branches  in  Illinois. 

Q I am  certified  as  a psychologist  under  the  Illinois  Psychologist  Registration  Act. 
Q I am  a psychiatrist  as  defined  in  Section  1-15  of  the  Mental  Health  Code. 

2. 1 personally  examined  at  m., 

on  - , 19 and  found  (describe  symptoms— attach  separate  sheet  if 

necessary) : 


3.  It  is  my  opinion  that  he  is 

□ in  need  of  mental  treatment  □ mentally  retarded 

and  that  he 

□ be  hospitalized  in  a suitable  public  or  private  hospital 

Q be  admitted  to  a hospital  immediately  as  an  emergency  for  the  protection  from 
physical  harm  of  himself  or  others 

(If  patient  is  to  be  admitted  as  an  emergency  this  examination  must  be  made 
within  72  hours  of  admission) 

□ be  placed  in  the  care  of  a relative  or  other  person 

This  certificate  is  issued  for:  (check  one) 

□ attachment  to  application  for  admission  (MHC-3) 

□ attachment  to  petition  for  admission  as  an  emergency  (MHC-7) 

□ attachment  to  petition  for  hospitalization  on  court  order  (MHC-7) 

□ court  ordered  examination 

□ inclusion  in  the  hospital  record  as  psychiatrist’s  examination 


(name  and  degree) 


(office  address-street) 


(city) 


, Illinois. 


(telephone  number) 


Hold  the  Physician  in  honor,  for  he  is  essential 

to  you,  and  God  it  was  who  established  his  profession. 

From  God  the  Doctor  has  his  wisdom. 

Thus  God's  creative  work  continues  without  cease. 

He  who  is  a sinner  toward  his  Maker  will  be  deficient 
toward  his  Doctor. 

Author  Unknown 


for  November,  1968 


701 


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MEETING  MEMOS 

Nov.  19— The  New  York  University  School 
of  Medicine  will  present  the  16th  Annual 
Sigmund  Pollitzer  Lecture.  “The  Hormon- 
al Control  of  Sebaceous  Gland  Function  in 
Man,”  will  be  this  year’s  address  given  by 
John  S.  Strauss,  M.D.,  professor  of  derma- 
tology, Boston  University;  8:15  p.m.;  Hall 
Auditorium,  550  First  Ave.,  New  York 
City, 

Nov.  22-24— “Psychiatry  and  the  Intern- 
ist,” will  be  the  topic  of  the  address  given 
by  Richard  E.  Hicks,  M.D.,  and  Paul  Jay 
Fink,  M.D.,  at  this  month’s  meeting  of  the 
Hahnemann  Medical  College  and  Hospital 
at  the  Marriott  Motor  Hotel,  Philadelphia, 
Pa. 

Dec.  1— To  be  held  in  Miami  Beach,  Fla., 
the  Tenth  National  Conference  on  the 
Medical  Aspects  of  Sports.  Sponsored  by 
the  American  Medical  Association.  Fea- 
tured luncheon  speaker  will  be  Payton 
Jordan,  head  coach  of  the  1968  U.S. 
Olympic  Track  and  Field  Team. 

Dec.  1-4— The  American  Medical  Associa- 
tion will  hold  its  22nd  Clinical  Conven- 
tion in  Miami  Beach,  Fla.  This  year’s  con- 
vention will  feature  over  125  scientific  ex- 
hibits. 

Dec.  16-18— The  Twenty-Second  Post- 
graduate Assembly  in  Anesthesiology. 
Sponsored  by  the  New  York  State  Society 
of  Anesthesiologists.  To  be  held  in  New 
York  City. 


Your  Best  Foot  Forward 

( Continued  from  page  689) 

guide  for  physician’s  actions  in  the  treat- 
ment of  his  patients. 

Medical  assistants  are  the  direct  link  be- 
tween the  physician  and  his  patients  . . . 
between  suppliers,  drug  detail  men,  profes- 
sional associates,  and  sometimes  even  his 
family.  Because  of  the  nature  of  the  job, 
it  is  mandatory  that  discretion  and  good 
judgment  be  employed  , . . just  as  the 
physician,  the  assistant  must  be  guided  by 
a code  of  ethics. 

Medical  assistants  have  a highly  respons- 
ible job.  They  are  an  important  member 
of  the  medical  team.  They  are  profes- 
sionals. They  are  the  link  between  the 
physician  and  his  patients. 

When  guided  by  ethics  in  everyday  life, 
your  best  foot  WILL  BE  FORWARD! 


702 


Illinois  Medical  Journal 


One  by  one 
the  family’s  downed 
Because  the 
G.L  bug’s  around 


Parepectolin  for  quick  relief  of  acute  diarrhea 
. . . soothes  colicky  pain  with  paregoric* 

. . . consolidates  fluid  stools  with  pectin 
. . . adsorbs  irritants  with  kaolin, 
and  protects  intestinal  mucosa 
Whether  it’s  a 24-hour  “bug”,  a food  problem, 
or  simply  nervousness  and  anxiety,  Parepectolin 
will  bring  the  diarrhea  under  control  until  etiol- 
ogy can  be  determined.  In  some  cases,  Parepec- 
tolin may  be  all  the  therapy  necessary. 


Parepectoriii 

Each  fluid  ounce  of  creamy  white  suspension  contains: 

♦Paregoric  (equivalent)  (1.0  dram)  3.7  ml. 

Contains  opium  (%  grain)  15  mg.  per  fluid 
ounce. 

warning:  may  he  habit  forming 

Pectin (2%  grains)  162  mg. 

Kaolin  (specially  purified)  ....  (85  grains)  5.5  Gm. 
(alcohol  0.69%) 

Usual  Adult  Dose:  One  or  two  tablespoonfuls  three 
times  daily. 

Usual  Children’s  Dose:  One  or  two  teaspoonfuls  three 
times  daily. 


WILLIAM  H.  RORER,  INC. 

Fort  Washington,  Pa. 

for  November,  1968 


anticostive* 

hematinic 


PERITINIC 

Hematinic  with  Vitamins  and  Fecal  Softener 

A tablet^day  provides: 

• Elemental  Iron  (as  Ferrous  Fumarate) . 100  mg 

• Dioctyl  Sodium  Sulfosuccinate  (to 

counteract  constipating  effect  of  iron)  100  mg 


Vitamin  Bi 7.5  mg 

Vitamin  B2 7.5  mg 

Vitamin  Bs 7.5  mg 

Vitamin  B12 50  mcgm 

Vitamin  C 200  mg 

Niacinamide 30  mg 

Folic  Acid 0.05  mg 

Pantothenic  Acid 15  mg 


Bottles  of  60 

anticostive,  ad],  {anti  opposed  to 
+ costive  causing  constipation.) 
Against  constipation.  Now  isn’t 
that  a good  idea  in  an  iron-contain- 
ing hematinic? 


LEDERLE  LABORATORIES 
A Division  of  American  Cyanamid  Company 
Pearl  River,  New  York  10965 


488-7R— 6062 


703 


OBITUARIES 


Dr.  Nelson  W.  Barker,  a native  of  Evans- 
ton and  retired  staff  physician  at  the  Mayo 
Clinic,  died  Sept.  13  at  the  age  of  69. 

*Dr.  Jerome  J.  Burke,  Round  Lake, 
president  of  Lake  County  Tuberculosis 
Sanitarium,  died  Sept.  13  at  the  age  of  45. 
He  was  past  president  of  the  Lake  County 
Medical  Society. 

*Dr.  John  H.  Coffey,  Belleville,  52,  died 
Sept.  6.  He  was  a member  of  the  American 
College  of  Physicians  and  a Diplomate 
of  the  Medical  Board  of  Internal  Medicine. 
*Dr.  John  J.  Corhin,  Chicago,  died  Sept. 
13  at  the  age  of  54.  He  was  past  president 
of  the  medical  staff  at  St.  Joseph’s  Hospital. 
*Dr.  James  A,  Day,  Springfield,  the  oldest 
physician  in  Sangamon  County,  died  Aug. 
30  at  the  age  of  98.  He  was  on  the  staff  of 
Passavant  Hospital  and  chief  surgeon  at 
Our  Saviour  Hospital  and  a member  of 
ISMS  Fifty-Year  Club. 

*Dr.  Chester  W.  Fouser,  Chicago,  died 
Sept.  18  at  the  age  of  80.  He  was  a mem- 
ber of  ISMS  Fifty-Year  Club. 

*Dr.  Elmer  W.  Hagens,  La  Grange  Park, 
died  Sept.  20  at  the  age  of  71.  He  was  on 
the  staff  of  Wesley  Memorial  Hospital  and 
a member  of  the  department  of  Otolaryn- 
gology at  Northwestern  University  Medical 
School. 

*Dr.  Roland  A.  Jacobson,  Arlington 
Heights,  died  Sept..  28  at  the  age  of  72. 
He  was  a member  of  the  American  College 
of  Surgeons,  retired  surgeon  and  former 
staff  member  at  Presbyterian-SC  Luke’s 
and  Resurrection  Hospitals. 

*Dr.  Walburga  L.  Kacin,  Morton  Grove, 
died  Sept.  21  at  the  age  of  88.  She  was  a 
member  of  ISMS  Fifty-Year  Club. 


*Dr.  Charles  O.  Lane,  West  Frankfort, 
died  Sept.  6 at  the  age  of  92.  He  had  served 
as  Councilor  of  the  9th  District  of  ISMS, 
and  was  past  president  of  the  Franklin 
County  Medical  Society;  a member  of  ISMS 
Fifty-Year  Club. 

Dr.  Franklin  C.  McLean,  Chicago,  pro- 
fessor emeritus  of  the  department  of  psy- 
chology at  the  University  of  Chicago,  died 
Sept.  10  at  the  age  of  80.  He  was  an  organ- 
izer and  director  of  National  Medical  Fel- 
lowships, Inc.,  organized  the  University  of 
Chicago  Clinics  and  was  past  director  of 
the  clinics. 

Dr.  Joel  P.  Oliver,  Chicago,  died  Sept.  13 
at  the  age  of  58. 

*Dr.  Sidney  Rosenberg,  Chicago,  died 
Sept.  11  at  the  age  of  63.  He  was  on  the 
staff  of  Mt.  Siani  and  Edgewater  Hospitals. 
*Dr.  Arthur  H.  Rothenberg,  Des  Plaines, 
died  Sept.  13  at  the  age  of  43.  He  was  on 
the  staff  at  Lutheran  General  and  Holy 
Family  Catholic  Hospitals. 

*Dr.  Lester  W.  Savage,  East  Moline,  as- 
sistant medical  superintendent  at  the  East 
Moline  State  Hospital,  died  Sept.  3 at  the 
age  of  57. 

Dr.  Burton  Solar,  Chicago,  died  Sept.  26 
at  the  age  of  67. 

Dr.  Nels  M.  Strandjord,  Chicago,  an  asso- 
ciate professor  of  radiology  at  the  Univer- 
sity of  Chicago’s  Pritzker  School  of  Medi- 
cine, died  Sept.  10  at  the  age  of  48. 

*Dr.  Earl  D.  Wise,  a practicing  physician 
in  Champaign  for  51  years,  died  Sept.  21  at 
the  age  of  81.  He  was  a member  of  ISMS 
Fifty-Year  Club. 

*Indicates  member  of  Illinois  State  Medical  Society. 


Frontiers  of  Medicine 


Recent  advances  in  medicine  for  phy- 
sicians in  practice  will  be  presented 
through  the  "1968-69  Frontiers  of  Medi- 
cine" program  being  sponsored  by  the 
Committee  on  Continuing  Medical  Educa- 
tion of  the  University  of  Chicago  Hospitals 
and  Clinics. 

This  series  of  eight  conferences,  given  on 
the  second  Wednesday  of  each  month  un- 
til May,  is  designed  to  provide  physicians 
with  a comprehensive  review  of  recent  de- 
velopments, with  particular  emphasis  upon 
clinical  application. 

Future  programs,  acceptable  for  credit 
by  the  American  Academy  of  General 


Practice,  include:  Dec.  II,  "Malabsorption 
Problems;"  Jan.  8,  "Thyroid  Disease;"  Feb. 
12,  "Diagnosis  and  Management  of  Res- 
piratory Insufficiency;"  April  9,  "Pathogen- 
esis, Diagnosis  and  Treatment  of  Rheu- 
matoid Arthritis;"  and  May  14,  "Manage- 
ment of  the  Patient  with  Acute  Myocardial 
Infarction." 

A fee  of  $15  will  be  charged  for  at- 
tendance at  each  session.  Advanced  regis- 
tration is  desirable.  For  further  informa- 
tion contact:  Frontiers  of  Medicine,  The 
University  of  Chicago,  950  E.  95th  St.,  Chi- 
cago 60637. 


704 


Illinois  Medical  Journal 


New  Book  for  Parents 

Parents’  difficulties  in  talking  to  their 
children  about  the  human  body  can  be 
easily  overcome  with  the  assistance  of  the 
American  Medical  Association’s  new  book, 
“Your  Body  and  How  It  "^Yorks.” 

AVritten  in  the  language  of  a child  in 
the  early  elementary  years,  the  book  is  de- 
signed for  the  parent  and  child  to  read  to- 
gether. The  entire  book  fosters  a whole- 
some attitude  that  the  body  is  a beautiful 
gift  and  encourages  an  interest  in  taking 
care  of  it. 

The  colorful,  30-page  booklet  mentions 
the  functions  of  the  exterior  parts  of  the 
body,  along  with  describing  and  illustrat- 
ing the  internal  systems,  such  as  the  heart 
and  circulatory,  nervous,  respiratory  and 
digestive.  The  section  on  the  respiratory 
system  describes  how  the  air  comes  into 
the  body  and  traces  the  route  of  air 
through  the  system  until  it  leaves  the  body. 
Illustrations  of  the  heart  and  circulatory 
system  show  the  mass  of  blood  vessels  in 
the  human  machine. 

Available  from  the  AMA’s  Order  Han- 
dling Department,  “Your  Body  and  How  It 


\Vorks’’  is  available  at:  single  copies,  45 
cents  each;  50-99  copies,  43  cents  each;  100- 
499  copies,  41  cents  each;  500-999  copies, 
39  cents  each;  and  1,000  or  more  copies,  35 
cents  each. 


University  of  Illinois  Medical 
Center  Accepts  $467^312 
in  Grants 

The  University  of  Illinois  Medical  Cen- 
ter campus,  Chicago,  has  accepted  an 
overall  total  of  $467,312  in  research  and 
training  grants  for  the  month  of  Septem- 
ber. Out  of  19  grants  listed,  17  grants 
totaling  $404,435  were  from  the  United 
States  Public  Health  Service. 

The  funds  were  allocated  as  follows: 
$31,638,  College  of  Dentistry;  $334,462, 
College  of  Medicine;  $90,412,  College  of 
Nursing;  and  $10,800,  College  of  Pharm- 
acy. The  largest  single  grant,  $102,481, 
was  awarded  to  Dr.  Sheldon  Dray,  profes- 
sor and  head.  Department  of  Microbiology 
in  the  College  of  Medicine  by  the  United 
States  Public  Health  Service  for  “Serum 
Protein  Allotypes.“ 


^^asy  on 

the^^udget... 

^^^asyon 

the^^other 

GAGATablets  ElixirV^V^ 
^J^or  ^ron  j^eficiency 


FAMOUS 


BREON  LABORATORIES  INC. 

Subsidiary  of  Sterling  Drug  Inc. 

90  Park  Avenue,  New  York,  N.Y.  10016 


brand  of  FERROUS 


on 

GLUCONATE 


for  November,  1968 


705 


Tuberculosis?  Influenza? 
Pneumonia?  Leukemia? 
Hodgkin's  Disease?  Syphilis? 
Systemic  Fungal  Diseases? 
Chronic  Chest  Diseases? 
or 

HISTO? 

(Histoplasmosis  — “The  Masquerader”) 


A new  aid  in  differential  diagnosis 

HISTOPLASMINJINE  TEST 

(Rosenthal) 

The  LEDERTINETM  Applicator  with  the  Blue  Handle 

Precautions — Nonspecific  reactions  are  rare,  but 
may  occur.  Vesiculation,  ulceration  or  necrosis 
may  occur  at  test  site  in  highly  sensitive  persons. 
The  test  should  be  used  with  caution  in  patients 
known  to  be  allergic  to  acacia,  or  to  thimerosal 
(or  other  mercurial  compounds). 


Ask  your  representative  for  details  or  write  Medical  Advisory  Dept., 
Lederle  Laboratories,  Pearl  River,  New  York  10965.  406-8 


Full  speed  ahead, 
Fred.  These  solid 
Cough  Calmers 
can  control  that 
cough  for  6 to 
8 hours. 


Each  Cough  Calmer^"  contains  the  same  active  ingredients 
as  a half-teaspoonful  oi  Robitussin-DM®:  Glyceryl  guaiaco- 
late,  50  mg.;  Dextromethorphan  hydrobromide,  7.5  mg. 
A.  H.  Robins  Company,  Richmond,  Virginia  23220 


AH'I^OBINS 


Over-65  Hospital  Population 
Increases 

The  nations’  over-65  population  con- 
tinued to  make  increasing  use  of  hospital 
facilities  in  the  first  quarter  of  1968,  ac- 
cording to  Hospital  Indicators,  a monthly 
report  which  appears  in  HOSPITALS, 
Journal  of  the  American  Hospital  Associa- 
tion. 

The  report  noted  an  8.4  per  cent  increase 
in  the  rate  of  admissions  of  persons  65  and 
over  to  community  hospitals  through  the 
first  three  months  of  1968  over  the  com- 
parable period  of  1967.  At  the  same  time, 
the  admission  rate  for  persons  under  65 
decreased  by  0.5  per  cent. 

In  all,  patients  65  and  over  accounted 
for  20.6  per  cent  of  admissions  in  1968’s 
first  quarter  and  also  accounted  for  33.3 
percent  of  all  inpatient  days.  In  the  first 
quarter  of  1967,  the  65  and  over  patients 
were  responsible  for  19.2  per  cent  of  all 
admissions  and  31  per  cent  of  the  inpatient 
days. 

Statistics  for  March  1968  show  that  the 
average  length  of  hospital  stay  for  elderly 
patients  decreased  slightly  from  a February 
high  of  13.7  days  to  13.2  days.  The  Feb- 
ruary figure  was  the  highest  since  the  start 
of  Medicare  in  July  1966.  Patients  under 
65  stayed  an  average  of  seven  days. 


Your  Protestant  Patient 

(Continued  from  page  682) 

There  is  growing  recognition  of  the  in- 
herent dangers  in  “labeling”  an  individ- 
ual’s religious  needs  simply  because  he  is 
a Protestant,  or  a Catholic,  or  a Jew.  Each 
person  expresses  his  religious  needs  in  a 
manner  unique  to  himself  and  his  own 
life  experiences. 

What  is  important  is  that  the  physician 
recognizes  the  multidimensional  character 
of  religious  needs  and  attempts  to  under- 
stand how  these  needs  may  be  helping  or 
hindering  the  patient  in  his  illness.  More- 
over, he  should  be  encouraged  to  seek  the 
assistance  of  an  informed  clergyman  when- 
ever he  is  in  doubt  as  to  the  religious 
concerns  of  a specific  patient. 


706 


Illinois  Medical  Journal 


— ^l^ecLa 
PROFESSIONAL 


eruLce 


idtinction 


man 


Professional  Protection 


CHICAGO  OFFICE:  Tom  J.  Hoehn  and  E.  M.  Brcier,  Representatives 
55  East  Washington  Street,  Room  1334,  Chicago  60602  Telephone:  312-782-0990 

MOUNT  PROSPECT  OFFICE:  Theodore  J.  Pandak,  Representative 
709  Hackberry  Lane  (P.  O.  Box  105)  Mount  Prospect  60056  Telephone:  312-259-2774 

ST.  CHARLES  OFFICE:  Joseph  C.  Kunches,  Representative 
1220  Wing  Avenue,  St.  Charles  60174  Telephone:  312-584-0920 

SPRINGFIELD  OFFICE:  William  J.  Nattermann,  Representative 
1124  South  Fifth  Street,  Springfield  62703  Telephone:  217-544-2251 


Nervous 

Geriatrics 


Mental 

Custodial 


Est.  1909 

RESTHAVEN 

This  modernly  equipped  institution  located  in  the  beautiful  Fox  River  Valley  35 
miles  west  of  Chicago,  cooperates  with  physicians  to  the  fullest  extent. 

It  provides  accommodations  for  100  patients  in  single  and  double  rooms.  Rest- 
haven  accepts  patients  by  referral  and  direct  admission. 

RESTHAVEN  HOSPITAL,  600  VILLA  ST.,  ELGIN,  ILL. 

Phone:  SH  2-0327 


Long  Term 
and  Short 
Term  Care 


Day  Care 
and  Mental 
Health  Clinic 


for  November,  1968 


707 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1968 

SPECIALTY  REVIEW  COURSE  IN  ORTHOPEDICS,  Nov.  18  & 
Dgc.  9 

SPECIALTY  REVIEW  COURSE  IN  UROLOGY,  Four  Days,  Nov.  18 
SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  II,  Dec.  2 
SPECIALTY  REVIEW  COURSE  IN  PEDIATRICS,  December  9 
PATHOLOGY  REVIEW  COURSES  FOR  SPECIALTIES,  Request 
Dates 

SURGERY  OF  COLON  & RECTUM,  One  Week,  No  ember  11 
VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Dec.  9 
GYNECOLOGY,  One  Week,  November  11 
OBSTETRICS,  One  Week,  November  18 
FIBEROPTIC  CULDOSCOPY  & PELVIC  PERITONEOSCOPY, 
Dec.  10 

ULTRAVIOLET  CYSTOSCOPY,  IV,  Days,  November  14 
SYMPOSIUM  ON  SHOCK,  Two  Days,  December  20 
ADVANCES  IN  PEDIATRICS,  One  Week,  November  11 
ADVANCES  IN  MEDICINE,  One  Week,  December  2 
CLINICAL  NEUROLOGY,  One  Week,  December  2 
RADIOISOTOPES,  One  or  Two  Weeks,  First  Monday  each 
Month 

ANESTHESIA,  Inhalation,  Endotracheal,  Regional,  Request 
Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request. 

TEACHING  FACULTY 
Attending  StaflF  of 
Cook  County  Hospital 

.^^ddf  6SS* 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


Foundlings  Home 
Openings 

There  are  now  a few  openings  available 
for  young  unmarried  mothers  at  the  Chi- 
cago Foundlings  Home.  Girls  are  accepted 
for  residence  at  the  Home  after  their  6th 
month  of  pregnancy,  or  earlier  if  need  be. 
Excellent  obstetrical  and  pediatric  facilities 
are  available.  Social  Workers  at  the  Home 
will  make  arrangements  for  adoptions  when 
requested. 

The  Home  was  founded  in  1871  by  Dr. 
George  E.  Shipman  and  has  served  the 
community  since. 

Physicians  interested  may  contact  Miss 
Mavis  M.  Koopman,  1720  W.  Polk  Street, 
or  telephone  her  at  TAylor  9-1446. 


Beer  and  Heart  Attachs 

Increasing  evidence  of  serious  heart 
disease  among  chronic  beer  drinkers  is  the 
basis  of  a research  program  at  the  Univer- 
sity of  Minnesota. 

According  to  Carl  S.  Alexander,  M.D., 
Associate  Professor  of  Medicine,  Univer- 
sity of  Minnesota,  principal  investigator, 
85-90%  of  the  patients  at  the  Minneapolis 
Veterans'  Hospital  with  primary  myocardial 
disease  are  chronic  beer  drinkers,  and  most 
of  these  patients  develop  alcoholic  cardio- 
myopathy, or  alcoholic  heart  failure. 

Major  aims  of  the  research,  according  to 
Dr.  Alexander,  are  to  see  If  alcohol  1)  pro- 
duces a depletion  of  necessary  elements 
found  in  the  heart,  such  as  magnesium, 
potassium  and  zinc,  2)  changes  the  level  of 
protein,  actomyosin  and  collagen  in  the 
heart,  and  3)  affects  heart  muscle  in  other 
ways. 

Researchers  have  already  shown  that 
heart  failure  symptoms  associated  with 
chronic  alcoholics  include  difficulty  in 
breathing,  rapidly  beating  heart,  swollen 
legs,  fatigue  and  weakness. 

Heavy  drinking  seems  often  to  be  the 
one  similarity  of  some  patients  who  sum- 
cumb  to  the  above  illness  suddenly,  yet 
show  no  evidence  of  other  types  of  heart 
disease  such  as  atherosclerosis,  valvular 
disease,  anemia  or  severe  malnutrition. 

A $52,685  grant  will  support  the  project 
for  the  first  year.  The  National  Institute  of 
Mental  Health  plans  two  additional  years 
of  support  subject  to  annual  review. 


708 


Illinois  Medical  Journal 


BLUE  SHIELD 


FOR 


PUBLISHED  MONTHLY  BY:  BLUE  SHIELD  PLAN  OF  ILLINOIS  MEDICAL  SERVICE  • 425  NORTH  MICHIGAN  AVENUE  • CHICAGO.  ILLINOIS  60690 


Vol.  2,  No.  12 


December,  1968 


Blue  Cross  and  Blue  Shield 
New  Small  Group  Plans 

Several  new  Blue  Cross  and  Blue  Shield  certi- 
ficates have  been  written  which  provide  broader 
coverage  to  smaller  groups  in  Illinois.  The  new 
health  care  programs  have  been  designed  by  Blue 
Cross  and  Blue  Shield  to  provide  this  important 
segment  of  the  market  with  a wide  selection  of 
comprehensive  programs  to  help  finance  their 
health  care  costs. 

Groups  as  small  as  four  may  now  benefit  from 
the  same  scope  of  coverage  oflFered  to  most  large 
employee  groups.  In  addition  to  improved  basic 
benefits,  Blue  Cross  and  Blue  Shield  will  extend 
Major  Medical  protection  as  well. 

These  contracts  will  provide  new  coverages  for 
maternity,  outpatient  diagnostic,  and  other  services 
previously  uncovered  or  limited  by  our  other  con- 
tracts. 

Two  Usual  and  Customary  programs  will  be 
offered.  One  will  pay  100%  and  the  other  80%  of 
the  Usual  and  Customary  charges  of  physicians  for 
a wide  range  of  covered  services. 


Fall  AAeetings  for 
AAedical  Assistants  Over 

The  final  Blue  Shield  meetings  for  medical  as- 
sistants were  held  on  November  13  and  14  at  the 
Knickerbocker  Hotel  in  Chicago.  Attendance 
reached  close  to  500  guests  at  these  two  meetings, 
making  a total  of  3,000  medical  assistants  attend- 
ing from  Cook,  Kane,  DuPage,  Lake  and  Will 
Counties  where  Blue  Shield  serves  as  Part  B car- 
rier for  Medicare.  All  medical  assistants  were  in- 
vited to  attend  one  of  these  meetings  which  have 
been  conducted  by  Blue  Shield  for  the  past  eleven 
years. 

Dr.  Leo  P.  A.  Sweeney,  President,  Blue  Shield 
Plan  of  Illinois  Medical  Service,  talked  to  the  group 
several  times  on  Blue  Shield’s  new  65  plan  and 
thanked  the  assistants  for  their  help  this  past  year. 
Following  the  discussion  of  Blue  Shield  65  which 
was  presented  by  Mr.  George  Hyland,  questions 
were  answered  by  our  panel  of  experts  on  matters 
pertaining  to  Blue  Shield  and  Medicare. 


Until  now.  Usual  and  Customary  Blue  Shield 
certificates  have  only  been  offered  to  groups  of  fifty 
or  more.  Blue  Shield  will  encourage  its  subscriber 
groups  to  protect  themselves  with  our  Usual  and 
Customary  programs  in  which  the  basis  of  payment 
is  related  directly  to  the  usual  charges  of  physicians 
rather  than  fixed  indemnity  benefit  schedules. 

Of  course.  Blue  Shield  will  continue  to  offer 
indemnity  programs. 

Because  the  size  of  a group  is  not  a standard  of 
health  care  needs.  Blue  Cross  and  Blue  Shield  are 
making  a determined  effort  to  extend  more  com- 
prehensive health  care  coverage  to  all  groups  re- 
gardless of  size. 

The  marketing  effort  will  start  shortly  and  pro- 
tection under  our  new  certificates  will  begin  early 
in  I960. 


Mrs.  O’Donnell,  Special  Representative,  Profes- 
sional Relations  Department,  arranges  the  meetings 
which  will  begin  again  in  early  spring  for  medical 
assistants  in  all  other  counties  throughout  the  State. 

We  also  conduct  special  two-hour  seminars 
which  are  scheduled  on  Wednesdays  and  Thurs- 
days for  medical  assistants  in  our  oflSces  which  will 
be  announced  when  the  date  and  time  has  been 
set.  We  encourage  all  medical  assistants  to  attend 
so  that  we  may  provide  them  with  information  to 
help  them  carry  out  their  responsibilities  for  you 
more  effectively. 

If  your  assistants  have  Blue  Shield  questions, 
they  may  be  directed  to  Loretta  O’Donnell,  Special 
Representative,  Professional  Relations,  222  N.  Dear- 
born. 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 

• • • ABOUT  MEDICARE 

Q Where  do  I submit  Medicare  claims  for  patients 
I treat  that  reside  in  another  state? 

A Medicare  claims  should  always  be  sent  to  the 
Medicare  office  in  the  area  where  the  physician 
practices. 

Q I have  a patient  who  expired  before  his  bill  was 
paid  and  he  has  no  known  relatives.  What  proce- 
dure do  I follow  to  receive  payment?  I will  accept 
assignment. 

A Complete  an  SSA  Form  1490  Request  for  Payment 
in  the  usual  manner.  Indicate  on  it  that  you  accept 
assignment  and  attach  a statement  explaining  that 
the  patient  has  expired  and  there  are  no  known 
relatives.  This  permits  the  Medicare  carrier  to 
make  payment  for  allowable  services  without  the 
beneficiary’s  signature. 

Q Should  I submit  a claim  each  time  I see  a patient 
or  should  I group  a number  of  visits  together  on 
one  claim? 

A Either  way  is  acceptable  but  by  grouping  visits 
together  the  amount  of  paper  work  performed  in 
your  office  can  be  reduced.  On  a multiple  visit 
claim,  Medicare  needs  the  date  of  service,  diagnosis 
and  charge  for  each  service  before  the  claim  can 
be  processed.  If  the  services  you  provided  extend 
from  one  calendar  year  into  the  next,  it  is  prefer- 
able to  submit  separate  claim  forms  as  they  will 
have  to  be  processed  separately. 

Q I have  a patient  who  entered  the  hospital  4 days 
before  he  became  65.  Is  he  entitled  to  Medicare 
benefits  for  these  4 days? 

A Yes,  if  he  had  applied  for  Part  B benefits  within 
the  3 months  prior  to  the  month  in  which  he  be- 
came 65.  In  such  cases  coverage  begins  on  the  first 
day  of  the  month  he  became  65. 

Q I have  a patient  who  submitted  an  itemized  bill 
to  Medicare  and  benefits  were  paid  directly  to  him. 
Now  I cannot  collect  for  his  unpaid  bill.  What 
procedure  do  I follow  to  get  this  bill  paid? 

A In  such  a situation,  a physician  can  follow  the 
same  procedure  he  uses  to  obtain  payment  for  his 
patients  who  are  not  covered  by  Medicare. 

Q What  procedure  do  I follow  in  submitting  a 
claim  for  a Railroad  Retiree? 

A Fill  out  an  SSA  Form  1490,  Request  for  Payment 
in  the  usual  manner  and  send  it  to  Travelers  In- 
surance Co.,  175  West  Jackson  Blvd.,  Chicago, 
Illinois. 


Medicare  Deductible  and 
Co-Insurance  Raised 

The  Social  Security  Administration  has  found  it 
necessary  to  increase  the  deductible  and  co-insur- 
ance portion  of  Medicare  for  which  the  beneficiary 
is  responsible.  Beginning  January  I,  1969  the  Part  A 
deductible  will  be  raised  from  $40.00  to  $44.00. 
However,  if  a benefit  period  begins  in  1968  and 
extends  into  1969,  the  deductible  will  still  be  $40.00. 

The  co-insurance,  the  portion  the  beneficiary 
pays,  from  the  sixty-first  to  the  ninetieth  day  of 
hospitalization  will  be  raised  from  $10.00  to  $11.00 
a day.  If  a beneficiary  chooses  to  use  any  of  his 
sixty  lifetime  reserve  days,  he  will  be  responsible 
to  pay  $22.00  a day  for  each  day  used. 

A beneficiary  in  an  extended  care  facility,  begin- 
ning January  I,  1969,  will  be  responsible  for  $5.50 
a day  from  the  twenty-first  day  to  the  one  hun- 
dredth day  of  care. 

These  changes  represent  a 10%  increase  in  the 
present  deductible  and  co-insurance. 

Any  changes  in  the  Part  B deductible  and  co- 
insurance  will  be  announced  in  December  1968  by 
the  Social  Security  Administration  and  will  become 
effective  in  July  1969. 

About  Prosthetic  Devices 

Prosthetic  devices  which  replace  an  internal  or- 
gan and  its  contiguous  tissues  are  covered  under 
Medicare.  The  replacement  and  repair  of  such 
devices  are  also  covered  when  done  by  order  of  a 
physician. 

Included  in  the  definition  of  an  “internal  organ” 
are  the  lenses  of  the  eyes  and  all  or  part  of  the 
ear  and  nose.  This  definition  allows  Medicare  to 
make  payment  for  the  prosthetic  lenses  used  during 
convalescence  from  the  surgical  removal  of  the 
eye’s  lens.  The  permanent  lens  needed  to  restore 
normal  vision  after  such  surgery  is  also  covered 
under  Medicare. 

Medicare  does  not  pay  for  the  examination  for 
or  purchase  of  a hearing  aid.  Artificial  legs,  arms 
and  eyes  also  are  covered  by  Medicare  when  fur- 
nished under  a physician’s  order.  Stump  stockings 
and  harnesses,  including  their  replacements,  are 
also  covered  if  they  are  necessary  for  the  effective 
use  of  the  artificial  device. 

Note:  If  you  or  your  office  assistant  have  any 
questions  regarding  Medicare,  they  may  be  directed 
to  Mr.  Richard  Quigley,  Special  Representative, 
Professional  Relations  Department,  Illinois  Blue 
Shield,  222  North  Dearborn. 


(This  is  not  an  advertisement) 


■mi. 


president’s  page 


Unitq  Begins 
with  the  Counties 

The  medical  profession  has  lost  much 
of  its  impetus  since  World  War  II  ...  is 
less  able  to  resist  assaults  on  its  freedom, 
preserve  its  image  and  influence,  plan  its 
future. 

Yet  we  need  more  strength  than  ever 
before,  because  the  attack  on  our  profes- 
sion—from  Big  Government,  Big  Welfare, 
Big  Labor— has  gained  impetus. 

Why  has  our  strength  slipped? 

To  find  one  of  the  chief  reasons,  let’s  dip 
into  history. 

There  was  a time  when  county  medical 
societies  were  the  pivotal  forces  in  local 
medical  affairs. 

While  some  are  notably  hale,  hearty  and 
well-organized,  many  of  the  county  societies 
in  our  state  have  withered.  They  cannot 
rally  enough  membership  support  to  have 
functioning  committees,  ambitious  pro- 
grams, fruitful  meetings. 

A key  reason  for  this  decay  is  that  physi- 
cians have  diverted  their  time  and  atten- 
tion to  their  specialty  groups.  The  first 
American  specialty  board  was  incorporated 
during  World  War  I,  but  the  real  upsurge 
came  with  World  War  II. 

Even  in  hospitals,  the  general  staff  con- 
ference has  largely  been  superseded  by 
meetings  of  specialized  departments. 

No  one  should  belittle  the  growth  of 
medical  skills,  and  their  refinement.  But 
overconcentration  on  specialties— especially 
at  the  local  and  county  level— segments  and 
divides  our  medical  house. 

We  need  the  general  unity  which  only 
the  all-inclusive  medical  societies  can  give 
us. 

We  need  such  unity  if  we  are  to  prevail 
on  the  key  socio-economic,  legislative  and 


Philip  G.  Thomsen,  M.D. 

political  issues  of  our  day  ...  if  we  are 
to  check  the  inroads  of  government,  cor- 
porate practice  and  quasi-medical  groups 
...  if  we  are  to  preserve  our  stature  and 
dignity  as  private  physicians. 

Only  in  unison  can  we  make  Springfield 
listen  to  us  on  such  impending  legislative 
issues  as  abortion,  drugs,  medical  educa- 
tion, state  revenue,  community  health,  a 
proposed  Medical  Review  Board  to  weed 
out  unsafe  drivers. 

Only  together— not  just  as  anesthesiolo- 
gists, radiologists  or  surgeons— can  we 
achieve  real  adjustments  in  physicians’ 
fees  under  public-aid  programs. 

ISMS  wants  to  deal  zealously  with  these 
issues— but  the  strength  of  your  State  So- 
ciety rests,  in  large  measure,  on  the  strength 
of  the  county  societies.  Our  efforts  will 
bear  fruit  only  if  they  are  nourished  at 
the  roots.  And  I’ve  been  saying  so  on  our 
President’s  Tours  up  and  down  the  state. 

Local  businessmen— whether  merchants 
or  foundry  managers— have  their  vigorous 
chambers  of  commerce.  Labor-union  locals, 
whether  bricklayers  or  teachers,  are  joined 
in  community  federations. 

So,  my  fellow  physicians,  let  us  not  be 
a Tower  of  Babel,  speaking  the  languages 
of  different  specialties.  Let  us  unite  from 
the  county  to  the  state  and  AMA  levels, 
and  be  a Tower  of  Strength. 


for  December,  1968 


719 


Meeting  Memos 

Dec.  26-31— The  American  Association  for 
the  Advancement  of  Science  will  hold  its 
135th  meeting  in  Dallas,  Texas.  Over  95 
symposia  will  be  featured  on  the  program, 
along  with  1,200  speakers  reporting  recent 
developments  in  all  branches  of  science. 
Jan.  9-12,  1969— The  Sixth  Annual  Post- 
graduate Seminar  in  Anesthesiology  will 
be  presented  by  the  University  of  Miami 
and  the  University  of  Florida  in  Miami 
Beach.  The  program  is  being  sponsored  by 
the  American  Society  of  Anesthesiologists. 
Jan.  12-17— The  recently  formed  Society 
for  Cryosurgery  will  hold  its  annual  meet- 
ing in  Miami  Beach,  Florida.  New  ad- 
vancements in  the  field  will  be  discussed 
and  papers  concerning  recent  develop- 
ments will  be  presented. 

Jan.  20-21— The  Cleveland  Clinic  Educa- 
tional Foundation  will  present  a post- 
graduate course  in  “Cardiovascular  and 
Renal  Clinical  Pharmacology.”  The  regis- 
tration fee  is  $40.00  and  should  be  sent 
to:  Education  Secretary,  The  Cleveland 
Clinic  Educational  Foundation,  2020  E. 
93rd  St.,  Cleveland,  Ohio  44106. 

Jan.  24-26— The  Seventh  Clinical  Confer- 
ence in  Pediatric  Anesthesiology  will  be 
presented  by  Childrens’  Hospital  of  Los 
Angeles  in  L.A.,  under  the  guidance  of 
the  American  Society  of  Anesthesiologists. 


The  paradox  of  the  smoking  habit,  so- 
ciety’s acceptance  and  promotion  of  it,  and 
medical  science’s  classification  of  it  as  being 
a health  hazard,  is  shown  in  a 20p^-minute 
black  and  white  film  entitled  “Getting 
Through.”  Intended  for  teenagers  as  well 
as  young  adults,  in  this  film  Burt  Lan- 
caster presents  some  of  the  troublesome 
questions  about  cigarette  smoking.  The 
film  dramatizes  the  “smokey”  world  in 
which  teenagers  live,  and  concludes  that 
the  final  decision  about  smoking  is  ulti- 
mately a personal  decision  which  each  teen- 
ager must  make  after  carefully  weighing 
the  facts.  Teachers,  youth  workers,  and 
parents  will  be  most  interested  in  this  film 
as  well  as  health-centered  personnel.  It  is 
available  for  free  short-term  loan  from  Na- 
tional Medical  Audiovisual  Center  (An- 
nex), Chamblee,  Ga.,  30005,  Attention: 
Film  Distribution  Department.  It  may  be 
purchased  from  DuArt  Film  Laboratories, 
245  W.  55th  St.,  New  York  10019. 


TXO  (triacetyloleandomycin) 

Brief  Summary 

INDICATIONS:  Include  staphylococci, 
streptococci,  pneumococci  and  gono- 
cocci. Recommended  for  acute,  severe  in- 
fections where  adequate  sensitivity  test- 
ing has  demonstrated  susceptibility  to 
this  antibiotic  and  resistance  to  less 
toxic  agents. 

CONTRAINDICATIONS:  Contraindicated  in 
pre-existing  liver  disease  or  dysfunction, 
and  in  individuals  hypersensitive  to  the 
drug. 

PRECAUTIONS:  CAUTION:  USE  OF  THIS 
DRUG  MAY  PRODUCE  ALTERATIONS  IN 
LIVER  FUNCTION  TESTS  AND  JAUNDICE.  CLIN- 
ICAL EXPERIENCE  AVAILABLE  THUS  FAR 
INDICATES  THAT  THESE  LIVER  CHANGES 
WERE  REVERSIBLE  FOLLOWING  DISCONTIN- 
UATION OF  THE  DRUG. 

Not  recommended  for  prophylaxis  or  in 
the  treatment  of  infectious  processes, 
which  may  require  more  than  ten  days 
continuous  therapy.  In  view  of  the  possi- 
ble hepatotoxicity  of  this  drug  when  ther- 
apy beyond  ten  days  proves  necessary, 
other  less  toxic  agents  should  be  used.  If 
clinical  judgment  dictates  continuation 
of  therapy  for  longer  periods,  serial  moni- 
toring of  liver  profile  is  recommended, 
and  the  drug  should  be  discontinued  at 
the  first  evidence  of  any  form  of  liver 
abnormality.  When  treating  gonorrhea  in 
which  lesions  of  primary  or  secondary 
syphilis  are  suspected,  proper  diagnostic 
procedures,  including  dark-field  examina- 
tions, should  be  followed.  In  other  cases 
in  which  concomitant  syphilis  is  sus- 
pected, monthly  serological  tests  should 
be  made  for  at  least  four  months.  When 
used  in  streptococcal  infections,  therapy 
should  be  continued  for  ten  days  to  pre- 
vent the  development  of  rheumatic  fever 
or  glomerulonephritis.  The  use  of  antibi- 
otics may  occasionally  permit  overgrowth 
of  nonsusceptible  organisms.  A resistant 
infection  or  superinfection  requires  re- 
evaluation  of  the  patient’s  therapy.  In  the 
event  such  occurs  with  this  drug  the 
medication  should  be  discontinued,  and 
specific  antibacterial  and  supportive 
therapy  instituted. 

ADVERSE  REACTIONS:  Although  reactions 
of  an  allergic  nature  are  infrequent  and 
seldom  severe,  those  of  the  anaphylac- 
toid type  have  occurred  on  rare  occasions. 

J.B.ROERIG  DIVISION 

CHAS.  PFIZER  & CO.,  INC. 

235  east  42nd  street 

NEW  YORK,  N.Y.  10017 


720 


Illinois  Medical  Journal 


Abstracts  of  Board  Actions 

Meeting  October  5,  1968— Springfield 

These  abstracts  are  published  so  that  members  of  the 
Illmois  State  Medical  Society  may  keep  advised  of  the  actions 
of  the  Board  of  Trustees.  It  covers  only  major  actions  and  is 
not  mtended  as  a detailed  report.  Full  minutes  of  the 
meetings  are  available  upon  any  member’s  request  to  the 
headquarters  office  of  the  ISMS.  * 

NEW  ADVISORY  COMMITTEE  ESTABLISHED 

An  ISMS  Advisory  Committee  to  the  Department  of  Vocational 
Rehabilitation,  to  be  established  separate  from  the  exist- 
ing  DVR  Medical  Committee,  since  the  latter  committee  has 
little  or  no  direct  contact  with  the  ISMS,  was  proposed.  It 
was  resolved  that  negotiations  should  proceed  with  Mr.  Sli- 
cer,  DVR  director,  on  the  establishment  of  this  Advisory 
Committee  separate  and  apart  from  the  ISMS  Committee  on 
Rehabilitation  Services. 

JOINT  CONFERENCE  WITH  NURSES  TO  BE  HELD 

The  Executive  Committee,  in  reviewing  activity  of  the 
Nursing  Committee  of  the  Illinois  Nurses  Association  with 
relation  to  the  Statement  on  Acute  Cardiac  Care,  felt  that 
a joint  conference  was  desirable  before  final  approval  was 
given,  and  that  the  services  of  legal  counsel  should  also 
be  utilized.  A joint  conference  including  representatives 
from  ISMS,  the  Illinois  Hospital  Association,  the  Illinois 
Nurses  Association  and  the  Illinois  and  Chicago  Heart  Asso- 
ciations, with  legal  counsel  present  was  recommended.  Dr. 
Taylor,  chairman  of  the  ISMS  Committee  on  Nursing,  indi- 
cated that  he  intends  to  meet  with  the  representatives  of 
the  Nurses  Association  and  the  other  groups  involved  and 
will  t^e  advantage  of  the  knowledge  of  legal  counsel  to 
establish  something  definitive.  He  also  stressed  that  there 
could  not  be,  over  the  State  of  Illinois,  uniform  rules  and 
regulations  for  every  hospital;  local  institutions  must  be 
allowed  some  flexibility  in  their  operations.  It  was  recom- 
mended that  a joint  conference  be  held  with  final  approval 
of  decisions  to  come  at  the  January  Board. 

CHICAGO  MEDICAL  SOCIETY  ASKED  TO  HELP  WITH 
HEALTH  CENTER 

The  Community  Interest  Committee  of  Southwest  Lawndale 
(Chicago)  requested  ISMS  assistance  in  the  establishment  of 
a neighborhood  health  center  without  government  support. 
Following  a discussion  as  to  the  ramifications  of  such  a 
project,  the  Board  referred  this  matter  to  the  Chicago  Medi- 
cal Society. 

HEALTH  INSURANCE  PLAN  SUPPORTED 

Dr.  W.  Randolph  Tucker,  medical  director,  Presbyterian- 
St.  Luke’s  Health  Centers,  presented  a plan  regarding  the 
development  of  a program  of  health  insurance  for  residents 
in  the  Chicago  west  side  area.  He  requested  ISMS  coopera- 
tion. Following  a description  of  the  proposed  plan,  the 
Board  voted  endorsement  in  principle  and  requested  prog- 
ress reports. 

(Abstracts  continued  on  page  806) 


for  December,  1968 


729 


early  relief  from 


At  the  recommended  Norpramin 
(desfpramine  hydrochloride) 
dosage  level— initially  150  mg. 
per  day— symptomatic 
improvement  may  often 
begin  within  two  to  five 
days.  As  depression  subsides, 
daytime  activity  improves . . . 
mood  fluctuations  lessen ... 

; sleep  is  sounder.  Fast  onset  of 
laction  and  usually  mild  side 
feffects  are  significant  reasons 
s for  Norpramin’s  use  in 
;^depression  of  any  type.,  .any 
fdegree  of  severity. 


IN  BRIEF: 


INDICATIONS:  In  mental  depression  of  any 
kind— neurotic  or  psychotic. 
CONTRAINDICATIONS:  Glaucoma,  urethral  or 
ureteral  spasm,  recent  myocardial  infarction, 
severe  coronary  heart  disease,  epilepsy. 
Should  not  be  given  within  two  weeks  of  treat- 
ment with  a monoamine  oxidase  inhibitor. 
RELATIVE  CONTRAINDICATIONS:  (1)  Patients 
with  a history  of  paroxysmal  tachycardia.  (2) 
Patients  receiving  concomitant  therapy  with 
thyroid,  anticholinergics  or  sympathomimet- 
ics  may  experience  potentiation  of  effects  of 
these  drugs.  (3)  Safety  in  pregnancy  has  not 
been  established.  (4)  Perform  liver  function 
studies  in  patients  suspect  of  having  hepatic 
disease. 

PRECAUTIONS:  (1)  Desipramine  hydrochloride 
should  not  be  substituted  for  hospitalization 
when  risk  of  suicide  or  homicide  is  consider- 
ed grave.  Suicidal  ingestion  of  large  doses 
may  be  fatal.  (2)  If  serious  adverse  effects 
occur,  reduce  dosage  or  alter  treatment.  (3) 
In  patients  with  manic-depressive  illness  a 
hypomanic  state  may  be  induced.  (4)  Discon- 
tinue drug  as  soon  as  possible  prior  to  elec- 
tive surgery. 


ADVERSE  EFFECTS:  The  following  side  ef^ 
have  been  encountered;  dry  mouth,  co^ 
tion,  dizziness,  palpitation,  delayed  urtii— , 
agitation  and  stimulation  (“jumpiness.f^ 
vousness,"  "anxiety,”  “insomnia”)  badr" 
sensory  illusion,  tinnitus,  sweating,  ''' 
ness,  headache,  hypotension  (ortha 
flushing,  nausea,  cramps,  weakness,  L . 
vision  and  mydriasis,  rash,  tremor,  atleiaj 
(gerjeral),  altered  liver  function,  atawa  ^ 
extrapyramidal  sighs,  agranulocytosis.,'^ 

Additional  side  effects  more  recently  rep 
include:  seizures,  eosinophilia,  confia 
states  with  hallucinations,  purpura,  phot 
sitivity,  galactorrhea,  gynecomastia,  ane 
potence.  Side  effects  which  could  occur! 
alogy  to  related  drugs)  include  weigf" 
heartburn,  anorexia,  and  hand  and  arn 
thesias. 

DOSAGE:  Optimal  results  are  obtai^ 
dosage  of  50  mg.  t.i.d.  (150  mg./da“ 

SUPPLIED:  NORPRAMIN  (desipramic 
chloride)  tablets  of  25  mg.;  bottles  ora 
and  1,000;  and  tablets  of  50  mg.  in  r 
30,  250,  and  1,000. 


LAKESIDE  LABORATORIES,  INC.  Milwaukee,.  Wiscon 


ISMS 

Division  of  Legislation 
& Public  Affairs 
Presents... 

Annual  Washington, 


NOW  is  the  time  for  all  ISMS  mem- 
bers to  plan  to  attend  this  year's 
Annual  Washington  ROUNDUP! 

Be  There  . . . On  Sunday,  Feb.  16 
when  ISMS  officials  and  fellow  Illi- 
nois physicians  meet  with  Illinois  Con- 
gressmen and  learn  what's  ahead  in 
this  crucial  post-election  year. 

Join  . . . U.S.  Chamber  of  Com- 
merce members  on  Feb.  17-18  as  they 
too  survey  the  legislative  prospects, 
hear  fascinating  speakers  and  be- 
come better  informed  citizens  and 
professionals. 

Don't  Delay!  Register  Now! 

For  further  Information  & Registration 
Information  Contact: 


D.C 

ROUNDUP 

February  16-18,  1969 


Sheraton  Park  Hotel 
Washington,  D.C. 


Washington  ROUNDUP 
Illinois  State  Medical  Society 
360  N.  Michigan 
Chicago  60601 


IMJ  NOW  ON  MICROFILM 

Arrangements  have  been  made  with 
University  Microfilms,  Ann  Arbor,  Mich. 
48106,  to  have  the  Illinois  Medical  Jour- 
nal available  on  microfilm.  The  Journal,  in 
miniature,  in  either  reduced  or  original 
size,  will  be  available  through  the  firm. 
Copies  may  be  purchased  simply  by  ad- 
dressing the  firm,  at  300  N.  Zeeb  Road, 
Ann  Arbor.  Write  for  their  catalog  and 
complete  information. 


ON  THE  COVER 

In  this  season  of  festivity,  we  wish  for  each  of  our  readers  a Happy  Holiday  Season  and  our 
hopes  for  a Prosperous  New  Year. 

A few  observations  about  various  customs  of  the  season  may  be  of  interest. 

The  next  time  someone  gets  bussed  under  the  mistletoe  you  may  want  to  inform  the  "Busser" 
that  years  ago  mistletoe  was  used  as  a charm  to  ward  off  witches  and  thunder.  If  you  keep 
your  Yule  log  lit  throughout  the  night,  that's  good  luck.  But  be  careful  if  a squinting  person  comes 
in  while  it's  burning.  An  ill  omen. 

On  New  Year's  Eve,  a ball  is  dropped  in  Times  Square  as  the  midnight  hour  approaches.  In 
Japan  bells  gong  108  times.  Italians  hurl  glasses  out  the  window,  while  Scots  walk  through 
the  streets  carrying  a barrel  of  tar.  In  Geneva  every  piece  of  available  artillery  is  fired.  The 
French  visit  all  their  friends  on  New  Year's  Day  to  inform  them  that  a new  year  has  arrived 
while  the  Mexicans  celebrate  with  a festive  fiesta. 

Called  "noels"  in  France,  "le  pastorali"  in  Italy  and  "weinichwiesi"  in  Germany,  Christmas 
Carols  have  a noteworthy  history.  The  earliest  consisted  of  gloomy  music  rather  than  happy 
sounds.  Before  Carols  were  sung  they  were  danced. 

Again,  best  wishes  for  a Joyful  Holiday  Season. 


for  December,  1968 


735 


It’s  almost  as  if  you  were  there  to 
give  an  injection  of  penicillin 


V-Cillin  K®,  Pediatric  dependable  oral  penicillin  therapy 

Potassium  Phenoxymethyl  Penicillin 


Description;  V-Cillin  K,  the  potassium  salt  of  V-Cillin®  (phe- 
noxymethyl penicillin,  Lilly),  combines  acid  stability  with  immedi- 
ate solubility  and  rapid  absorption.  Higher,  more  rapid  serum 
levels  are  obtained  than  with  equal  oral  doses  of  penicillin  G. 
Indications:  Streptococcus,  pneumococcus,  and  gonococcus  in- 
fections: infections  caused  by  sensitive  strains  of  staphylococci; 
prophylaxis  of  streptococcus  infections  in  patients  with  a history 
of  rheumatic  fever;  and  prevention  of  bacterial  endocarditis  after 
tonsillectomy  and  tooth  extraction  in  patients  with  a history  of 
rheumatic  fever  or  congenital  heart  disease. 

Contraindication:  Penicillin  hypersensitivity. 

Warnings;  In  rare  instances,  penicillin  may  cause  acute  anaphy- 
laxis which  may  prove  fatal  unless  promptly  controlled.  This  type 
of  reaction  appears  more  frequently  in  patients  with  a history  of 
sensitivity  reactions  to  penicillin  or  with  bronchial  asthma  or 
other  allergies.  Resuscitative  drugs  should  be  readily  available. 
These  include  epinephrine  and  pressor  drugs  (as  well  as  oxygen 
for  inhalation)  for  immediate  allergic  manifestations  and  anti- 
histamines and  corticosteroids  for  delayed  effects. 

Precautions:  Use  cautiously,  if  at  all,  in  a patient  with  a strongly 
positive  history  of  allergy. 

In  prolonged  therapy  with  penicillin,  and  particularly  with  high 
parenteral  dosage  schedules,  frequent  evaluation  of  the  renal 
and  hematopoietic  systems  is  recommended. 

In  suspected  staphylococcus  infections,  proper  laboratory 
studies  (including  sensitivity  tests)  should  be  performed. 

The  use  of  penicillin  may  be  associated  with  the  overgrowth 
of  penicillin-insensitive  organisms.  In  such  cases,  discontinue 
administration  and  take  appropriate  measures. 


Adverse  Reactions:  Although  serious  allergic  reactions  are  much 
less  common  with  oral  penicillin  than  with  intramuscular  forms, 
manifestations  of  penicillin  allergy  may  occur. 

Penicillin  is  a substance  of  low  toxicity,  but  it  possesses  a sig- 
nificant index  of  sensitization.  The  following  hypersensitivity  re- 
actions have  been  reported:  skin  rashes  ranging  from  maculo- 
papular  eruptions  to  exfoliative  dermatitis:  urticaria:  and  reac- 
tions resembling  serum  sickness,  including  chills,  fever,  edema, 
arthralgia,  and  prostration.  Severe  and  often  fatal  anaphylaxis 
has  occurred  (see  Warnings).  Hemolytic  anemia,  leukopenia, 
thrombocytopenia,  and  nephropathy  are  rarely  observed  side- 
effects  and  are  usually  associated  with  high  parenteral  dosage. 

Administration  and  Dosage:  Usual  dosage  range,  125  mg. 
(200,000  units)  three  times  a day  to  500  mg.  (800,000  units)  every 
four  hours.  For  infants,  50  mg.  per  Kg.  per  day  divided  into  three 
doses. 

See  package  literature  for  detailed  dosage  instructions  for 
prophylaxis  of  streptococcus  infections,  surgery,  gonorrhea,  and 
severe  infections. 

How  Supplied:  Tablets  V-Cillin  K®  (Potassium  Phenoxymethyl 
Penicillin  Tablets,  U.S.P.),  125  mg.  (200,000  units),  250  mg. 
(400,000  units),  and  500  mg.  (800,000  units). 

V-Cillin  K®  (potassium  phenoxymethyl  penicillin,  Lilly),  Pedi- 
atric. for  Oral  Solution.  125  mg.  (200,000  units)  and  250  mg. 
(400,000  units)  per  5 cc.  of  solution  (approximately  one  tea- 
spoonful). [042667a] 

Additional  information  available 
to  physicians  upon  request. 

Eli  Lilly  and  Company,  Indianapolis,  Indiana  46206 


600198 


736 


Illinois  Medical  Journal 


Illinois  Medical  Journal 


volume  134,  number  6 


December,  1968 


Intensive  Cardiac  Care 


Two  Years  Experience 

By  Herbert  E.  Bessinger^  M.D.,  F.A.C.C., 

Jerome  Silver^  M.D.,  Cheng-Yee  Teng^  M.D., 

Erlindo  Evaristo,  M.D.,  Ernesto  Chua,  M.D., 

Eern  Becker^  R.N.,  and  Pat  Rothmund^,  R.N. /Chicago 


Herbert  E.  Bessinger,  M.D.,  F.A.C.C.,  is  Clinical 
Assistant  Professor  of  Medicine,  the  University  of 
Illinois  College  of  Medicine.  In  addition  he  is  Di- 
rector of  Medical  Education  and  Medical  Director 
of  the  Intensive  Cardiac  Care  Unit,  Louis  A.  Weiss 
Memorial  Hospital.  Jerome  Silver,  M.D.,  is  Clinical 
Assistant  Professor  of  Surgery,  the  University  of 
Illinois  College  of  Medicine  and  Chairman  of 
Weiss  Hospital’s  Intensive  Cardiac  Care  Unit  Com- 
mittee. Cheng  Teng,  M.D.,  is  an  Instructor  in  Medi- 
cine, the  University  of  Illinois  College  of  Medicine. 
He  is  Assistant  Medical  Director  of  the  Intensive 
Cardiac  Care  Unit.  In  addition  he  served  the  Dept, 
of  Adult  Cardiology,  Cook  County  Hospital  and  is 
Director  of  the  Cardiac  Care  Unit,  MacNeal  Me- 
morial Hospital,  Berwyn  Erlindo  Evaristo,  M.D.,  is 
a fellow  in  cardiology  at  Weiss  Memorial.  Ernesto 
Chua,  M.D.,  is  a medical  Resident  at  Weiss.  Fern 
Becker,  R.N.,  is  Supervisor,  and  Pat  Rothmund, 
Assistant  Supervisor  of  the  Weiss  Intensive  Cardiac 
Care  Unit. 


On  January  5,  1965,  Louis  A.  Weiss  Me- 
morial Hospital  opened  a fifteen  bed 
monitored  Intensive  Cardiac  Care  Unit.  A 
full  time  Medical  Director  supervised  the 
unit.  Review  of  the  literature  indicated  the 
need  for  cardiac  monitoring  in  all  patients 
with  severe  sustained  angina  pectoris  re- 
gardless of  the  absence  of  electrocardiogram 
abnormalities. 

The  nurse-patient  ratio  was  1:3  with  ad- 
ditional nursing  aide  and  secretarial  help. 
A resident  physician  was  assigned  to  the 
unit  for  24  hours.  The  nurses  selected  for 
I.C.C.U.  received  80  hours  of  lectures  on 
cardiac  physiology,  therapy,  and  ECG  in- 
terpretation. Admissions  and  transfers  were 
approved  by  the  director  of  the  unit.  Pa- 
tient visiting  was  limited  to  five  minutes 
on  the  hour  around  the  clock. 

Initial  efforts  were  directed  toward  the 
treatment  of  cardiac  arrest;  later  experience 
related  more  to  the  prevention  of  cardiac 
arrest,  particularly  the  immediate  treat- 
ment of  ectopic  ventricular  beats,  early 
heart  failure,  and  incipient  cardiogenic 
shock. 


for  December,  1968 


737 


Selection  of  Patients 

All  patients  with  severe  or  sustained  an- 
gina were  admitted  to  I.C.C.U.  Patients 
with  old  myocardial  infarctions  having  sus- 
tained angina,  syncope,  or  pulmonary 
edema  were  also  admitted.  Frequently,  such 
patients’  electrocardiograms  showed  no 
change  from  previous  tracings  except  for 
the  presence  of  ectopic  ventricular  com- 
plexes. Other  patients  admitted  had  either 
arrhythmia  or  heart  block. 

The  I.C.C.U  data  included  all  patients 
treated  in  the  emergency  room  for  either 
cardiac  arrest  or  severe  cardiogenic  shock 
and  pulmonary  edema,  as  all  such  patients 
were  admitted  to  I.C.C.U, 


Table  I 


MORTALITY 

FROM  MYOCARDIAL  INFARCTION 
LOUIS  A WEISS  MEMORIAL  HOSPITAL 
1963-64 

General  1965-66  1966-67 

Care  I.C.C.U.  I.C.C.U. 


Total  Patients 

admitted 

with  M.I.  213  241  311 

Total  Deaths*  65  60  48 

Mortality  Rate  30.5%  25%  15.4% 

*A11  patients  admitted  to  I.C.C.U.,  including  mori- 
bund patients  with  pulmonary  edema  and  cardio- 
genic shock,  expiring  any  time  after  admission 
from  the  emergency  room  or  general  hospital. 


Physical  Examination 

The  patient  with  severe  coronary  insuf- 
ficiency or  myocardial  infarction  often  ex- 
hibited cool,  moist  skin,  pallor,  and  a rapid, 
weakened  pulse.  He  frequently  had  a pal- 
pable apical  cardiac  impulse,  and  a fourth 
heart  sound  of  atrial  systole  with  presystolic 
ventricular  filling  sound  heard  late  in  the 
diastolic  period.  Less  frequently,  a third 
heart  sound  of  early  ventricular  filling  was 
heard  at  the  apex  suggesting  left  ventri- 
cular insufficiency.  Reduced  intensity  of 
the  first  heart  sound  was  common. 

Treatment 

On  arrival  at  the  unit,  the  patient  was 
immediately  monitored  and  an  intravenous 
needle  inserted  either  as  a glucose-potas- 
sium infusion  or  with  a heparin  adapter. 
Every  effort  was  made  to  reduce  the  pa- 
tient’s anxiety  and  discomfort.  Patients 
with  suspect  infarction  were  monitored 
three  to  five  days,  and  patients  with  definite 


infarction  were  monitored  seven  to  ten 
days.  Most  authorities  have  agreed  on  a 
minimum  of  seven  days  monitoring  for 
patients  with  myocardial  infarction.  We 
have  experienced  unexpected  deaths  after 
transfer  from  I.C.C.U.  indicating  the  need 
for  longer  periods  of  monitoring.  Proper 
selection  of  electrodes  reduced  false  alarms 
and  caused  a minimum  of  skin  irritation. 
Floating  electrodes  and  silver-silver  chlor- 
ide electrodes  were  well  tolerated  as  were 
short  23  gauge  stainless  steel  needles.  Pa- 
tients with  complications  had  central  ven- 
ous pressure  monitoring  and  fluid  infusion 
with  additional  access  to  an  arm  vein 
through  an  intravenous  needle  or  cut  down 
with  a plastic  catheter.  Five  percent  glucose 
with  40  meq.  KCl  was  infused;  saline  solu- 
tions were  avoided  in  acute  cardiac  pa- 
tients. True  hyponatremia,  not  dilutional 
as  in  congestive  heart  failure,  was  treated 
with  100  cc.  infusions  of  5%  NaCl.  Oc- 
casional patients  developed  hypotension 
after  vigorous  diuretic  therapy  due  to  vol- 
ume depletion  and  received  fluid  volume 
restoration  with  central  venous  pressure 
monitoring.  KCl  therapy  was  avoided  in 
patients  with  second  or  third  degree  heart 
block  and  in  patients  with  cardiogenic 
shock  unless  hypokalemic.  Oxygen  therapy 
was  given  for  two  to  three  days  with  care- 
ful monitoring  of  vital  signs  for  undesir- 
able physiological  effects  of  O2  therapy. 
Arterial  oxygen,  carbon  dioxide,  and  pH 
values  were  obtained  in  patients  with 
cardiogenic  shock  and  pulmonary  edema. 
Serum  potassium  was  determined  on  ad- 
mission of  all  patients.  Most  patients  re- 
ceived an  admission  portable  chest  x-ray  to 
evaluate  the  presence  of  hilar  vascular  con- 
gestion. 

The  smallest  effective  doses  of  opiates 
were  used  for  the  relief  of  pain,  and  re- 
peated only  as  needed  because  of  the  fre- 
quent development  of  hypotension,  sinus 
bradycardia  and  varying  degrees  of  A-V 
block  when  large  doses  of  opiates  were  ad- 
ministered. Such  undesirable  effects  were 
treated  with  0.5  to  1 mg.  of  I.V.  atropine, 
and  1 mg.  isoproterenol  in  1 liter  of  5% 
dextrose  in  distilled  water;  hypotension  was 
treated  with  central  venous  pressure  moni- 
toring and  volume  expansion  if  the  CVP 
was  below  10  cm.  Vasopressor  therapy  was 
instituted  when  the  hypotension  was  as- 
sociated with  oliguria  and  other  approaches 
ineffective. 


738 


Illinois  Medical  Journal 


Sedatives  and  tranquilizers  were  given 
in  reduced  dosage  until  their  effects  on 
physiological  parameters  were  observed. 
Catecholamine  depleting  drugs  were  avoid- 
ed. Synergism  between  sedatives,  tranquil- 
izers, and  opiates  was  observed. 

All  patients  were  placed  on  a liquid  low 
salt  diet  for  two  to  three  days  after  admis- 
sion when  the  possibility  of  cardiac  arrest 
was  greatest.  Careful  attention  was  given 
to  the  patient’s  excretory  functions  to  avoid 
distention  of  the  urinary  bladder  or  rectal 
ampulla,  and  possible  reflex  vagal  cardiac 
effects.  Foley  catheters  were  necessary  in 
some  patients  and  were  always  inserted  in 
patients  with  cardiogenic  shock.  Most  pa- 
tients were  allowed  the  use  of  a bedside 
commode  with  an  aide  or  nurse  present 
and  monitoring  continued. 

Treatment  of  Complications 

We  have  observed  our  patients  with  left 
ventricular  insufficiency  and  pulmonary 
edema  as: 

a)  Patients  with  mild  pulmonary  edema 
and  normal  blood  pressure; 

b)  Patients  with  massive  foaming  pul- 
monary edema  and  hypertension; 

c)  Patients  with  massive  pulmonary 
edema  and  severe  cardiogenic  shock. 

The  first  two  types  of  patients  were 
treated  with  10  mg.  of  morphine  sulfate, 
tourniquets,  and  intravenous  ethacrynic 
acid  or  furosemide  50  to  100  mg.  The 
patients  with  severe  pulmonary  edema  were 
venesected  300-500  cc.’s  of  blood  immedi- 
ately on  arrival  to  the  emergency  room  or 
while  on  the  I.C.C.U.  Patients  not  on  main- 
tenance digitalis  preparations  were  given 
0.4  mg.  cedilanid  intravenously  with  careful 
monitoring  for  ventricular  ectopic  rhythms 
and  atrio-ventricular  blocks  before  addi- 
tional amounts  were  given.  It  has  been  our 
policy  not  to  push  digitalis  preparations  in 
patients  with  myocardial  infarctions  hoping 
to  gain  an  inotropic  response  with  less  than 
complete  doses.  Short  acting  preparations 
were  used.  Lidocaine  was  effective  in  many 
atrial  arrhythmias  as  well  as  those  of  ven- 
tricular origin.  Positive  pressure  ventilation 
was  beneficial  in  those  patients  who  tol- 
erated the  mask.  Large  doses  of  intra- 
venous hydrocortisone,  500  mg.  to  1 Gm., 
were  given  to  treat  severe  bronchospasm. 
The  patients  with  foaming  pulmonary 
edema  and  no  obtainable  blood  pressure 


gave  us  our  highest  mortality  in  patients 
with  acute  myocardial  infarction  and  sel- 
dom responded  to  vasopressor  therapy. 

Arrhythmias 

Ectopic  ventricular  complexes  have  been 
treated  with  the  immediate  intravenous  in- 
jection of  50  mg.  of  2%  Lidocaine  every 
three  to  five  minutes  for  three  to  four  doses, 
and  1 to  2 Gms.  of  Lidocaine  added  to  1 
liter  of  5%  Dextrose  solution  to  run  at 
10  to  15  drops  a minute.  When  Lidocaine 
was  ineffective  in  eliminating  frequent  or 
coupled  premature  ventricular  contractions, 
100  mg.  of  procaine  amide  was  injected 
intravenously  every  two  to  three  minutes 
up  to  0.5  or  1 Gm.  Subsequent  treatment 
with  1 to  2 Gms.  of  procaine  amide  in  1 
liter  of  glucose  solution  was  given  as  an 
intravenous  drip.  Lidocaine  did  not  cause 
hypotension  or  seizures  in  our  patients. 

Tahle  11 

MORTALITY 

FROM  MYOCARDIAL  INFARCTION 
PULMONARY  EDEMA  AND  CARDIOGENIC 


SHOCK 

Patients  with 

1963-64 

Pulmonary 

General 

1965-66 

1966-67 

Edema  and  Car- 

Care 

I.C.C.U. 

I.C.C.U. 

diogenic  Shock 

39 

50 

56 

Deaths 

30 

36 

38 

Mortality  Rate 

77% 

72% 

69% 

Expired  under  1 hour 

8 

7 

Expired  1-24  hours 

8 

10 

We  have  not  routinely  given  patients  anti- 
arrhythmic  drugs  on  admission  to  the  unit 
and  have  preferred  Lidocaine  as  a less  de- 
pressant antiarrhythmic  drug.  Tachycardias 
possibly  digitalis  induced  were  treated 
with  intravenous  injections  of  0.1  to  0.5 
mg.  propranolol  every  five  to  ten  minutes 
up  to  3 to  4 mg.  observing  for  excessive 
slowing  of  the  pacemaker  and  pulmonary 
edema.  In  patients  with  myocardial  infarc- 
tion we  have  observed  extreme  sinus 
bradycardia  and  periods  of  pacemaker  ar- 
rest during  intravenous  propranolol  injec- 
tion necessitating  resuscitation  and  isopro- 
terenol. Brief  periods  of  unilateral  carotid 
sinus  pressure  of  four  to  five  seconds  has  al- 
lowed recognition  of  “p”  or  flutter  waves 
in  some  patients.  Either  supraventricular 
or  ventricular  tachycardias  were  treated 
with  oxygen  and  metaraminol  when  the 
patients  with  myocardial  infarction  were 
hypotensive.  If  the  tachycardia  persisted 
and  the  non-digitalized  patient  experienced 


for  December,  1968 


739 


severe  pain  or  pulmonary  edema,  we  elected 
direct  current  countershock  as  the  safest 
procedure  and  most  effective  for  terminat- 
ing the  tachycardia.  Following  counter- 
shock, appropriate  antiarrhythmic  drugs 
were  maintained  for  several  weeks.  Supra- 
ventricular tachycardia’s  in  non-digitalized 
patients  with  myocardial  infarction  were 
treated  initially  with  cedilanid  0.4  mg.  in- 
travenously up  to  1.0  mg.  Digitalized  pa- 
tients needing  emergency  countershock  were 
given  intravenous  Lidocaine  or  procaine 
amide  and  an  intravenous  glucose-potas- 
sium infusion  prior  to  countershock.  Re- 
cently we  have  also  used  0.1  to  0.5  mg.  in- 
travenous injections  of  propranolol  up  to 
3 mg.  at  three  to  five  minute  intervals. 

Sinus  tachycardia  has  proved  difficult 
to  treat  in  patients  with  extensive  infarc- 
tion even  though  digitalized  and  with  nor- 
mal electrolytes,  blood  volumes,  and  cen- 
tral venous  pressures.  Sinus  bradycardia 
was  treated  with  intravenous  atropine  and 
an  infusion  of  1 mg.  isoproterenol  in  a liter 
of  glucose  solution.  When  such  patients 
were  hypotensive,  either  metaraminol  or 
levarterenol  was  given  in  slow  intravenous 
drip.  Patients  with  posterior  or  inferior 
infarction  responded  to  conservative  ther- 
apy although  a transvenous  pacemaker  was 
inserted  in  patients  with  oliguria  and  hypo- 
tension. We  used  similar  treatment  for  pa- 
tients with  inferior  infarction  who  devel- 
oped second  or  third  degree  heart  block, 
and  inserted  a transvenous  pacemaker 
when  unsuccessful  or  when  ventricular  tach- 
ycardia resulted  from  isoproterenol  stimu- 
lation. Digitalis  and  antiarrhythmic  drugs 
were  not  given  to  patients  with  sinus  brady- 
cardia or  heart  block  unless  a pacemaker 
was  functioning.  Most  patients  having 
Stokes-Adams  episodes  were  paced. 


Table  m 

DEATHS  AFTER  TRANSFER  FROM  I.C.C.U. 


1965 

- 1966 

1966  - 1967 

Days  on 

Day  of  Death 

Days  on 

Day  of  Death 

I.C.C.U. 

after  transfer 

I.C.C.U. 

after  Transfer 

3 

16 

6 

6 

3 

6 

6 

5 

3 

6 

8 

5 

6 

7 

8 

21 

10 

7 montlis  9 

21 

10 

7 

14 

4 

30 

4 

14 

7 

Cardiogenic  Shock 

Our  greatest  mortality  was  in  patients 
with  severe  cardiogenic  shock.  We  observed 
three  main  clinical  types  of  patients  with 
acute  myocardial  infarction  and  cardio- 
genic shock:  1)  patients  with  cool,  wet  skin, 
hypotension,  pallor,  experiencing  chest 
pain  at  the  time  of  admission  but  not  pres- 
sor dependent;  2)  patients  with  severe  car- 
diogenic shock,  oliguria,  moderate  pulmon- 
ary edema  who  were  pressor  dependent;  3) 
patients  with  severe  cardiogenic  shock  and 
massive  foaming  pulmonary  edema,  un- 
responsive to  pressor  drugs  and  other  treat- 
ment. The  highest  mortality  was  in  pa- 
tients with  massive  pulmonary  edema  and 
no  recordable  blood  pressure  or  femoral 
pulse,  not  responding  to  levarterenol  dur- 
ing constant  monitoring. 

All  patients  in  shock  had  central  venous 
pressure  catheters  inserted  and  were  vol- 
ume expanded  if  central  pressures  were  be- 
low 10  cm.  water,  and  were  given  0.8  mg. 
of  cedilanid  in  divided  doses  if  the  central 
venous  pressure  was  above  15  cms.  Aramine 
or  levophed  was  infused  after  volume  ex- 
pansion if  hypotension  persisted  with  oli- 
guria; sodium  bicarbonate  and  antiarrhy- 
thmic drugs  were  used  as  indicated.  Iso- 
proterenol was  only  given  in  glucose  solu- 
tion if  bradycardia  or  partial  A-V  block 
was  associated  with  shock.  When  oliguria 
persisted  during  pressor  therapy  with  sys- 
tolic arterial  pressure  of  100  to  110  mm. 
Hg.,  40  mg.  phentolamine  was  added  to 
the  glucose  infusion  of  15  to  20  drops  per 
minute.  This  therapy  resulted  in  diuresis 
and  warming  of  the  skin  in  recent  patients 
treated. 

Cardiac  Arrest 

Most  patients  expiring  with  unsuccessful- 
ly treated  cardiogenic  shock  and  pulmonary 
edema  demonstrated  acidotic  rhythms  with 
descending  pacemakers  and  final  slow  wide 
bizarre  ventricular  complexes  terminating 
in  asystole.  Resuscitation  in  these  patients 
was  invariably  unsuccessful.  Sudden  ven- 
tricular fibrillation  was  not  observed  unex- 
pectedly when  premature  ventricular  beats 
were  treated  by  intravenous  Lidocaine,  fol- 
lowed by  Lidocaine  or  pronestyl  slow  in- 
travenous drip  infusion.  Patients  with  end- 
stage  hearts,  marked  cardiomegaly,  refrac- 
tory heart  failure,  and  azotemia  were  un- 
successfully resuscitated  and  in  general  had 


740 


Illinois  Medical  Journal 


complications  and  were  not  unexpected 
cardiac  arrests.  Techniques  of  resuscitation 
were  standard  with  immediate  thumping  of 
the  chest,  external  cardiac  massage  and  re- 
suscitube  or  bag  ventilation.  Defibrillation 
was  done  in  the  shortest  possible  time  with 
no  delay,  and  not  interrupting  massage  for 
any  procedure,  such  as  endotracheal  intu- 
bation. Rapid  resuscitation  with  restora- 
tion of  a normal  sinus  rhythm  usually  re- 
sulted in  a conscious  or  semi-stuporous  pa- 
tient with  spontaneous  respiration  and 
blood  pressure.  Comatose  patients  were  in- 
tubated until  recovering  consciousness.  De- 
fibrillation was  done  with  300-400  Joules  or 
Watt/seconds,  0.5  Gm.  procaine  amide  was 
injected  directly  I.V.,  and  2 Gms.  added  to 
glucose  infusion  as  slow  drip;  88  meq.  of 
sodium  bicarbonate  was  injected  every  five 
minutes,  and  levophed  infused  as  needed. 
Most  of  our  successful  resuscitations  have 
followed  defibrillation  done  within  one  to 
two  minutes  after  onset  of  ventricular  fib- 
rillation. 

Asystole  was  treated  with  cardiopulmon- 
ary resuscitation  and  intravenous  injections 
of  0.5  mg.  epinephrine  repeated  at  two  to 
three  minute  intervals.  Ventricular  fibrilla- 
tion which  at  times  followed  was  then 
countershocked.  Fewer  successful  resuscita- 
tions resulted  when  the  arrest  was  due  to 
asystole. 

Summary 

Intensive  cardiac  care  of  high  risk  pa- 
tients reduces  mortality  from  ischemic 
heart  disease,  and  allows  for  early  detection 
and  management  of  complications.  Unex- 
pected cardiac  arrest  in  monitored  patients 
should  seldom  occur.  Patients  with  ad- 
vanced heard  disease  and  severe  cardiogenic 


shock  have  the  greatest  mortality. 

This  review  offers  the  authors’  current 
approach  to  the  daily  problems  encount- 
ered on  the  cardiac  care  unit,  recognizing 
the  need  for  individual  patient  manage- 
ment, and  the  unpredictibility  of  patient 
responses  to  therapy  during  acute  ischemic 
episodes. 

References 

1.  Baroldi,  G.:  Myocardial  infarction  and  sudden 
coronary  heart  death  in  relation  to  coronary  oc- 
clusion and  collateral  circulation.  Am.  Ht.  J., 
71:6,  (June,  1966)  826-836. 

2.  Bessinger,  H.:  Physiology  of  the  normal  and 
ischemic  heart.  Hosp.  Topics,  44:11,  (Nov., 

1966)  44-48. 

3.  Day,  H.,  and  Averill,  K.;  Recorded  arrhythmias 
in  an  acute  coronary  care  area.  Diseases  of  the 
Chest,  49:2,  (Feb.,  1966)  113-118. 

4.  Day,  H.:  Unit  increases  patients’  chances  of 
survival  after  cardiac  arrest.  Hosp.  Topics, 
44:11,  (Nov.,  1966)  20-22. 

5.  Gunnar,  R.,  et  al.:  Myocardial  infarction  with 

shock:  hemodynamic  studies  and  results  of 

therapy.  Circ.  33  (May,  1966)  753-762. 

6.  Killip,  T.,  Ill,  and  Kimball,  J.T.:  Treatment  of 
myocardial  infarction  in  a coronary  care  unit. 
Am.  J.  Card.,  20:4,  (Oct.,  1967)  457-464. 

7.  Town,  B.:  Coronary  care  unit:  new  perspec- 
tives and  directions.  JAMA,  199:3,  (Jan.  16, 

1967)  188-198. 

8.  Meltzer,  L.,  and  Kitchell,  J.:  Incidence  of  ar- 
rhythmias associated  with  acute  myocardial  in- 
farction. Progress  in  C.V.D.,  9:1,  (July,  1966) 
50-63. 

9.  Nachlas,  M.  et  al.:  Observations  on  defibrilla- 
tors, defibrillation  and  synchronized  counter- 
shock. Progress  in  C.V.D.,  9:1,  (July,  1966)  64- 
89. 

10.  Progress  in  Cardiovascular  Diseases:  Acute  Myo- 
cardial Infarction  and  Coronarv'  Care  Units— I, 
II,  & III,  10:5,  10:6,  11:1  (March,  May,  & 
July,  1968.) 

11.  Shubin,  H.,  and  Weil,  M.:  Treatment  of  shock 
complicating  acute  myocardial  infarction.  Pro- 
gress in  C.V.D.,  10:1,  (July,  1967)  30-54. 

12.  Silver,  J.:  Anatomy  and  physiology  of  a cardiac 
care  unit.  Bull,  of  Louis  A.  Weiss  Mem.  Hosp. 
(Chicago,)  Spring,  1966,  Vol.  7,  13-31. 

13.  Surawicz,  B.:  Sudden  Cardiac  Death,  Grune  & 
Stratton,  New  York,  N.Y.,  1964. 


Stretch  Garment  Dermatitis 

A disease  of  the  skin,  not  hitherto  described,  is  caused  by  pressure  or  ten- 
sion on  the  skin  from  the  wearing  of  tight-fitting  stretch  garments  such  as 
''stretch  bras,"  "stretch  girdles"  and  "stretch  socks."  The  condition  is  not  due 
to  chemical  sensitization  of  fabrics,  dyes  or  other  additives  but  is  of  mechan- 
ical origin. 

The  eruption  may  assume  various  clinical  forms  and  may  be  characterized 
by  a nondescript  erythematous  and  eczematous  oppearance  or  may  consist 
of  an  exaggeration,  in  the  areas  covered  by  the  stretch  garment,  of  already 
existing  dermatosis  such  as  lichen  planus,  psoriasis,  acne  vulgaris,  discoid 
lupus  erythematosus  or  atopic  dermatitis.  (Richard  Mihan  and  SameuI  Ayres, 
Jr.,  "Stretch  Garment  Dermatitis";  Calif.  Med.  [Feb.]  1968;  108:2;  pgs.  109- 
112.) 


for  December,  1968 


741 


Simultaneous  Adenocarcinoma  Of 
The  Esophagus  And  Stomach 

By  Bernard  Peison,  M.D. /Chicago 


Although  simultaneous  primary  malig- 
nancies of  the  colon  and  rectum  as  well  as 
the  respiratory  tract  are  not  uncommon, 
few  reports  have  dealt  with  multiple  pri- 
mary tumors  of  the  upper  gastrointestinal 
tract. 

This  report  concerns  the  pathological 
findings  of  simultaneous  adenocarcinoma  of 
the  esophagus  and  stomach.  The  case,  at 
autopsy,  revealed  an  extensive  and  wide- 
spread adenocarcinoma  of  the  esophagus. 
The  tumor  originated  from  the  mucosal 
esophageal  glands  rather  than  from  dis- 
placed or  heterotopic  gastric  glands  as  has 
been  reported  by  other  authors^'^.  There 
was,  in  addition,  a second  independent 
adenocarcinoma  in  the  cardiac  portion  of 
the  stomach.  The  case  had  a radiological 
diagnosis  of  esophageal  hiatal  hernia.  Its 
association  with  esophageal  carcinoma  will 
be  discussed. 

The  purpose  of  this  paper  is  to  alert  the 
pathologist  and  clinician  of  the  possible  co- 
existence of  two  independent  primary 
glandular  tumors  at  the  cardio-esophageal 
junction,  so  that  a masked  adenocarcinoma 
of  the  gastric  cardia  is  not  overlooked. 
That  adenocarcinoma  of  the  esophagus  is 
a distinct  clinical  and  pathological  entity, 
which  may  originate  from  esophageal 
mucosal  glands  at  any  level.  Because  of  its 
intramural  submucosal  location,  the  tumor 
may  produce  negative  roentgenographic 
and  fundoscopic  findings  or  mimic  a ben- 
ign lesion. 


Bernard  Peison,  M.D. 
is  Associate  Director 
of  Laboratories,  Mercy 
Hospital  and  Associate 
Pathologist.  He  is  also 
Clinical  Associate  in 
Pathology,  the  Univer- 
sity of  Illinois  College 
of  Medicine.  Dr.  Pei- 
son received  his  M.D. 
from  Havana  Medical  School,  Cuba,  and  trained 
in  pathology  at  Bellevue  Medical  Center,  New 
York  and  at  Mercy  Hospital.  He  is  certified  by 
the  American  Board  of  Pathology. 


Report  of  a Case 

A forty-two  year  old  man  entered  Mercy 
Hospital  complaining  of  peri-umbilical 
pain  for  approximately  two  months.  The 
patient  noted  black  stools  and  he  vomited 
blood  on  one  occasion.  There  was  a 15 
pound  weight  loss  since  the  onset  of  his 
illness. 

Physical  examination  revealed  a thin 
adult  man  in  no  distress.  The  blood  pres- 
sure was  130/90  mm  Hg;  the  pulse  was  82 
per  minute;  and  the  temperature  98.6°F. 
The  heart  and  lungs  were  normal. 

A chest  film  revealed  a metastatic  lesion 
on  the  right  sixth  rib.  Upper  gastro-intes- 
tinal  films  demonstrated  a fixed  hiatal  her- 
nia. Proctoscopy  and  esophagoscopy  were 
negative.  The  patient  had  a protracted 
downhill  course  and  expired  61  days  fol- 
lowing admission. 


Fig.  1.  Gastroesophageal  junction  with  neo- 
plasm involving  the  lower  end  of  the  esopha- 
gus and  portions  of  the  cardia. 


Post  mortem  examination  showed  an  ex- 
tensive ulcerated  tumor  involving  the  mid- 


742 


Illinois  Medical  Journal 


Fig.  2.  Esophageal  mucosa  with  neoplastic  transformation 
of  cardiac  or  superficial  esophageal  glands.  Hematoxylin 
and  eosin  stain,  x 150. 


Fig.  3.  Esophageal  mucosa  with  neoplastic  mucosal  glands. 
Hematoxylin  and  eosin  stain,  x 150. 


Fig.  4.  Neoplastic  transformation  of  cardiac  esophageal 
glands.  Note  nests  of  tumor  cells  in  the  left  upper  corner. 
Hematoxylin  and  eosin  stain,  x 150. 


die  and  lower  third  o£  the  esophagus  and 
extending  into  the  cardiac  portion  of  the 
stomach  (Fig.  1).  The  tumor  appeared  to 
encircle  the  entire  circumference  of  the 
esophagus  and  measured  six  by  four  cms. 
There  were  metastases  in  the  lymph  nodes, 
lungs,  adrenal  glands,  liver,  pancreas,  right 
sixth  rib  and  fourth  thoracic  vertebra.  His- 
tological examination  revealed  the  entire 
esophagus  involved  with  a neoplasm  aris- 
ing from  the  esophageal  mucosal  glands 
(Figs.  2,  3,  4).  The  tumor  displayed  a gland- 
ular pattern  with  areas  of  squamous  meta- 
plasia. In  other  areas  the  pattern  was  com- 
pletely undifferentiated  (Fig.  5).  There 
were  large  areas  of  necrosis  and  massive 
lymphatic  and  vascular  permeation  (Fig. 
6)  . 

Mucicarmine  stain  showed  small 
amounts  of  mucin  in  an  occasional  neoplas- 
tic acini.  There  was  another  independent 
primary  neoplasm  in  the  gastric  cardia, 
arising  distinctly  from  the  gastric  mucosa. 
The  tumor  was  a mucin  producing  adeno- 
carcinoma which  extended  into  the  muscu- 
laris  (Fig.  7).  In  some  areas,  there  was  an 
admixture  of  both  types  of  tumor  cells,  due 
to  the  invasion  of  the  gastric  wall  by  the 
esophageal  neoplasm  (Fig.  8).  Tumor  cells 
from  the  stomach  were  not  identified  in 
the  esophagus.  The  esophageal  squamous 
epithelium  was  thinned  but  not  ulcerated. 
The  cardio-esophageal  junction  showed  no 
direct  continuity  between  both  neoplasms. 

Discussion 

The  coexistence  of  two  primary  neo- 
plasms at  the  esophago-gastric  junction  is 
extremely  rare.  On  reviewing  the  literature 
only  two  similar  reports  were  found.  Mingh 
and  Bullough^  reported  a preinvasive  pa- 
pillary adenocarcinoma  of  the  esophagus 
accompanied  by  an  invasion  poorly  differ- 
entiated adenocarcinoma  at  the  cardia  of 
the  stomach.  Dodge^  reported  a collision 
tumor,  where  a gastric  adenocarcinoma  and 
an  esophageal  anaplastic  carcinoma  had 
grown  together  to  form  a single  tumor 
mass.  Adenocarcinoma  of  the  esophago- 
gastric junction  has  merited  extensive  con- 
sideration in  the  surgical  literature  because 
of  its  insidious  behavior  and  ominous  prog- 
nosis. Adenocarcinoma  of  the  esophago- 
gastric junction  is  characteristically  associa- 
ted with  a greater  degree  of  submucosal  in- 
vasion of  the  esophagus  than  the  squamous 


for  December,  1968 


743 


cell  variety.  Distant  metastases  tends  to  oc- 
cur earlier  than  with  the  squamous  tumor®. 

Although  there  are  inherent  difficulties 
in  any  attempt  to  demonstrate  the  exist- 
ence of  two  primary  independent  foci  of 
neoplasia,  the  tumors  in  the  case  being  pre- 
sented were  clearly  of  separate  origin.  The 
sharp  demarcation  of  each  tumor  and  the 
striking  differences  in  histological  pat- 
terns tend  to  establish  these  neoplasms  as 
separate  primaries. 

Carcinoma  of  the  esophagus  constitutes 
approximately  five  per  cent  of  all  visceral 
carcinomas^.  Most  of  the  tumors  are  of 
squamous  epithelial  type  with  a small  per- 
centage being  definitely  glandular.  The 
origin  of  malignant  glandular  tumors  aris- 
ing in  the  esophagus  remains  controversial. 
It  has  been  stated®  that  all  adenocarcino- 
mas at  the  cardia  are  derived  from  either 
normally  situated  or  heterotopic  gastric 
glands,  or  from  an  epithelium  capable  of 
differentiating  into  both  glandular  and 
squamous  epithelium,  thus  forming  an 
“adenoacanthoma.”  An  inconstant  finding 
is  the  presence  of  patches,  usually  small, 
of  gastric  mucosa  replacing  portions  of 
the  lining  squamous  epithelium.  Rector 
and  Connerly®  found  it  to  be  7.8  per  cent 
in  a series  of  1,000  infants  and  children. 
They  found  such  glandular  patches  to  be 


Fig.  5.  Portion  of  tumor  where  the  cells  are  less  differen- 
tiated. Note  the  intact  thinned  squamous  mucosa.  Hema- 
toxylin and  eosin  stain,  x 60. 

more  common  in  the  upper  than  in  the 
lower  esophagus.  Rector  and  Connerly^ 
regard  gastric  patches  in  the  esophagus  to 
be  due  to  an  embryological  displacement 
during  the  descent  of  the  stomach.  Willis^® 
believes,  on  the  contrary,  that  it  is  an  ex- 
ample of  heteroplasia,  observing  that  the 
embryonic  endoderm  from  the  upper  eso- 
phageal to  the  mid-colonic  level  is  able  to 
form  gastric  mucosa  by  heteroplastic  dif- 
ferentiation, Finally  one  must  consider  the 
comparatively  rare  esophageal  anomaly  in 
which  a variable  length  of  the  esophagus  is 
lined  by  glandular  epithelium  of  cardiac 
type,  which  is  in  continuity  at  its  lower 


Fig.  O.  Nesls  of  esophageal  carcinoma  in  gastric  lymphatic.  Note  the  mucoepider- 
moid character  of  the  tumor  cells.  Mucicarmine  stain,  x 150. 


744 


Illinois  Medical  Journal 


Fig.  7.  Adenocarcinoma  arising  from  the  gastric  cardia.  Hematoxylin  and  eosin,  x 30. 


level  with  the  glandular  epithelium  of  the 
stomachal.  This  condition  is  termed  Barrett 
esophagus  by  some  authors.  Others  believe 
that  the  term  more  accurately  describes  an 
acquired  condition  following  ulcerative 
esophagitis  in  a patient  with  hiatal  hernia. 

Rare  Type 

Primary  adenocarcinoma  of  the  esopha- 
gus is  rare,  being  encountered  less  often 
than  the  squamous  cell  type.  It  usually  in- 
volves the  lower  third  of  the  organ,  where 
it  is  not  always  possible  to  differentiate  the 
lesion  from  a primary  tumor  in  the  stom- 
ach. It  is  estimated  that  primary  adenocar- 
cinoma of  the  esophagus  comprises  approx- 
imately eight  to  ten  percent  of  the  pri- 
mary esophageal  tumors^^^  xhe  exact  ori- 
gin of  the  tumor  in  many  of  the  cases  re- 
ported has  been  largely  speculative  because 
the  lesion  was  in  an  advanced  state  of 
development  at  the  time  of  examination. 
While  some  authors  admit  that  adenocar- 
cinoma may  arise  in  the  esophageal  glands, 
most^^'i^  of  the  reports  infer  an  origin 
from  ectopic  gastric  glands  in  the  esopha- 
gus.^"^ Raphael,  et  al,^^  reviewed  the  records 
of  1,312  patients  seen  at  the  Mayo  Clinic 
from  Jan.  1946  through  Dec.  1963  who  had 
a diagnosis  of  primary  adenocarcinoma  of 
the  esophagus.  They  found  only  ten  to  ful- 
fill the  criteria  as  true  examples  of  pri- 
mary esophageal  adenocarcinoma.  Accord- 
ing to  Azzopardi  and  Menzies^^  the  exis- 
tence of  adenoid  cystic  tumors  of  the  eso- 
phagus constitute  incontrovertible  evidence 
of  the  existence  of  primary  esophageal 

for  December,  1968 


adenocarcinoma,  since  the  issue  is  not  ob- 
scured here  by  the  question  of  secondary 
spread  from  the  stomach,  the  possibility  of 
a thoracic  stomach,  or  an  origin  from  the 
junctional  epithelium. 

In  the  case  object  of  this  study,  the  eso- 
phagus was  extensively  infiltrated  by  nests 
of  tumor  cells  which  were  distinctly  seen 
arising  from  the  superficial  mucosal  glands 
as  demonstrated  in  Figs.  2,  3 and  4.  The 
overlying  squamous  mucosa  was  intact  and 
present  throughout  its  entire  extension,  al- 
though it  was  markedly  attenuated  by  com- 
pression of  the  underlying  tumor.  One  can 
exclude  therefore  the  existence  of  a patch 
of  gastric  mucosa  or  a Barrett  type  of  eso- 
phagus, from  where  the  tumor  cells  could 
conceivably  have  arisen.  Submucosal  spread 
was  extensive  and  associated  with  vascular 
and  perineural  lymphatic  invasion.  The 
tumor  cells  displayed  a glandular  pattern 
with  areas  of  squamous  metaplasia,  giving 
a pattern  of  the  so  called  “adenoacantho- 
ma.”  Small  amounts  of  mucin  were  present 
in  some  of  the  neoplastic  acini.  In  other 
areas  the  tumor  cells  were  completely  un- 
differentiated and  arranged  in  large  sheets. 

In  the  cardiac  portion  of  the  stomach 
there  was  another  primary  tumor  (Fig.  7). 
The  gastric  tumor  cells  were  seen  arising 
by  gradual  transition  from  the  gastric  mu- 
cosa. They  were  arranged  in  well  defined 
glandular  acini  and  the  lumina  contained 
large  amounts  of  mucin  as  demonstrated  by 
the  mucicarmine  and  PAS  stains.  Although 
it  is  stated  that  most  adenocarcinomas  of 
the  lower  end  of  the  esophagus  represent 

745 


an  upward  extension  from  a primary  tum- 
or in  the  stomach,®  when  tumors  of  this 
histological  type  involve  the  esophagus  at 
higher  levels  there  is  no  option  but  to  re- 
gard them  as  primary  esophageal  neo- 
plasms. The  gastric  adenocarcinoma  was 
seen  infiltrating  the  muscularis,  and  in  a 
few  areas  the  gastric  and  esophageal  tu- 
mor cells  were  intermingled.  At  no  time 
was  there  direct  microscopal  continuity 
between  the  gastric  and  esophageal  tumors. 
Neoplastic  cells  from  the  stomach  were  not 
identified  in  the  esophagus,  with  numerous 
nests  of  esophageal  neoplastic  cells  within 
the  gastric  wall  and  lymphatics.  It  may  be 
argued  that  because  of  the  widespread  lym- 
phatic permeation,  the  gastric  lesion  may 
well  have  been  metastatic  or  viceversa. 

The  distinct  origin  of  the  neoplasms 
from  the  cardiac  esophageal  glands  and 
gastric  mucosa  will  clearly  demonstrate 
that  the  tumors  are  of  separate  origin.  Dis- 
tant metastases  in  the  rest  of  the  organs 
were  primarily  from  the  esophageal  neo- 
plasm as  evidenced  by  their  mucoepider- 
moid character.  Stout,  et  al®,  states  that  no 
true  case  of  metastasizing  esophageal  aden- 
ocarcinoma has  been  reported.  This  case 
demonstrates  that  true  adenocarcinoma  of 


the  esophagus  may  become  extremely  ag- 
gressive and  metastasize.  Raphael,  et  al,i^ 
in  their  series,  reached  similar  conclusions. 

Attempt  to  Explain  Origins 

Smithers^^  postulated  that  there  are  three 
possible  origins  of  true  adenocarcinoma  of 
the  esophagus  as  distinguished  from  pri- 
mary gastric  carcinomas:  carcinoma  arising 
in  ectopic  islets  of  gastric  mucosa;  in  eso- 
phageal mucous  secreting  glands;  in  eso- 
phageal mucous  membrane  which  have 
failed  to  undergo  squamous  transformation 
before  birth.  Primary  intraesophageal 
adenocarcinoma  probably  arises  either 
from  superficial  cardiac  glands,  from  deep 
glands,  or  from  a columnar  type  of  epi- 
thelium. 

Of  great  interest  was  the  presence  of  an 
esophageal  hiatal  hernia.  Many  authors 
have  been  impressed  with  the  frequency 
with  which  carcinoma  of  the  gastric  cardia 
and  associated  hiatal  hernia  are  encount- 
ered. Esophageal  hiatal  hernia  is  extremely 
common,  particularly  in  middle  aged  and 
elderly  persons,  in  whom  there  is  also  a re- 
latively high  incidence  of  carcinoma.  It  be- 
comes apparent  that  the  incidence  of  car- 
cinoma under  these  circumstances  is  higher 


Fig»  8»  Gastric  adenocarcinoma  arising  from  normal  adjacent  mucosa.  Note  in  the  lower 
corner^  nests  of  tumor  cells  from  the  esophagus.  Mucicarmine  stain,  x 30. 


746 


Illinois  Medical  Journal 


than  coincidence  alone  would  permit. 
Groves  and  Effler^®  found  12  cases  during 
a period  of  approximately  12  years,  in 
which  more  than  500  patients  were  surgi- 
cally treated  for  esophageal  hiatal  hernia. 
All  of  the  neoplasms  in  these  12  patients 
were  adenocarcinomas.  They  postulated 
that  chronic  gastritis  attendant  to  the  long 
standing  reflux  esophagitis  may  well  pre- 
dispose to  adenocarcinoma  associated  with 
hiatal  hernia.  According  to  Smithers  the 
two  most  common  factors  responsible  for 
the  association  of  adenocarcinoma  of  the 
esophagus  and  hiatal  hernias  would  seem 
to  be:  that  a small  lower  portion  of  the 
esophagus  is  frequently  lined  by  glandular 
epithelium  which,  at  this  constricted  site, 
is  particularly  liable  to  malignant  disease, 
and  that  there  is  preferential  spread  in  the 
submucous  lymphatics  of  the  esophagus  by 
tumors  arising  at  the  cardia.  As  both  these 
tumor  types  develop  in  the  hiatal  tunnel, 
they  tend  to  cause  dilation  and  produce  ir- 
ritation, both  of  which  predispose  to  herni- 
ation. 

The  unusual  opportunity  afforded  by 
the  numerous  tissue  sections  obtained  in 
the  case  made  possible  the  identification  of 
the  two  independent  primary  neoplasms  at 
the  cardio-esophageal  junction.  Although  it 
is  indeed  difficult  to  establish  double  pri- 
maries in  organs  with  similar  histological 
features,  it  is  believed  that  this  can  be  estab- 
lished in  the  case  studied,  based  in  the  ori- 
gin and  different  histological  features  of 
both  tumors  and  in  the  asyncrony  and  dif- 
ferent invasive  characteristics. 

Summary 

A case  of  primary  independent  adeno- 
carcinoma involving  the  esophagus  and  gas- 
tric cardia  is  documented.  Histological  evi- 
dence is  presented  to  show  that  primary 
esophageal  adenocarcinoma  may  arise  from 
the  superficial  esophageal  glands  at  any 
level.  Because  of  its  extraluminal  and  yet 
entirely  intramural  location,  the  esopha- 
geal tumor  may  produce  negative  roent- 
genographic  and  fundoscopic  findings. 

The  association  of  adenocarcinoma  of 
the  esophagus  and  gastric  cardia  with  eso- 


phageal hiatal  hernia  is  demonstrated.  It 
is  suggested  that  the  reflux  esophagitis  and 
or  chronic  irritation,  may  not  only  predis- 
pose to  adenocarcinoma  of  the  esophagus 
but  also  of  the  gastric  cardia.  It  is  recomen- 
ded  that  multiple  sections  be  taken  in  such 
instances,  so  that  a masked  carcinoma  of 
the  gastric  cardia  is  not  overlooked. 

References 

1.  Armstrong,  R.  A.,  Blalock,  J.  B.  and  Carrera, 
G.  M.  Adenocarcinoma  of  the  Middle  Third 
of  the  Esophagus  Arising  from  Ectopic  Gastric 
Mucosa.  J.  Thor.  Surg.  37:398-403,  1959. 

2.  Carrie,  A.  Adenocarcinoma  of  the  Upper  End 
of  the  Oesophagus  Arising  from  Ectopic  Gas- 
tric Epithelium.  Brit.  J.  Surg.  37:474,  1950. 

3.  McCorkle,  R.  C.  and  Blades,  B.  Adenocarci- 
noma of  the  Esophagus  Arising  in  Aberrant 
Gastric  Mucosa.  Amer.  Surg.  21:781-785,  1955. 

4.  Mingh,  S.  G.  and  Bullough,  M.  B.  Coexisting 
Adenocarcinomas  of  the  Esophagus  and  of  the 
Esophagogastric  Junction.  Report  of  a case. 
Amer.  J.  Dig.  Dis.  8:439-443,  1963. 

5.  Dodge,  O.  G.  Gastro-eosophageal  carcinoma 
of  mixed  histological  type.  J.  Path.  & Bact. 
81:459-471,  1961. 

6.  Block,  G.  E.  and  Lancaster,  J.  R.  Adenocarci- 
noma of  the  cardio-esophageal  junction.  Arch, 
of  Surg.  88:852-859,  1964. 

7.  Robbins,  S.  L.  Textbook  of  Pathology  with 
Clinical  Application.  2nd  Ed.  Philadelphia:  W. 
B.  Saunders  Company,  p.  651,  1962. 

8.  Stout,  A.  P.  and  Lattes,  R.  Tumors  of  the 
Esophagus.  Armed  Forces  Institute  of  Path- 
ology. Washington,  p.  72,  1957. 

9.  Rector,  L.  E.  and  Connerley,  M.  L.  Aberrant 
Mucosa  in  Esophagus  in  Infants  and  in  Chil- 
dren. Arch.  Path.  31:285-294,  1941. 

10.  Willis,  R.  A.  The  Borderland  of  Embryology 
and  Pathology.  London:  Butteru'orths,  p.  315, 
1958. 

11.  Barrett,  H.  R.  The  lower  esophagus  lined  by 
columnar  epithelium.  Surg.  41:881-894,  1957. 

12.  Azzopardi,  J.  G.  and  Menzies,  T.  Primary 
Oesophageal  Adenocarcinoma;  Confirmation  of 
its  Existence  by  the  Finding  of  Mucous  Gland 
Tumors.  Brit.  J.  Surg.  49:497-506,  1962. 

13.  McPeak,  E.  and  Warren,  S.  Histologic  features 
of  carcinoma  of  cardio-esophageal  Junction 
and  cardia.  Am.  J.  Path.  24:971-991,  1948. 

14.  Raphael,  H.  A.,  Ellis,  F.  H.  Jr.  and  Dockerty, 
M.  B.  Primary  Adenocarcinoma  of  the  Eso- 
phagus: 18-Year  Review  and  Review  of  Litera- 
ture. An.  of  Surg.  164:785-796,  1965. 

15.  Smithers,  D.  W.  Adenocarcinoma  of  the  Esoph- 
agus. Thorax,  11:257-267,  1956. 

16.  Groves,  L.  K.  and  Effler,  D.  B.  Cancer  of  the 
Gastric  Cardia  associated  with  Esophageal 
Hiatus  Hernia.  Surg.  Gyn.  Obst.  116:463-468, 
1963. 

17.  Smithers,  D.  W.  The  Association  of  Cancer  of 
the  Stomach  and  Oesophagus  with  Herniation 
at  the  Oesophageal  Hiatus  of  the  Diaphragm. 
Brit.  J.  Radiol.  28:554-564,  1955. 


There  is  one  thing  more  exasperating  than  a wife  who  can  cook  and  won’t,  and 
that’s  the  wife  who  can’t  cook  and  will— Robert  Frost 


for  December,  1968 


747 


Atlas  of  Urological  Surgery.  By  Philip 
R.  Roen,  M.D.,  F.A.C.S.,  Appleton-Cen- 
tury-Crofts,  Division  of  Meredith  Pub- 
lishing Company,  New  York,  1968. 

It  is  17  years  since  the  first  edition  of 
Roen’s  Atlas  of  Genito-Urinary  Surgery  ap- 
peared. 

The  present  volume  is  more  extensive 
and  shows  considerable  improvement  over 
the  original  one.  The  old  line  drawings 
have  been  replaced  by  superb  wash  draw- 
ings of  almost  photographic  quality  by  the 
same  illustrator.  The  text  has  also  been 
expanded. 

Although  this  book  is  pleasant  and  easy 
to  read  it  seems,  to  this  reviewer,  that  it 
presents  some  deficiencies  which  cannot  be 
overlooked.  The  author  is  careless  in  his 
use  of  anatomic  terms.  Thus  the  trans- 
versus  musle,  for  example,  is  called  the 
transversalis  muscle  and  the  ilio-hypogastric 
nerve  the  hypogastric  nerve. 

Standard  operative  procedures  such  as 
the  Boari  flap  and  the  Cooney  Horton 
operation  for  post-operative  incontinence 
in  the  male  are  presented  without  mention- 
ing the  names  of  the  originators. 

In  places  the  text  and  the  illustrations 
do  not  coincide  exactly  and  the  description 
and  the  illustration  of  the  operative  pro- 
cedure are  not  presented  in  step  by  step 
fashion  so  as  to  serve  as  an  exact  guide  to 
the  future  performance  of  the  operation. 
The  author  takes  the  reader’s  knowledge 
too  much  for  granted  and  often  omits  es- 
sential steps  in  the  procedure.  He  fails  to 
present  accurately,  for  example,  the  exact 
placement  of  the  sutures.  The  Cordonnier 
technique  for  uretero-sigmoid  anastomosis 
shows  only  one  layer  of  sutures  instead  of 
two  and  then  this  layer  is  not  described 
adequately. 

The  short  section  on  adrenal  surgery  is 


so  sketchy  as  to  be  useless.  Standard  and 
well  proved  procedures  are  sometimes  not 
even  mentioned. 

It  seems  that  the  section  on  transurethral 
surgery  is  wholly  inadequate  and  would 
better  have  been  omitted  from  a volume 
such  as  this. 

In  spite  of  these  deficiencies,  the  book 
does  serve  as  pleasant  reading  and  should 
be  of  interest  to  the  resident  in  training. 
It  is  not  sufficiently  detailed  to  be  of  value 
to  the  experienced  Urologist. 

Frederick  A.  Lloyd,  M.D. 

ViROLOGiCAL  Procedures.  J.  Mitchell  Hos- 
kins, M.A.,  Ph.D.  Appleton-Century- 
Crofts,  New  York,  1967.  358  pages, 
$13.75. 

Microbiologists  and  others  particularly 
interested  in  the  strategy  employed  in  diag- 
nostic virology  will  find  Virological  Pro- 
cedures valuable  reading.  This  book  begins 
with  a brief  description  of  facilities,  equip- 
ment and  biological  supplies  required  for 
operation  of  a virology  laboratory  and  an 
explanation  of  how  these  can  be  combined 
to  isolate  and  identify  viruses  from  clinical 
materials.  It  continues  with  a discussion  of 
information  needed  to  complete  confirma- 
tion of  virus  infection  and  consideration  of 
the  applicability  of  these  procedures  to 
particular  groups  of  viruses. 

Dr.  Hoskins  has  limited  the  procedures 
included  in  this  book  to  those  he  personal- 
ly favors,  but  has  not  written  a cookbook. 
He  has  emphasized  methods  dependent  on 
tissue  culture  techniques  and  has  assigned 
a complementary  role  to  those  that  use  em- 
bryonated  eggs  and  experimental  animals. 
The  result  has  been  a book  which  seems 
more  suited  for  use  in  planning  than  for 
use  at  the  bench  in  the  daily  conduct  of 
experiments. 

Byron  S.  Berlin,  M.D. 


748 


Illinois  Medical  Journal 


Pulmonary  Embolism 

and 

Renal  Failure 


Surgical  Grand  Rounds  are  held  weekly 
on  Saturday  at  8:00  a.m.;  alternating  be- 
tween the  Staff  Room,  Chicago  Wesley 
Memorial  Hospital  and  Offield  Audito- 
rium, Passavant  Memorial  Hospital.  Patient 
presentations  from  these  hospitals  and  from 
the  Veterans  Administration  Research  Hos- 
pital form  the  basis  of  the  discussions.  This 
case  report  was  part  of  the  Surgical  Grand 
Rounds  held  at  Chicago  Wesley  Memorial 
Hospital  071  March  30,  1968. 


Case  Presentation: 

Dr.  David  Winchester;  The  patient  is  a 
62  year  old  white  male,  who  was  admitted 
to  Chicago  Wesley  Memorial  Hospital 
through  the  Emergency  Room  on  Feb. 
16.  d’he  day  of  admission  he  was  walk- 
ing down  the  street  when  he  experienced 
an  episode  of  dyspnea.  He  walked  a few 
more  steps,  then  collapsed  and  fainted.  In 
doing  so  he  struck  his  head.  He  was 
brought  to  the  Emergency  Room  where  he 
was  conscious  when  examined.  He  had  felt 
perfectly  well  the  day  of  admission  until 
this  episode.  He  had  a long  history  of  epi- 
lepsy, which  had  been  controlled  with  med- 
ication. In  Dec.,  1967,  he  fell  down  some 
stairs  and  injured  his  back.  He  continued 
to  have  discomfort  for  several  days  so  that 
he  sought  medical  attention.  X-rays  were 
taken  and  showed  “pneumonia.”  Accord- 
ing to  the  patient,  the  “pneumonia”  was 
thought  to  be  related  to  his  injury.  In  ad- 


dition, a history  of  mild,  recently  diagnosed 
gout  was  given.  The  patient  also  had  been 
subjected  to  transurethral  resection  for  be- 
nign prostatic  hypertrophy  twice  in  the 
past.  History  of  cardiovascular  and  pul- 
monary disease  was  absent.  When  admitted 
to  the  Emergency  Room  the  patient  was  in 
shock.  His  initial  blood  pressure  was  60 
systolic,  pulse  120,  respirations  were  28  and 
labored,  and  temperature  was  100.8°.  He 
appeared  cyanotic.  The  chest  examination 
was  essentially  negative,  and  the  abdomin- 
al examination  was  likewise  unremarkable. 
The  abdomen  was  soft  and  non-tender,  and 
nomal  bowel  sounds  were  present.  There 
were  minor  facial  contusions.  Peripheral 
pulses  were  intact.  Hematocrit  was  45  per 
cent,  white  count  16,000,  and  the  urinaly- 
sis was  negative.  A central  venous  pressure 
catheter  was  inserted  and  the  initial  CVP 
was  five.  He  responded  promptly  to  plas- 


750 


Illinois  Medical  Journal 


ma  infusion  and  his  blood  pressure  rose 
to  a normal  level.  An  electrocardiogram 
revealed  a right  bundle  branch  block.  His 
family  physician  stated  that  this  finding 
had  not  been  present.  A nasogastric  tube 
yielded  approximately  50  cc.  of  Hematest- 
positive  material.  Thirty  cc.  of  urine  were 
obtained  by  catheter,  but  during  the  next 
few  hours  there  was  very  little  urinary  out- 
put. Twelve  and  one-half  grams  of  Manni- 
tol were  given  in  the  Emergency  Room  and 
120  cc.  of  urine  was  excreted  in  the  next 
three  hours.  X-rays  were  taken  in  the 
Emergency  Room  of  the  chest  and  abdo- 
men. 

Dr.  Abram  Cannon:  The  chest  film  at  the 
time  of  admission  was  not  diagnostic. 
There  was  engorgement  of  the  vessels  on 
the  right  side.  We  have  films  of  the  abdo- 
men which  were  made  a little  later.  The 
abdominal  film  made  in  the  Emergency 
Room  demonstrated  scattered  gas  in  the 
abdomen  without  specific  findings.  Oblique 
and  lateral  films  were  obtained  to  see  if 
the  aorta  might  be  the  site  of  a possible 
aneurysm.  There  was  a little  calcium  in 
the  aorta,  but  we  couldn’t  really  come  up 


with  anything  that  was  very  helpful  on 
this  man.  There  was  an  old  compression  in 
the  body  of  L-3. 

Dr.  Winchester:  At  this  point  diagnosis 
was  unknown,  but  the  possibility  of  a pul- 
monary embolus  was  considered.  The  pa- 
tient was  admitted,  and  during  the  course 
of  the  afternoon  he  experienced  some  shak- 
ing chills.  His  fever  rose  to  102°.  Later  on 
in  the  evening  his  blood  pressure  dropped 
to  60  systolic,  and  Aramine  was  necessary 
for  maintenance  of  his  blood  pressure.  His 
respirations  increased  gradually  to  36  per 
minute.  During  the  course  of  the  afternoon 
he  had  complained  of  back  pain,  but  not 
of  abdominal  pain.  A lung  scan  was  per- 
formed. The  left  lung  failed  to  visualize  on 
the  anterior  view,  and  only  a small  portion 
was  seen  on  the  posterior  scan  (Fig.  1). 
The  right  lung  was  reported  to  be  normal 
in  this  perfusion  scan.  Heparin  was  started 
and  the  patient  was  digitalized.  Because 
he  developed  another  episode  of  hypoten- 
sion during  the  evening  with  increasing 
difficulty  in  breathing,  a pulmonary  arter- 
iogram was  done  in  the  evening  about 
eleven  o’clock.  The  left  main  pulmonary 


Fig.  1.  Lung  scan  using  Indium  ferric  hydroxide  demonstrates  little  uptake  in  the  left  lung,  seen 
only  on  the  posterior  view.  This  is  compatible  with  pulmonary  embolism. 


for  December,  1968 


751 


artery  did  not  fill.  The  patient  tolerated 
this  procedure  very  well.  He  was  taken  to 
the  operating  room  and  median  sternotomy 
was  performed.  Cardiopulmonary  by-pass 
was  employed.  The  pulmonary  artery  was 
opened,  and  12  to  14  clots  were  removed 
from  both  pulmonary  arteries  and  branch- 
es. There  were  three  or  four  clots  that  were 
three  or  four  inches  in  length,  and  these 
were  milked  out  by  opening  both  pleural 
cavities  and  squeezing  the  lungs. 

Prior  to  institution  of  cardiopulmonary 
by-pass  his  systolic  blood  pressure  was  90. 
A perfusion  pressure  of  60  to  65  was  main- 
tained during  the  procedure.  After  the 
pump  was  stopped  his  pressure  ranged 
from  80  to  120  systolic.  Because  he  had 
continued  to  embolize  on  Heparin,  a right 
transverse  abdominal  incision  was  made  to 
ligate  the  inferior  cava.  It  was  soon  appar- 
ent that  there  was  a large  amount  of  dark 
fluid  in  the  peritoneal  cavity  which  looked 
like  blood.  The  peritoneal  cavity  was 
opened  and  was  found  to  contain  a large 
amount  of  blood.  The  incision  was  ex- 
tended to  the  left  side  of  the  abdomen  and 
a ruptured  spleen  was  found  and  removed. 
The  inferior  vena  cava  was  ligated.  He  was 
stable  postoperatively,  and  his  urinary  out- 
put varied  from  30  to  50  cc.  per  hour.  On 
the  second  day  his  BUN  was  noted  to  be 
54  mgm.%.  The  next  day  he  became  olig- 
uric, and  this  progressed  almost  to  com- 
plete anuria.  His  BUN  and  serum  creatin- 
ine showed  a gradual  elevation  and  he  be- 
came uremic.  A renogram  seven  days  after 
the  onset  of  oliguria  did  not  show  obstruc- 
tion. He  was  managed  with  hemodialysis. 
Nine  hemodialyses  were  required  during 
the  next  thirty  days  as  he  continued  to  put 
out  no  urine.  Thirty-five  days  later  he  be- 
gan to  put  out  urine,  and  his  BUN  had  be- 
gun to  decrease  although  he  still  was  azo- 
temic. 

Patient  enters : 

Dr.  Arthur  DeBoer:  Do  you  remember 
very  much  of  the  surgery  at  all? 

Patient:  No,  I didn’t  even  know  I had 
had  an  operation. 

Patient  leaves : 

Dr.  John  Beal:  Dr.  DeBoer,  I wonder  if 
you  would  tell  us  what  led  to  your  sus- 
picion that  he  had  a pulmonary  embolus. 
There  are  a number  of  unusual  features 
here;  the  initial  low  central  venous  pres- 
sure, for  example. 

752 


Dr.  DeBoer:  He  was  admitted  from  the 
Emergency  Room  to  the  medical  service 
and  we  were  called  about  eleven  o’clock 
that  night.  I think  it  brings  out  a couple 
of  things.  One  is  the  fact  that  this  man 
who  arrived  in  shock  with  a very  suspicious 
clinical  picture  of  a pulmonary  embolus 
because  of  his  severe  tachypnea  and  cyano- 
sis, but  after  a couple  of  units  of  plasma 
his  blood  pressure  promptly  rose  from  60 
to  100  and  his  central  venous  pressure  re- 
mained low.  Then  with  a negative  x-ray  of 
his  chest  suggesting  no  intra-pulmonary 
pathology  the  tachypnea  and  cyanosis  must 
be  considered  strongly  as  caused  by  a pul- 
monary embolus.  With  a negative  x-ray  of 
his  chest  and  a positive  pulmonary  scan,  I 
think  this  is  fairly  convincing  evidence  of 
a pulmonary  embolus.  He  was  treated  then 
as  having  a pulmonary  embolus,  in  spite  of 
the  fact  that  on  two  occasions  he  responded 
to  the  administration  of  plasma  and  I.V. 
fluids  by  an  increase  in  blood  pressure  and 
urinary  output.  With  a history  of  epilepsy, 
a bruise  on  his  face  from  falling,  and  the 
persistence  of  back  pain  of  which  he  com- 
plained, one  becomes  exceedingly  uncom- 
fortable with  the  diagnosis  of  pulmonary 
embolus.  I considered  the  possibility  that 
perhaps  the  pulmonary  scan  abnormality 
was  a residuum  of  the  pneumonitis  he  had 
a couple  of  months  ago.  With  all  these 
complex  variables  the  diagnosis  of  pulmon- 
ary embolus  had  to  be  proven  before  an 
operation  could  be  considered.  Did  this 
man  have  a myocardial  infarct  evidenced 
by  changes  in  the  EKG?  Did  he  have  a 
ruptured  peptic  ulcer  with  blood  in  the 
stomach  thereby  giving  him  pain  and  chills 
and  fever  of  102°  that  afternoon?  Or  did 
he  really  have  a pulmonary  embolus? 
These  were  the  considerations  we  enter- 
tained. A pulmonary  angiogram  was  done 
immediately  before  taking  him  to  the  oper- 
ating room.  The  angiogram  was  done  in 
the  heart  station  adjacent  to  the  operating 
room  while  we  were  setting  up  the  operat- 
ing room  and  the  pump.  Pulmonary  em- 
bolectomy,  of  course,  is  not  a new  opera- 
tion. The  old  Trendelenburg  procedure 
was  done  in  the  1900’s  without  cardiopul- 
monary by-pass.  Following  that,  I believe, 
the  first  successful  pulmonary  embolectomy 
in  the  United  States  was  done  in  1958. 
Then  in  1961  Sharp  did  the  first  successful 
pulmonary  embolectomy  with  cardiopul- 

Illinois  Medical  Journal 


monary  by-pass.  I think  today  there 
is  very  little  justification  for  the  old 
Trendelenburg  procedure;  that  is  re- 
moving the  clot  from  only  one  pul- 
monary artery.  It  would  be  kind  of  entic- 
ing to  open  up  just  the  left  pulmonary  ar- 
tery in  this  case.  But  almost  invariably  if 
a pulmonary  embolus  is  massive  enough  to 
cause  hypotension  more  than  just  one  lung 
is  occluded.  One  can  almost  always  find 
clots  in  the  other  side.  Therefore,  it  is  said 
that  more  people  have  died  from  the  Tren- 
delenburg procedure,  that  is  unilateral  pul- 
monary embolectomy,  than  have  been  bene- 
fited. I think  this  is  also  true  today.  The 
preferred  method  of  pulmonary  embolec- 
tomy is  with  cardiopulmonary  by-pass  to 
remove  the  clots  from  both  lungs.  If  one 
looks  carefully  on  the  angiogram  you  can 
see  the  clot  defect  floating  in  the  right  pul- 
monary artery  as  well.  The  second  part  of 
the  operation  is,  of  course,  to  ligate  the 
vena  cava  providing  the  patient  is  in  satis- 
factory condition.  We  have  had  a couple  of 
patients  who  had  low  blood  pressure  after 
the  pulmonary  embolectomy  and  with 
questionable  central  nervous  system  effi- 
ciency because  of  prolonged  hypotension 
preoperatively  and  I elected  not  to  do  a 
vena  cava  ligation.  With  this  man  I felt 
we  should  do  a vena  cava  ligation,  and  this 
decision  became  the  life  saving  feature  of 
the  operation,  because  when  we  did  the 
retroperitoneal  dissection  I saw  evidence  of 
blood  in  the  peritoneal  cavity. 

I previously  had  another  case  with  a 
ruptured  spleen  associated  with  a massive 
pulmonary  embolus  and  failed  to  recognize 
the  torn  spleen.  However,  when  we  saw 
blood  in  the  peritoneal  cavity  as  the  vena 
cava  was  being  exposed  for  ligation,  the 
spleen  was  exposed  and  a two  inch  lacera- 
tion of  the  spleen  was  found.  The  cause  of 
the  ruptured  spleen  could  be  due  to  the  in- 
itial fall,  or  possibly  from  sudden  elevation 
of  the  venous  pressure  due  to  obstruction 
of  the  pulmonary  arteries.  It  seems  reason- 
able if  the  central  venous  pressure  is  low 
and  a massive  pulmonary  embolus  has 
been  demonstrated  that  the  possibility  of 
an  injured  spleen  must  be  considered. 

Another  interesting  factor  in  this  case 
is  that  this  patient  developed  a high  out- 
put renal  failure  postoperatively.  I am  sure 
this  is  not  uncommon.  Usually,  if  there  is 
good  urinary  output,  we  don’t  worry  too 


much  about  kidney  failure.  This  man  had 
an  hourly  urinary  output  of  about  40  cc. 
but  was  obviously  in  renal  failure  as  evi- 
denced by  a rising  BUN  and  creatinine.  I 
presume  it  was  caused  by  repeated  episodes 
of  low  blood  pressure  prior  to  the  time  we 
saw  him.  He  came  into  the  Emergency 
Room  at  11:00  a.m.  and  we  saw  him  about 
11:00  p.m.  after  two  periods  of  hypoten- 
sion and  very  little  urinary  output.  It  was 
because  of  his  lethargy  and  his  slurring 
speech  that  we  were  alerted.  I assumed  that 
his  BUN  was  rising  because  of  blood  hemo- 
lysis, but  his  creatinine  was  also  elevated 
and  this  was  the  clue  that  there  was  some 
renal  failure.  I think  this  is  an  unusual  pic- 
ture for  tubular  necrosis.  After  dialysis  he 
never  did  develop  diuresis,  he  just  gradu- 
ally started  putting  out  urine.  However,  I 
have  had  very  little  experience  with  suc- 
cessful dialysis.  In  fact,  I have  repeated  sev- 
eral times,  this  is  the  first  man  I have  seen 
survive  following  dialysis.  But  the  patients 
I refer  for  dialysis  are  following  ruptured 
aortic  aneurysms,  and  these  are  all  in  the 
older  60  to  70  year  age  group.  This  man 
is  alive  today  because  of  the  persistence  of 
the  dialysis  team. 

Dr.  Beal:  Do  you  think  the  Aramine 
might  have  contributed  to  the  renal  fail- 
ure? 

Dr.  DeBoer:  Aramine  is  a bad  drug  for 
the  treatment  of  hypovolemia.  If  one  uses 
central  venous  pressure  as  a guide  in  the 
treatment  of  hypotension  I am  sure  vaso- 
pressor agents  such  as  Aramine  would  sel- 
dom be  used  in  the  presence  of  hypovole- 
mia. It  is  safe  to  give  parenteral  fluids  in 
an  unlimited  quantity  if  the  central  venous 
pressure  does  not  rise. 

Dr.  John  Grayhack:  This  is  a peculiar 
type  of  postoperative  high  output  failure. 
I have  seen  it  before  and  it  is  difficult  to 
understand.  The  patient  has  a high  output 
for  about  24  hours  and  suddenly  becomes 
oliguric  as  this  patient  did.  In  the  usual 
high  output  failure  the  patient  maintains 
a high  urinary  output  (1,000-f-cc.  per  day). 
His  azotemin  is  discovered  belatedly  when 
his  deteriorating  clinical  condition  nec- 
essitates a search  for  a cause.  The  type 
of  oliguric  failure  seen  in  this  patient  has 
followed  multiple  transfusions  in  my 
limited  experience  with  it.  The  mechan- 
ism is  unknown.  Dialysis  is  as  important 
an  aid  in  management  of  these  patients  as 
it  was  in  this  instance. 


for  December,  1968 


753 


THE  VIEW  BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Diagnostic  Radiology,  Cook  County  Hospital, 
and  Clinical  Professor  of  Radiology,  Chicago  Medical  School 


The  patient  was  a 63  year  old  diabetic 
female  with  a history  of  dysuria  and  fre- 
quency. Physical  examination  was  unre- 
markable. The  urine  revealed  3-j-  mucose, 
15-20  WBC,  and  8-10  RBC. 

What’s  your  diagnosis? 


Fig.  1 


(Answer  on  page  821) 


Fig.  2 


754 


Illinois  Medical  Journal 


Medical  Progress  in 

ARTIFICIAL  INSEMINATION 


By  Charles  T.  GilRber,  M.D./Chicago 


From  the  throes  of  the  sexual  revolu- 
tion is  emerging  a new  idea  of  the  famtly 
unit.  The  use  of  oral  contraception  is  al- 
lowing the  family  to  contain  itself,  arith- 
metically, within  those  bounds  most  feasi- 
ble for  its  prosperous  existence.  Artificial 
insemination,  on  the  other  hand,  has  al- 
lowed expansion  of  the  family  unit  to 
achieve  its  full  potential  in  some  cases  in 
which  it  had  become  obscured  in  the  dis- 
appointment of  childlessness.  As  with  any 
new  concept,  artificial  insemination  will 
require  a great  deal  of  refinement,  but 
through  its  judicious  use  it  may  rid  itself  of 
shackles  similar  to  those  which  impeded 
the  progress  of  so  many  other  fields  of 
medicine  upon  their  inception.  This  pre- 
sentation attempts  to  place  it  in  an  appro- 
priate perspective  in  the  area  of  infertility 
investigation  and  treatment. 


Medical  Progress 


Harvey  Kravitz,  M.D. 
Medical  Progress  Editor 


Dr.  Gerber  is  Chief  Resident,  Department  of 
Obstetrics  and  Gynecology,  Michael  Reese  Hos- 
pital, Chicago. 


Modern  society  is  undergoing  a curious 
metamorphosis  in  the  field  of  general 
medical  awareness.  Diagnostic  advances 
have  transformed  microscopic  cellular 
change  into  the  headline  CANCER  em- 
blazoned in  the  cerebral  cortex  of  the 
American  public.  One  of  the  latest  medical 
advances,  “the  pill,”  has  entered  the  mind 
if  not  the  body  of  nearly  every  married, 
marrying  and  marriable  woman  in  this 
country.  It  has  altered  the  social  and  moral 
habits  of  the  country,  is  causing  the  revi- 
sion of  theological  doctrine,  and  may  even- 
tually be  known  as  the  cause  of  the  sexual 
revolution. 

There  is  another  aspect  of  the  sexual 
revolution  which  is  seldom  publicized  and 
instead  is  shrouded  in  mystery  and  mis- 
giving. Little  is  known  about  artificial  in- 
semination mainly  because  silence  is  one 
of  its  prerequisites;  but  silence  perpetu- 
ates ignorance;  ignorance  propagates  fear, 
and  fear  intolerance.  And  so  it  is  that  this 
aspect  of  medical  progress  has  not  come  to 
share  in  the  limelight  of  sexual  modernity. 

Some  form  of  contraception  is  said  to  be 
practiced  by  between  55%  and  75%  of 
married  couples  in  this  country.  This  fig- 
ure would  be  increased  still  further  if  it 
could  be  broadened  to  include  the  10-15% 
of  all  marriages  which  are  childless.  The 
popular  belief  that  childlessness  is  the 
fault  of  a “barren”  female  is  quite  passe 
and  the  finding  that  35-40%  of  childless 
marriages  are  due  to  the  male  partner  is 
a new  burden  which  must  be  borne  by  the 
male  ego.  As  a result  of  this  male  factor 


for  December,  1968 


755 


there  are  some  one  million  potentially  fer- 
tile women  in  this  country  who  are  mar- 
ried, but  who  cannot  conceive.  In  a study 
of  300  infertile  couples  by  Varangot  et  al. 
the  responsibility  for  the  infertility  was 
placed  on  the  husband  in  30.5%,  the  wife 
25.5%  and  jointly  by  both  partners  in  44% 
of  the  cases.^ 

Fundamentals  of  Reproduction 

In  order  to  better  understand  the  etio- 
logy of  infertility  it  is  necessary  first  to 
review  certain  fundamentals  of  the  repro- 
ductive process.  Through  the  diligent  ef- 
forts of  many  workers  certain  standard 
values  have  been  established  in  an  attempt 
to  define  the  boundaries  of  fertility.  To 
achieve  fertilization  the  average  semen 
specimen,  for  example,  should  be  2-4  cc. 
per  ejaculate;  there  must  be  40-100  mil- 
lion spermatozoa  of  which  at  least  80% 
must  be  of  normal  morphology  and  70% 
must  be  actively  motile.^  Using  these  as 
our  criteria  we  are  able  to  gain  insight  into 
the  abnormal  semen  specimen  which  is 
not  capable  of  achieving  conception.  A list 
of  these  semen  abnormalities  is  given  in 
Table  I. 


Table  I. 

SEMEN  ABNORMALITIES 

A-spermia— absence  of  ejaculate 
Azo-spermia— absence  of  sperm  in  ejaculate 
Necro-spermia— absence  of  living  sperm  in  ejaculate 

Hyper-spermia— ejaculate  greater  than  6 ml. 
Hypo-spermia— ejaculate  less  than  1 ml. 
Oligo-spermia— less  than  60  million  sperm  per  ml. 

of  ejaculate 

In  an  evaluation  of  the  semen  of  1000 
fertile  men,  MacLeod  and  Gold  were  able 
to  demonstrate  the  direct  relationship  be- 
tween the  number  of  sperm  and  the  fer- 
tility of  the  subject.^  (Table  II.) 

There  are  many  diverse  factors  which 
may  account  for  the  male  role  in  infertil- 
ity. Some  of  these  (hot  baths,  tropical  cli- 
mates) may  be  easily  reversed  by  proper 
management  and  hygiene.  Other  factors 
such  as  infection,  tumors,  hormonal  ther- 
apy or  congenital  anomalies  are  based  up- 
on the  inability  of  the  husband  in  the 
mechanical  act  of  insemination.  These  may 
be  of  an  anatomic  (hypospadius),  physi- 
ologic (hostile  cervical  mucus)  or  psycholo- 
gic (premature  ejaculation)  nature. ^ 


Table  II. 

RELATIONSHIP  BETWEEN  SPERM  COUNT 
AND  FERTILITY* 


Spermatozoa 

Fertility 

(Million/ml) 

(%) 

<1 

0.1 

<10 

2.0 

<40 

16.0 

<60 

29.0 

>60 

47.0 

‘Series  of  1000  fertile  men  (MacLeod  and  Gold)^ 


Basic  Process  Described 

The  term  “insemination”  refers  to  the 
deposition  of  seminal  fluid  within  the 
vagina.  To  simplify  this  still  further  let  us 
draw  an  analogy  with  the  depositing  of 
money  within  a bank.  In  order  for  this  to 
occur  there  must  be  3 factors:  a depositor, 
a bank,  and  of  course,  money.  Were  any  of 
these  factors  to  be  absent  this  transaction 
could  not  occur.  The  object  of  the  transac- 
tion is  that  money  be  placed  in  a bank; 
who  deposits  the  money  or  by  what  means 
he  reaches  the  bank  matters  little  so  long 
as  the  objective  is  accomplished.  If  the  ob- 
jective of  the  childless  couple  is  to  have 
children,  then  3 factors  must  be  present: 
first,  there  must  be  sperm  and  semen  (ac- 
cording to  the  criteria  of  fertility  I have 
described);  second,  there  must  be  the  “fer- 
tile female”  (with  all  of  the  ramifications 
that  the  term  implies);  and  third,  there 
must  be  a method  of  achieving  deposition 
of  the  seminal  fluid  into  the  vagina  of 
such  a fertile  female. 

If  the  husband  were  able  to  produce 
seminal  fluid  and  achieve  insemination 
through  coitus  with  his  fertile  wife,  then 
the  couple’s  childless  state  would  be  short- 
lived. If  the  husband  produced  “good” 
sperm  but  was  not  able  to  achieve  in- 
semination due  to  some  anatomic,  physio- 
logic or  psychologic  factor  the  couple’s  fer- 
tility would  go  unrewarded.  The  collection 
of  a semen  specimen  from  such  a husband 
by  a physician  and  the  deposition  of  this 
specimen  into  the  vagina  of  the  man’s 
wife  might  very  well  achieve  conception 
and  subsequently  the  birth  of  the  couple’s 
child.  The  child  is  theirs.  It  is  the  product 
of  union  of  the  germ  cells  of  husband  and 
wife;  it  bears  their  genes;  it  is  living  and 
real.  The  child  is  hardly  “artificial”  as  the 
term  “artificial  insemination”  implies.  This 
term  “artificial  insemination”  or  “AI”  has 
been  one  of  the  major  drawbacks  to  the 
general  public  acceptance  of  this  proce- 


756 


Illinois  Medical  Journal 


Table  III. 

MILEPOSTS  IN  HISTORY  OF 
ARTIFICIAL  INSEMINATION!  3 

220  A.D.  Talmud 

Questions  patemitv'  of  child  bora  of  a Avoman 
accidently  fertilized  in  bath  rvater 
1200’s  Rabbi 

Questions  fertilization  of  a Avoman  sleeping  on 
a linen  contaminated  by  male  ejaculate 
1300’s  Arab  Shiek 

Inseminated  a pure  strain  of  his  enemy’s  fine 
mares  ^vith  semen  from  sick  inferior  stallions 
\^arasotto 

Artificial  insemination  in  sheep 
1400’s  Don  Ponchom 

Artificial  insemination  in  fish 
1550  Bartholomeus  Eustachius 

Advised  digital  guidance  of  semen  toward  the 
ceiA'ical  os  following  coitus 
1677  Louis  Van  Hamman 
Discovery  of  spermatozoa 
1775  Spallanzani 

Artificial  insemination  in  reptiles  and  dogs 
1790  Dr.  John  Hunter 

Achieved  the  first  recorded  pregnano'  and  de- 
livery’ of  a child  conceived  through  *AI 
1838  Girault 

Blew  sperm  into  vagina  through  hollow  tube 
1866  J.  Marion  Sims 

First  successful  AI  in  the  United  States 
1870  Courty 

Coitus  condomatosus 
1876  de  Lajatre 

88%  successful  treatment  of  567  women 
1884  Pancoast 

First  artificial  insemination  donor 

dure.  Popular  terms  arose,  such  as  “test 
tube  babies”  and  “instrumental  pregnan- 
cy,”3  tvhich  added  to  the  sense  of  artificial- 
ity and  unacceptance.  And  yet  the  child  is 
real,  not  artificial.  He  was  conceived  in 
the  womb  of  his  mother  and  nursed  at 
her  breast.  He  is  not  born  from  a test  tube 
heated  over  a bunsen  burner.  The  fallacy 
of  the  belief  that  pregnancies  conceived  by 
“artificial”  insemination  (and  I use  that 
term  only  because  it  avoids  adding  an- 
other term  to  the  morass  of  nomenclature 
that  is  medicine)  is  different  from  those 
conceived  by  coitus  is  borne  out  by  the 
facts  that  (1)  there  is  an  equal  incidence 
of  abortions  or  stillbirths  (although  only 
2%  abortion  occur  in  some  series),  (2) 
there  is  no  difference  in  the  ease  of  prena- 
tal course  and  confinement,  and  (3)  the 
incidence  of  fetal  anomalies  is  not  increas- 
ed!. Artificial  insemination  has,  hotvever, 
been  shot\Ti  to  (1)  result  in  fewer  multiple 
births,  and  (2)  have  a higher  male: female 
sex  ratio  (160:100)  than  pregnancies  re- 
sulting from  coitus  (105:100)^. 

The  history  of  AI  is  certainly  interesting 
as  it  parallels  the  development  and  sophis- 
tication of  medicine  in  general.  As  history 
depends  on  accuracy  for  its  validity,  the 


history  of  AI  is  incomplete  because  of 
hesitancy  of  its  pioneers  to  publish  their 
results  and  to  encourage  its  use.  Table  III 
presents  some  of  the  highlights  in  the  de- 
velopment of  artificial  insemination!’^. 

In  considering  the  technical  factors  in- 
volved in  artificial  insemination  tve  must 
first  review  the  methods  of  semen  collec- 
tion. Table  IV  presents  a list  of  some  of 
the  methods!.  These  methods  are,  for  the 
most  part,  self  explanatory.  It  is  of  his- 
torical interest  that  the  founder  of  coitus 
condomatosus  was  Antonius  Liberatis  who, 
in  150  AD  describes  the  use  of  an  artificial 
membrane  prepared  from  a goat’s  bladder 
to  prevent  the  fertilization  of  the  wife  of 
King  Minos  of  Crete.*’!  Coitus  condoma- 
tosis  is  no  longer  used  for  AI  for  several 
reasons: 

1.  insufficiently  aseptic; 

2.  inability  to  maintain  required  temp- 
erature; 

3.  partial  loss  of  volume  on  removal; 

4.  adverse  effect  of  incorporated  chem- 
icals (rubber,  powder  are  sperimici- 
dal); 

5.  reduction  in  duration  of  motility. 

As  regards  sperm  motility,  Bilding  has 
sho'^ra  that  sperm  from  masturbated  speci- 
mens retain  motility  for  105  hours  under 
optimal  conditions,  while  sperm  from  coi- 
tus condomatosus  placed  under  similar  con- 
ditions have  adequate  motility  for  only  35 
hours.! 

Semen  Collection 

The  manner  of  collection  of  the  semen 
specimen  may  greatly  enhance  the  suit- 
ability of  a given  specimen  for  use  in 
achie\4ng  conception.  The  first  third  of  the 
ejaculate  has  been  found  to  contain  up  to 
75%  of  the  spermatozoa;  hence  by  division 
of  the  ejaculate  at  the  time  of  collection 
a more  concentrated  specimen  may  be  ob- 
tained. The  centrifugation  of  a semen 
specimen  has  also  been  used  and  has  shown 
that  the  number  of  active  sperm  is  in- 
creased to  89%.! 

Once  the  specimen  has  been  obtained  it 

• The  term  “condom”  has  a diverse  origin,  in- 
cluding the  following  possibilities:^ 

1.  Con  ton— the  French  physician  Avho  is  said  to 
have  invented  it; 

2.  Condom— a French  town; 

3.  “condus”  (L)— someone  who  guards  or  pre- 
serves something; 

4.  “kondu”  (Persian)— a vessel  in  which  some- 
thing is  stored. 


for  December,  1968 


757 


may  be  treated  in  such  a manner  as  to  en- 
hance its  fertilizing  capability.  Freezing  of 
the  semen  specimen  with  the  addition  of 
glycerol,  isopentane,  liquid  nitrogen  or  dry 
ice  has  enabled  up  to  a 67%  three-month 
survival  rate.^  The  use  of  such  methods 
has  led  to  the  establishment  of  semen  banks 
whicli  aid  in  building  large  supplies  of 
sperm  from  which  samples  may  be  drawn 
when  needed.  Such  a semen  bank  calls 
upon  the  physician  to  sacrifice  anonymity 
of  the  procedure  by  the  employment  of 
such  staff  as  is  necessary  for  the  proper 
organization.  If,  on  the  other  hand,  such 
anonymity  is  maintained  he  risks  the  prob- 
lem of  mistaken  identification  of  semen. 

The  addition  of  certain  factors  to  the 
semen  has  been  shown  to  increase  its  con- 
ceptual capabilities.  Hyaluronidase  facili- 
tates sperm  penetration  of  the  oocyte  by 
causing  disruption  of  the  corona  radiata. 
The  addition  of  a testicular  enzyme  has 
been  shown  to  dissolve  cervical  mucus  thus 
facilitating  sperm  transport.  Alpha-amylase 
prolongs  sperm  motility  by  maintaining 
liquefaction  of  the  semen.  Penicillin  des- 
troys harmful  bacteria.  Certain  diluents 
enhance  sperm  motility,  including  Ringer- 
Locke  and  physiological  salt  solution.^ 

Table  IV. 

METHODS  OF  SEMEN  COLLECTION 

A.  Post  Coital 

1.  Vagina 

2.  Bladder 

3.  Urethra 

B.  Intracoital 

1.  Coitus  interruptus 

2.  Coitus  condomatosus 

C.  Extra  Coital 

1.  Masturbation 

2.  Massage  of  seminal  vesicles 

3.  Electrically  induced  ejaculation 

4.  Nocturnal  emission 

D.  Other 

1.  Testicular  or  epididymal  punctate 

2.  Semen  from  a corpse 

The  time  of  insemination  of  a collected 
semen  specimen  must  be  chosen  in  accord- 
ance with  the  time  of  ovulation.  Such 
methods  as  basal  body  temperature,  cervi- 
cal mucus  (Spinnbarkeit),  vaginal  smear, 
endometrial  biopsy,  rat  ovary  hyperemia 
test  as  well  as  clinical  symptoms  have  been 
useful  in  attempting  to  detect  the  time  of 
ovulation.  The  longer  term  of  viability  for 
spermatozoa  (24-72  hours)  than  the  ovum 
(12  hours)  suggests  that  insemination 
should  be  performed  shortly  before  ovula- 
tion rather  than  after  it.^ 


Locale 

The  site  of  insemination  may  be  one  of 
many.  The  semen  may  be  placed  in  the 
posterior  fornix  of  the  vagina  (intrava- 
ginal),  in  the  vicinity  of  the  external  cer- 
vical os  (paracervical)  or  to  a depth  of  a 
few  millimeters  beyond  the  external  os  (in- 
tracervical).  These  are  the  most  commonly 
used  sites  in  AI.  It  may  also  be  placed  be- 
yond the  internal  os  (intrauterine)  or  near 
the  ostia  of  the  fallopian  tubes  with  pres- 
sure exerted  to  enable  entrance  into  the 
tubes  (intra-tubal).  Intraperitoneal  methods 
such  as  paraovarian  deposition  or  injection 
into  the  pouch  of  Douglas  are  seldom  used. 
The  intrauterine  technique  has  been  found 
to  cause  both  severe  colic-type  pain  and  an 
increased  incidence  of  infection. i ® 

Several  methods  have  been  used  in  an 
attempt  to  prolong  the  contact  of  semen 
with  the  external  cervical  os.  The  semen 
might  thus  be  protected  from  vaginal  acid- 
ity and  the  determination  of  exact  time 
of  ovulation  would  no  longer  be  as  critical 
a factor  in  achieving  conception.  The  cer- 
vical cup,  spoon,  sperm  chamber,  and  va- 
ginal diaphragm  are  but  a few  of  these 
methods.^’® 

In  our  discussion  heretofore,  we  have 
considered  the  husband  as  the  source  of 
semen  for  artificial  insemination.  Of  pri- 
mary importance  in  the  evaluation  of  a 
woman  for  the  problem  of  infertility  is 
a careful  evaluation  of  the  husband’s  semen 
and  sperm.  As  has  been  inferred,  should 
the  couple’s  infertility  be  based  on  a de- 
ficiency in  the  husband’s  semen  (or  sperm) 
another  source  must  be  found.  This  is 
another  phase  of  AI  termed,  appropriately. 
Artificial  Insemination  Donor  or  AID. 

Donor  Selection 

The  selection  of  a donor  is  critical. 
This  selection  may  be  made  by  the  couple; 
he  may  be  a member  of  the  husband’s 
family.  On  the  other  hand,  the  selection 
may  be  made  by  the  physician,  in  which 
case  the  donor  may  remain  unknown  to 
the  couple.  In  some  instances  committees 
have  been  created  for  the  selection  of 
donors.  Such  a committee  may  include  a 
gynecologist,  urologist,  psychiatrist,  geneti- 
cist and  biologist. 

The  qualifications  of  a prospective  donor 
are  numerous.  The  precision  with  which 
the  donor  is  selected  will  determine  the 


758 


Illinois  Medical  Journal 


measure  of  success  in  this  procedure.  He 
should  be  of  proven  fertility:  some  physi- 
cians require  that  he  be  the  father  of  at 
least  two  healthy  children.  He  must  be 
free  of  any  illness  which  may  be  transmit- 
ted to  the  fetus  (or  to  its  mother).  He 
should  be  matched  phenotypically  with 
the  husband  as  closely  as  possible,  that  is 
he  should  physically  resemble  the  husband 
in  body  build  as  well  as  hair  and  eye  color. 
Racial  differences  must  be  carefully  avoid- 
ed. Blood  groupings  are  essential  in  that 
the  Rh  of  the  donor  must  be  similar  to 
that  of  the  prospective  recipient.  Similari- 
ties in  religion  have  the  advantage  of  avoid- 
ing any  psychological  problem  on  the  part 
of  the  parents.  Some  physicians  prefer 
donors  over  30  years  of  age  to  avoid  such 
diseases  as  schizophrenia  which  are  likely 
to  have  become  apparent  by  this  age.^ 

Such  features  as  character,  temperament, 
cooperative  spirit,  education  and  the  like, 
although  seemingly  general  in  overall 
scope,  certainly  add  to  the  precision  of 
selection  when  applied  to  donor-husband 
matching.! 

As  a group,  medical  personnel  (resi- 
dents, interns  and  medical  students)  are 
most  readily  available  to  serve  as  donors. 
It  is  also  felt  that  such  a person,  if  afflicted 
with  a transmittable  disease,  would  be 
more  likely  to  recognize  the  presence  of 
such  an  illness  and  seek  treatment  for  it. 
Financial  remuneration  for  donors  has 
become  established,  the  sum  varying  from 
$5  to  $50  and  averaging  $15  to  $25  per 
ejaculate.  As  can  be  imagined,  there  are 
some  “professional”  semen  donors.  The 
use  of  pooled  semen  specimen  from  several 
donors  may  add  to  the  anonymity  of  the 
specific  donor  but  certainly  serves  to  lessen 
the  similarity  between  donor  and  husband.^ 

Problems 

As  might  be  expected,  there  are  many 
problems  involved  in  the  field  of  artificial 
insemination.  Difficulties  i n infertility 
evaluation,  technical  problems  in  collec- 
tion and  instillation  of  semen  specimen, 
and  problems  in  selection  of  a donor  have 
already  been  discussed. 

There  are  other  problems  confronting 
artificial  insemination,  such  as  problems  in 
the  fields  of  psychiatry,  law  and  religion 
which  may  not  be  overcome  for  many  years 
and  even  then  will  require  some  great 
social  change. 


Consider  first  the  husband  who  is  made 
aware  of  his  critical  role  in  his  wife’s  in- 
ability to  conceive.  He  may  adopt  feelings 
of  inferiority  and  a lack  of  manliness.  He 
is  to  “blame”  for  his  wife’s  frustrations 
and  longings.  His  instinct  for  survival  and 
drive  toward  fatherliness  (as  a form  of 
self-perpetuation)  are  abruptly  halted.  He 
assumes  the  sense  of  personal  degradation 
and  may  be  consumed  by  the  fear  that  his 
inadequacies  may  be  discovered  by  others. 
A child  begot  by  donor  insemination  is  a 
constant  reminder  of  his  failure.  He  may 
develop  a pathologic  jealousy  for  his  wife 
whose  conceptual  ability  has  become  evi- 
dent, and  toward  the  donor  who  has 
fathered  a child  who  should  be  his  own 
child.  He  develops  a hatred  and  aversion 
for  this  “alien”  child  who  has  succeeded 
in  stripping  him  naked  in  front  of  the 
world,  if  only  in  his  own  mind.!’®'^-!® 

The  wife  is  relieved  to  learn  of  her  hus- 
band’s causative  role  in  the  couple’s  in- 
fertility. She  has  been  “cheated”  by  her 
husband’s  deficiency.  Her  hostility  may 
seek  revenge  through  AID  and  her  over- 
indulgence  of  her  baby  serves  to  exclude 
her  husband.  She  may  come  to  challenge 
her  husband’s  masculine  role  on  material 
matters,  in  his  occupation  and  the  like.  She 
may  develop  a yearning  to  know  the  iden- 
tity of  the  donor;  this  yearning  may  be- 
come an  obsession.  The  donor  likewise  may 
yearn  to  know  of  the  recipient’s  identity; 
the  fathering  of  unknown  children  may 
weigh  heavily  on  his  psyche.  The  donor’s 
secrecy  from  his  own  wife  may  lead  to 
distrust.  Flattery  of  his  male  ego  may  grow 
into  feelings  of  a superman.  Financial 
greed  may  supercede  feelings  of  compas- 
sion and  idealism.!'®'!®  According  to  Ger- 
stel  the  participation  in  AI  indicates  an 
emotional  disturbance.®  It  is  not  difficult  to 
understand  from  the  preceding  that  AI 
certainly  exposes  its  participants  to  a mul- 
tiplicity of  psychological  factors. 

Legality 

The  legality  of  AI  is  unsettled. !'^'!®  The 
involvement  of  the  participants  of  AID  in 
adultery,  as  well  as  the  status  of  the  child 
are  questions  which  have  received  diver- 
gent rulings  in  different  courts.  The  wife’s 
denial  that  she  gave  her  consent  for  the 
insemination  may  indeed  constitute  rape 
by  her  physician  as  well  as  by  an  unknown 
donor.  A birth  certificate  must  bear  the 


for  December,  1968 


759 


donor’s  name  as  father  or  the  physician  is 
guilty  of  fraud.  The  donor’s  wife  may  seek 
a divorce  because  of  her  husband’s  extra- 
marital sexual  affairs.  Were  donor’s  anony- 
mity not  to  exist  a donor’s  child  could 
demand  support  and  inheritance  right  from 
the  donor;  and,  on  the  other  hand,  a donor 
might  demand  support  from  a wealthy 
AID  child. 

Many  attempts  have  been  made  to  con- 
tain AI  within  the  legal  framework  of  our 
society.  The  mixing  of  husband  and  donor 
semen,  as  described  previously,  retains 
legitimacy  of  the  child;  the  more  the  semen 
specimen  is  diluted  with  ineffectual  hus- 
band’s semen  the  less  the  chance  of  con- 
ception. The  signing  of  consent  forms  and 
the  keeping  of  records,  so  as  to  protect  the 
physician,  lessen  the  secrecy  of  AI  and 
secrecy  may  be  its  keynote  for  success.  The 
adoption  of  a child  conceived  through  AI 
appears  the  most  certain  method  of  assur- 
ing its  legitimacy.  The  Bureau  of  Legal 
Medicine  of  the  AMA  summarized  the 
problem  of  legality  of  artificial  insemina- 
tion thusly: 

No  act  is  illegal  unless  prohibited  by 
some  law,  either  written  or  unwritten, 
and  society  has  formed  no  opinion  and 
enacted  no  law  regarding  artificial  donor 
insemination. 

The  overlapping  influences  of  church 
and  state  have  served  to  mold  our  present 
society.  It  is  thus  understandable  that  AI 
with  all  of  its  complex  social  and  legal 
ramifications  will  also  be  influenced  by  re- 
ligion. The  implication  of  adultery  and 
illegitimacy  is  of  religious  as  well  as  legal 
import.  The  Roman  Catholic  Church  de- 
nounced AI  in  1877  and  Pope  Pius  XII 


rejected  it  absolutely  in  1949.  The  com- 
mittee of  the  Archbishop  of  Canterbury  in 
1948  had  stated  that  AI  was  “contrary  to 
Christian  principles  and  morals  and  worthy 
to  be  considered  a criminal  offense.”® 

In  addition  to  adultery  and  illegitimacy 
the  problem  of  incest  plays  a dominant 
role  in  religious  condemnation.  With  the 
anonymity  of  AID  there  exists  the  possi- 
bility that  two  children  produced  by  AID 
might  marry  and  their  marriage  would  be 
that  of  a brother  and  sister.  The  possibility 
of  such  a marriage  certainly  exists  but,  ac- 
cording to  Rubin,i®  “even  if  AID  increased 
by  twenty  times  in  England  there  would  be 
no  more  than  the  possibility  of  one  con- 
sanguineous marriage  every  50-100  years.” 


References 

1.  Schellen,  A.  M.,  Artificial  Insemination  in  the 
Human.  Amsterdam,  Elsevier,  1957. 

2.  MacLoed,  J.  and  Gold,  R.,  “An  Analysis  of 
Human  Male  Fertility,”  Int.  J.  Fert.  3:382,  1958. 

3.  Finegold,  W.  J.,  Artificial  Insemination, 
Springfield,  Illinois,  Charles  C Thomas,  1964. 

4.  Seymour,  F.  I.  and  Koerner,  A.,  “Artificial  In- 
semination; present  status  of  U.S.  as  shown 
by  recent  survey,”  JAMA  116:2747,  June,  1941. 

5.  Watters,  W.  W.  and  Sousa-Poza,  J.,  “Psychia- 
tric Aspects  of  Artificial  Insemination,”  Canad. 
Med.  Assoc.  J.  95:106,  July,  1966. 

6.  Guttmacher,  A.  F.,  “Artificial  Insemination,” 
Ann.  N.Y.  Acad.  Set.  97:623,  Sept.,  1962. 

7.  Weisman,  A.  I.,  “Symposium  on  Sterility  and 
Fertility,”  West.  J.  Surg.  50:142,  1942. 

8.  Gerstel,  G.,  “A  Psychoanalytic  View  of  Artifi- 
cial Donor  Insemination,”  Am.  J.  Psychother. 
17:64,  Jan.,  1963. 

9.  Deutsch,  H.,  The  Psychology  of  Women.  New 
York,  Grime  and  Stratton,  1954. 

10.  Rubin,  B.,  “Psychological  Aspects  of  Human 
Artificial  Insemination,”  Arch.  Gen.  Psych. 
13:121,  Aug.,  1965. 

11.  Medicolegal  Aspects  of  Artificial  Insemination: 
A Current  Appraisal.  JAMA  157:1638,  April 
30,  1955. 


Coronary  Artery  Disease 

The  results  of  our  study  appear  rather  alarming;  in  our  100  patients 
with  classic  angina  pectoris  and  angiographically  proved  coronary  ob- 
structive lesions,  only  12  had  lesions  limited  to  a single  coronary  branch, 
and  17  to  two  vessels.  In  71  cases,  the  three  main  arterial  trunks,  together 
with  one  or  more  secondary  branches,  were  the  seat  of  vascular  lesions. 
In  58  of  the  100  individuals  it  was  possible  to  demonstrate  complete  oc- 
clusions in  one  or  more  segments,  with  a total  of  68  occlusions.  . . . 

These  data  indicate  once  again  that  coronary  artery  disease,  when 
capable  of  producing  clinical  symptomatology,  has  already  acquired  the 
stature  of  an  extensively  morbid  process,  with  multiple  areas  of  localiza- 
tion in  the  coronary  tree.  In  about  70  percent  of  the  cases,  this  involves 
the  three  main  trunks  and  their  secondary  branches.  (G.  G.  Gensini  and 
C.  Buonanno.  Coronary  Arteriography.  Conclusion.  Dis.  of  the  Chest  (Aug.) 
1968;  54:2;  pgs.  91-99.) 


760 


Illinois  Medical  Journal 


Dr.  Samuel  Van  Meter 
and  the 

Illinois  Medical  lnfirmart{, 
1857-1877 


By  Harold  M.  Gavins,  Ed.D.,  and  Harry 


Sam  Van  Meter  at  15  was  a tanner’s 
apprentice.  Dr.  Samuel  \^an  Meter  at  44 
had  built  a medical  practice  into  an  in- 
firmary in  Charleston  that  grossed  S186,- 
000  in  one  year  (1868).  In  between  he 
fought  Indians  and  white  renegades  on  a 
goldrush  junket  to  California,  and  helped 
patch  up  the  shooting  \ictims  of  the  Civil 
"War-spawned  Charleston  Riot 

Van  Meter  occasionally  mixed  his  medi- 
cine 'vHth  morality— he  once  refused  to 
treat  a patient  until  the  fellow  agreed  to 
forsake  his  saloon  business^— and  with 
tongue-in-cheek  philosophy  after  an  ill-ad- 
vised excursion  into  the  field  of  canine 
problems:  after  prescribing  a remedy  aimed 


Harold  M.  Cavins,  Ed. 
D.,  is  Professor  Emeri- 
tus, Health  Education, 
Eastern  Illinois  Univer- 
sity. He  is  a charter 
member  and  past  presi- 
dent of  the  Illinois  Pub- 
lic Health  Association. 
His  doctorate  is  from 
Stanford  University. 

Harrv-  Read  Director  of  Information  and 

Publications  for  Eastern  Illinois  University. 


Read/ Charleston 

at  curing  a dog  of  sucking  eggs,  he  ^vas 
told  that  the  antidote  had  killed  the  dog. 
The  doctor  replied,  “"Well,  he  won’t  suck 
eggs  anymore.  ”2 

The  doctor  also  had  the  kind  of  incisive 
wit  that  night  club  comedians  need  to  put 
down  hecklers.  On  this  occasion  he  was 
riding  his  horse  down  the  street  carrying 
a cabbage  head  he  had  received  from  a pa- 
tient. A young  man  yelled,  “There  goes  two 
cabbage  heads  on  horseback.”  The  doctor 
repHed,  “Young  man,  do  you  know  the  dif- 
ference between  this  cabbage  and  you?  It 
has  had  a sight  more  cultivation  than  you 
have  had.”3 

Dr.  \’"an  Meter  operated  the  Illinois 
Medical  Infirmary  in  Charleston  for  20 
years.  It  closed  its  doors  in  about  1877 
“when  the  doctor,  worn  out  Tvith  his  con- 
stant and  arduous  labors,  rethed  from  the 
active  practice  of  his  profession.”^ 

The  Infirmary  opened  in  about  1857  and 
during  its  peak  years  published  “The  Na- 
tion’s Journal  of  Health.”  An  (undated) 
issue*  of  the  publication  (“Devoted  to  the 
Suffering  Fathers  and  Sons,  "Wives,  Moth- 
ers and  Daughters  of  America”)  proclaims 
that  “Health  is  the  fii'st  want  of  the  In- 
dividual, the  Nation,  and  the  Race,”  and 
it  cautions  its  readers  to  “Caie  well  for  the 
Tabernacle  of  the  Flesh,  that  Prosperity 
and  ripe  old  age  may  be  yours.” 

•Undated,  but  marked  No.  9,  Vol.  XXX;  internal 
evidence  indicated  it  appeared  in  about  1875. 


for  December,  196S 


761 


The  yellowing,  brittle  pages  of  the  Jour- 
nal bear  mute  evidence  to  the  esteem  in 
which  former  patients  held  Dr.  Van  Meter 
and  his  infirmary.  It  contains  some  25 
testimonial  letters  (or  excerpts)  plus  the 
names  of  265  references.  Among  this  group 
are  the  names  of  30  elders  (apparently  his 
prestige  group),  17  reverends,  seven  doc- 
tors and  approximately  215  patients.  Read- 
ers were  admonished  to  “Enclose  a stamp 
and  WRITE  to  some  of  the  above  refer- 
ences.” 

A breakdown  of  addresses  shows  persons 
given  as  references  lived  in  Illinois,  Mis- 
souri, Kentucky,  Iowa,  Indiana,  Tennessee, 
Ohio,  North  Carolina,  West  Virginia,  Ne- 
braska, Alabama,  Kansas,  Texas,  Georgia, 
California,  Wisconsin,  Michigan,  Arkansas, 
Pennsylvania,  Mississippi,  Minnesota,  Loui- 
siana, and  Canada. 

One  of  the  letters  of  testimony  was 
signed  by  a County  Court  Judge  from 
Missouri.  It  reads: 

“You  may  refer  all  doubters  to  me. 
Among  a score  of  others  benefitted  by 
you  in  this  community  was  a nephew 
of  mine,  who  went  to  you  when  a mere 
skeleton,  and  his  doctors  and  friends  be- 
lieved he  could  not  live  longer  than  one 
month.  He  is  now  well,  and  weighs  more 
than  he  ever  did  before  he  was  sick.” 

“Tell  them  I know  money  is  not  your 
sole  object.  That  once  when  I was  at 
your  Infirmary,  you  examined  a man, 
and  told  him  that  no  doctor  on  earth 
could  benefit  him,  but  to  go  home  and 
save  his  money.  The  man  told  you  he 
had  come  600  miles,  and  if  you  could 
benefit  him,  money  was  no  object.  You 
told  him  to  be  wise,  go  home  and 
straighten  up  his  affairs,  save  his  money 
for  his  children;  that  you  could  not  cure 
him.  . . .” 

Dr.  Van  Meter  told  potential  patients 
via  the  Journal  that  “the  afflicted  are  in- 
vited to  visit  our  Infirmary,  and  if  they 
are  not  convinced  that  it  is  one  of  the 
best  appointed  institutions  in  the  whole 
country,  and  do  not  believe  that  we  un- 
derstand the  treatment  of  Chronic  Diseases 
thoroughly,  and  have  not  the  necessary 
means  for  their  successful  treatment,  then 
we  agree  TO  PAY  YOUR  HOTEL  BILL 
WHILE  HERE.” 

The  Journal  declared: 

“We  treat  all  diseases  of  the  Throat, 
Lung  and  Head,  Consumption,  Catarrh, 


Asthma,  Bronchitis,  Ulcerated  Sore 
Throat,  Affections  of  the  Heart,  Piles 
and  Fistula,  Diseases  of  the  Liver,  Dys- 
pepsia, Rheumatism,  Scrofula,  Affections 
of  the  Eye,  Deafness,  Salt  Rheum,  Ery- 
sipelas and  all  Skin  Diseases,  Epilepsy, 
Diabetes,  Diseases  of  Males  and  Females, 
Private  Diseases,  and  Chronic  Diseases 
of  all  other  forms  and  types.” 

It  was  reported  that  patients  came  to 
the  Infirmary  “from  the  Pacific  Coast,  and 
from  England,  and  other  countries  beyond 
the  sea.”® 

A contemporary  Charleston  city  directory 
placed  the  location  of  the  Infirmary  on 
the  south  side  of  the  square,  across  the 
street  from  the  courthouse.  At  about  the 
time  Dr.  Van  Meter  retired  from  the  opera- 
tion of  the  Infirmary,  Charleston,  as  a 
“health  center,”  had  a population  of  3,136 
(White  males,  1,468;  White  females,  1,637; 
Colored  males,  19;  Colored  females,  12).® 
Samuel  Van  Meter  was  born  in  Grayson 
County,  Ky.,  in  1824.  His  father  was  killed 
in  a fall  from  a horse  in  1827  and  his 
mother,  Catherine  Keller  Van  Meter, 
brought  the  family  of  five  children  to  Coles 
County.  Young  Sam  had  a common  school 
education,  and  at  15  he  was  apprenticed 
to  a tanner.^ 

Sam  apparently  decided  that  the  life 
of  a leather  worker  was  not  his  calling 
and  his  mother  purchased  his  time  from 
the  tanner.  He  then  began  to  study  with 
Dr.  T.  B.  Trower,  a native  of  Albermarle 
County,  Va.  Dr.  Trower  came  from  Ken- 
tucky to  Shelbyville,  practiced  medicine 
there  and  was  an  officer  in  the  Moultrie 
County  bank.  Dr.  Trower  studied  medi- 
cine under  Drs.  Beamiss  and  Merryfield,  of 
Bloomington,  Ky.®  He  moved  to  Charles- 
ton in  1836,  where  he  lived  for  42  years, 
and  at  one  time  was  a vice  president  of 
the  Charleston  First  National  Bank. 

Under  the  precept  system  of  the  time, 
the  student  would  make  calls  with  the  doc- 
tor. On  the  return  trips  by  buggy,  doctor 
and  student  would  discuss  the  cases.  First 
hand  observation  and  discussions,  plus  de- 
dicated work  in  Dr.  Trower’s  medical  li- 
brary, added  up  to  Van  Meter’s  education 
in  medicine. 

There  was  nothing  unusual  about  Dr. 
Van  Meter’s  method  of  obtaining  a medical 
education.  The  first  doctor  in  Springfield 
was  Gershom  Jayne,  who  had  no  formal 
medical  education,  other  than  preceptor- 


762 


Illinois  Medical  Journal 


ship.  He  was  a noted  physician  and  a 
friend  of  Abraham  Lincoln.  His  two  sons 
were  among  the  first  native  Illinoisians  to 
attend  formal  medical  schools.  The  ma- 
jority of  the  early  doctors  served  precep- 
torships  before  medical  schools  were  or- 
ganized in  St.  Louis  and  Chicago.  Some 
of  the  earliest  doctors  who  helped  organize 
societies,  including  the  Illinois  State  Medi- 
cal Society,  had  no  intramural  formal 
medical  education. 

In  1850,  when  he  was  26  years  old.  Dr. 
Van  Meter  was  employed  by  five  men 
from  Chicago  to  accompany  them  to  Cali- 
fornia as  the  party’s  doctor.  He  was  paid 
$5,000  in  gold  before  he  left.  The  prudent 
physician  left  $4,000  at  home  with  his  wife, 
sewed  $1,000  in  his  clothes,  and  headed 
west.  The  small  party  had  a number  of 
brushes  with  Indians  and  with  white  men 
seeking  to  steal  horses.^ 

Dr.  Van  Meter  remained  in  California 
for  several  months,  but  apparently  found 
only  a small  amount  of  gold.  His  return 
trip  was  made  in  a sailing  vessel  to  the 
Isthmus  of  Panama,  a mule  train  trip 
across  the  isthmus,  another  ship  to  New 
Orleans,  then  home. 

Van  Meter  practiced  with  Dr.  Trower 
for  three  years  after  his  return  to  Charles- 
ton, before  launching  his  own  practice 
about  1854.  Dr.  Van  Meter  then  had  a 
partner  in  the  Infirmary  for  a number  of 
years.  Dr.  H.  R.  Allen.  Dr.  Allen  even- 
tually left  Charleston  to  become  proprietor 
of  the  National  Surgical  Institute,  India- 
napolis, Ind. 

In  1868,  the  year  the  Infirmary  grossed 
$186,000,  expenditures  of  $1,400  per  month 
at  the  Charleston  post  office  for  postage 
were  recorded. The  Journal  describes  the 
Infirmary  “as  the  peer  of  any  similar  in- 
stitution on  the  Western  continent  and  a 
monument  to  the  skill,  energy  and  hon- 
orable calling  for  its  founder.  . . .” 

Van  Meter,  via  the  Journal,  declared 
that  the  success  of  the  Infirmary  was 
reached  by  “constant  study,  by  persistent, 
untiring,  unremitting  labor.  We  have  it 
on  the  best  authority  that  the  great  part 
of  what  is  generally  termed  genius  is  these 
things.  The  great  pianist  Rubenstein,  when 
asked  how  it  was  that  he  attained  such 
wonderful  success  in  his  art,  replied,  as 
if  surprised  by  the  question,  ‘It  is  only  by 
Study.’  ’’  “Michael  Angello  [sic],  when  he 
was  an  old  man  said,  ‘I  carry  my  satchel 


still,’  thus  indicating  that  his  was  a life  of 
perpetual  study  and  preparation.” 

Dr.  Van  Meter  also  emphasized  that  man 
must  have  a specialty  (“Agassiz  knew  noth- 
ing of  music”  and  “we  do  not  take  our 
watches  to  a blacksmith  to  have  them  re- 
paired”). The  doctor  apparently  referred 
to  the  general  field  of  medicine  as  his  spe- 
cialty, without  intending  to  single  out  a 
specialty  within  the  field. 

Although  he  doesn’t  use  the  word.  Dr. 
Van  Meter  was  an  eclectic:  “We  do  not 
ride  a ‘hobby’  or  run  a theory.  We  take 
advantage  of  every  remedy  that  is  good  . . .” 
And:  “The  Illinois  Medical  Infirmary 

stands  upon  its  own  footing,  free  from 
the  influence  of  dogmas,  untrammelled  by 
creeds  or  schools.  To  cure  our  patients  is 
our  sole  desire,  and  we  care  not  whether 
the  remedy  was  recommended  by  some 
high-toned  professor  or  originated  in  the 
practical  brain  of  our  grandmother.” 
The  doctor  warn- 
ed in  the  Journal 
that  the  Infirmary 
had  no  “agents”  else- 
where in  the  coun- 
try. He  also  tried  to 
assist  the  ill  and  in- 
firm in  their  pil- 
grimages to  the  In- 
firmary: 

“For  the  bene- 
fit of  those  living 
at  a distance,  and  would  like  a reliable 
map  to  ascertain  the  best  route  to  Charl- 
eston, we  have  just  published  at  consid- 
erable cost  a large  and  handsome  chrome 
map  of  the  United  States,  printed  in 
four  colors,  and  containing  all  the  rail- 
roads in  the  country.  This  map  is  suit- 
able for  an  office  or  a private  dwelling. 
Every  home  should  have  a map  on  its 
walls.  It  is  useful  to  both  parents  and 
children.  The  map  will  be  sent  to  any 
address  on  receipt  of  six  cents.” 

On  March  28,  1863,  the  Charleston  Riot 
made  coast-to-coast  headlines  when,  in  a 
pitched  battle  on  the  courthouse  lawn  be- 
tween anti-war  Democrats  and  Union  sol- 
diers home  on  leave,  nine  men  were  killed 
and  twelve  were  Avounded. 

When  the  shooting  started.  Dr.  Van 
Meter  took  his  six-year  old  son  to  the 
family  residence,  three  blocks  aAvay,  then 


for  December,  1968 


763 


returned  to  attend  to  the  bleeding  vic- 
tims of  the  riot  throughout  the  remainder 
of  the  day  and  night.  The  day  after  the 
Riot  Dr.  Van  Meter  was  walking  down 
the  street  when  a soldier,  one  member  of 
a detail,  pointed  to  him  and  called,  “There 
goes  a Copperhead!  Shoot  him!”  How- 
ever, the  officer  in  charge  of  the  detail  knew 
the  doctor  well  and  no  trouble  developed. 
Probably  because  of  his  Kentucky  back- 
ground, the  doctor  was  a Southern  sympa- 
thizer (as  were  many  people  in  Charles- 
ton), but  did  or  said  nothing  disloyal  to 
the  Union. 

In  contemporary  accounts.  Dr.  Van 
Meter  was  described  as  a “remarkable  per- 
sonality.” He  was  reported  as  having  a 
“lithe,  slender  figure,  straight,  coal-black 
hair,  black  eyes  and  swarthy  complex- 
ion. . . .” 

“He  was  a man  of  boundless  energy,  and, 
as  a boy,  was  the  wonder  of  all  his  school- 
mates by  reason  of  his  originality  and  dar- 
ing. He  was  a natural  mimic,  brimming 
over  with  animal  spirits  and  constantly  sur- 
prising by  his  witty  comments  and  retorts.” 

Records  in  the  Coles  County  Courthouse 
indicate  that  Dr.  Van  Meter  became  an 


extensive  property  owner.  He  gave  a son 
1,000  acres  of  farm  land  and  gave  his  two 
daughters  large  tracts  of  land  in  Douglas 
and  Coles  counties.  One  of  the  doctor’s 
brothers,  Keller  Van  Meter,  was  killed 
while  serving  with  the  Confederacy. 

Dr.  Van  Meter  died  on  September  18, 
1902  at  the  age  of  78.  His  wife,  Frances, 
died  on  January  31,  1917,  when  she  was 
88.  Dr.  Trower  died  on  April  15,  1878. 
All  three  were  buried  in  Mound  Cemetery, 
Charleston. 

References 

1.  Editor,  Southern  Christian  Weekly,  Rev.  L. 
W.  Scott,  quoted  in  Dr.  Van  Meter’s  “Jour- 
nal of  Health.” 

2.  Correspondence  with  Mr.  Craig  Van  Meter, 
Mattoon,  111.,  grandson  of  Dr.  Van  Meter, 
hereafter  cited  as  Craig  Van  Meter. 

3.  Craig  Van  Meter  (grandson). 

4.  History  of  Coles  County,  Illinois,  Wm.  Le- 
Baron,  Jr.  and  Co.,  Chicago,  1879,  p.  536. 

5.  Ibid.  LeBaron,  p.  536. 

6.  Chas.  Emerson  & Co.,  Mattoon  and  Charles- 
ton, Illinois,  City  Directories,  1878-1879. 

7.  Op  cit.  LeBaron,  p.  536. 

8.  Op  cit.  LeBaron,  p.  535. 

9.  Craig  Van  Meter  (grandson). 

10.  Op  cit.  LeBaron,  p.  536. 

11.  Craig  Van  Meter  (grandson). 

12.  History  of  Coles  County,  Edited  by  Edward 
Wilson,  Munsell  Publishing  Co.,  Chicago, 
1906. 


Activists 

Perhaps  the  greatest  disadvantage  of  SHO  (Student  Health  Organiza- 
tions) will  redound  to  the  very  students  who  most  wholeheartedly  espouse 
its  causes.  In  their  idealism,  they  tend  to  become  increasingly  intolerant  of 
those  whom  they  will  succeed.  They  condemn  the  intern  who  becomes  "A 
sarcastic,  cynical,  loudmouth  tyrant,"  and  they  speak  with  disdain  of  the 
practicing  physician  whom  they  see  as  treating  his  patients  carelessly  and 
callously.  This  attitude  is  an  intensification  of  the  disparagement  traditional- 
ly implied  by  references  to  "the  LMD."  It  is  also  an  unfortunately  restricted 
prospect  of  medical  practice.  The  adherents  of  SHO  are  so  concerned  with 
the  community,  the  recipient  of  health  care,  that  they  are  blinded  to  the 
problems  of  the  supplier.  Yet  the  exercise  of  good  medicine  is  unavoidably 
a two-way  interaction,  and  students  who  do  not  appreciate  the  stultifying 
constraints  of  routine,  the  discouraging  impact  of  a "difficult"  patient,  and 
the  distracting  pressures  of  a competitive  society  may  find  adjustment  in- 
calculably difficult  when  their  role  is  suddenly  that  of  the  house  officer  or 
practitioner.  (Activists  in  Medical  School.  New  England  Jl.  of  Medicine  [July 
11]  1968;  279:2;  pgs.  101-102.) 


764 


Illinois  Medical  Journal 


Single  Daily  Dosage  of 
Griseofulvin  in  Fungus  Diseases 


By  Roland  S.  Medansky,  M.D. /Chicago 


Many  patients  find  the  routine  of 
drug  dosage  not  only  complicated,  but  in- 
convenient. Attempting  to  remember 
whether  or  not  they  missed  taking  their 
last  dosage  often  proves  upsetting.  Sing- 
le daily  doses  of  any  compound  are,  there- 
fore, preferable  to  both  patient  and  phy- 
sician since  it  means  avoidance  of  error  and 
convenience  of  administration.  However, 
effectiveness  of  a single  daily  dose  is  still 
another  matter.  The  ideal  preparation  is 
one  which  combines  effectiveness  and  a 
single  daily  dosage. 

In  fungous  infections,  topical  agents  re- 
quire a repetitive  routine  of  applications 
which,  if  forgotten  or  used  in  error,  often 
result  in  incomplete  therapy.  Moreover, 
there  are  certain  conditions  where  topical 
agents  do  not  completely  achieve  the  re- 
sult the  physician  is  seeking.  An  oral  prep- 
aration which  is  systemically  active  against 
various  fungi  would,  in  most  instances,  be 
preferable  in  such  situations. 

Such  an  oral  antifungal  preparation  is 
griseofulvin.  Griseofulvin,  as  an  orally  ad- 
ministered fungistatic  agent,  has  become 
the  drug  of  choice  in  treating  Trichophy- 
ton, Epidermophyton,  and  Microsporum 
infections  of  the  hair,  skin,  and  nails. 

Recently,  a micronizing  principle  was 
developed  which  apparently  increases  the 
area  and  absorbability  of  its  particles.  The 
micronized  griseofulvin  (C17,  H lu  Oe,  Cl) 
is  an  odorless,  white,  thermostable  powder 
which  is  prepared  by  a special  dry  milling 
procedure.  The  preparation  is  known  as 


Roland  S.  Medansky, 

M.D.,  is  Chairman  of 
the  Department  of  Der- 
matology, Illinois  Ma- 
sonic Hospital  and  is 
on  staff  at  Lutheran 
General  and  Holy  Fam- 
ily Hospitals.  His  M.D. 
is  from  the  University 
of  Illinois  and  he  in- 
terned at  Michael  Reese 
Hospital.  A residency  in 
dermatology  was  taken  at  the  University  of  Illinois 
Hospitals,  br.  Medansky  holds  the  rank  of  Clinical 
Instructor  in  Dermatology,  the  University  of  Illin- 
ois College  of  Medicine  and  is  board  certified. 


Fulvicin-U/F,  (R)*  a 500  mg.  tablet  of 
ultra-finely  divided  material  for  improved 
absorption  and  higher  blood  levels. 

Kraml  and  his  associates'-^  found  that 
serum  concentrations  of  ultra-fine  griseo- 
fulvin were  almost  twice  that  by  an  equal 
weight  of  standard  griseofulvin.  Clinical 
trials  supported  this  implication.^'®  The 
fact  that  the  drug  was  efficacious  and  clin- 
ically potent  in  less  than  one-half  the  stan- 
dard dose  of  griseofulvin  led  to  a decision 
to  examine  the  preparation  from  the  stand- 
point of  therapeutic  efficacy  as  a single 
daily  dosage  in  treating  stubborn  infec- 
tions of  the  skin,  hair,  and  nails. f 

Since  there  were  no  previous  clinical  re- 
ports in  the  literature  on  the  use  of  this 
preparation  in  the  form  of  a single  daily 
dose  as  a 500  mg.  tablet,  it  was  felt  the 
study  would  be  a worthwhile  clinical  un- 
dertaking. 

Outline  of  Study 

This  study,  therefore,  attempted  to  de- 
termine the  therapeutic  efficacy  of  a single 
daily  dosage  in  treating  fungous  infections 
of  the  skin,  hair,  and  nails.  Fifty  patients 
of  varied  ages  with  the  diagnoses  of  tinea 
capitis,  tinea  cruris,  tinea  corporis,  tinea 
pedis,  and  onychomycosis  were  chosen.  In 
order  to  establish  the  presence  and  subse- 
quent disappearance  of  the  organism,  cul- 
tures for  the  examination  of  fungi  were 
taken  on  Sabouraud’s  agar  before  and  after 
treatment  of  lesions  in  all  patients. 

If  the  condition  persisted  beyond  the  ex- 
pected period  of  treatment,  another  cul- 
ture was  taken.  Treatment  was  continued 
until  clinical  and/or  laboratory  evidence 
indicated  a definite  response. 

The  criteria  established  for  determining 
a response  consisted  of  the  following: 
Excellent— complete  clinical  and  labora- 
tory cure 

Good  —50%  to  75%  clinical  cure 

Fair  —25%  to  50%  clincial  cure 

Poor  —no  clincial  or  laboratory  re- 
sponse 

^Product  of  Schering  Corporation,  Bloomfield/ 
Union,  N.J. 

fThe  Fulvicin-U/F  was  kindly  supplied  by  the 
Medical  Department  of  Schering  Laboratories. 


for  December,  196S 


765 


1 


Fig.  1.  Finger  nail  before  onset  of  treatment. 


The  study  included  eleven  patients  hav- 
ing onychomycosis,  ten  having  tinea  cruris, 
sixteen  having  tinea  pedis,  nine  having  tin- 
ea corporis,  and  four  having  tinea  capitis. 

The  initial  culture  showed  Trichophy- 
ton rubrum  in  thirty  patients,  T.  menta- 
grophytes  in  four,  E,  floccosum  in  five,  M. 
canis  in  three,  and  one  in  each  of  the  fol- 
lowing: T.  tonsurans,  Mucoraceae,  and 

Streptomyces. 

Although  it  is  felt  that  every  patient 


Fig.  2.  Finger  nail  three  months  after  onset  of 
treatment. 


should  have  an  identifiable  organism  cul- 
tured before  being  treated,  there  were  five 
instances  where  initial  cultures  were  nega- 
tive or  unobtainable;  yet  KOH  prepara- 
tions were  positive.  This  is  an  expected 
response  since,  as  so  many  physicians  have 
found,  there  are  always  a few  individuals 
where  an  organism  cannot  be  identified 
yet  the  clinical  eye  and  KOH  scraping  re- 
veal a fungous  infection. 


Table  I 

RESULTS  WITH  SINGLE  DAILY  DOSAGE  OF  GRISEOFULVIN 
IN  FUNGOUS  DISEASES 


DIAGNOSES: 

Pts. 

INITIAL  CULTURES: 

Pts. 

Tinea  Cruris 

10 

T.  Rubrum 

30 

Tinea  Corporis 

9 

T.  Mentagrophytes 

4 

Tinea  Pedis 

16 

E.  Floccosum 

5 

Tinea  Capitis 

4 

Mucoraceae 

1 

Onychomycosis 

11 

Streptomyces 

1 



T.  Tonsurans 

1 

TOTAL  (45  male;  5 female) 

50 

M.  Canis 

3 

KOH  Positive,  Culture 

Negative 

5 

FINAL  CULTURES: 

DURATION  OF  TREATMENT: 

Negative 

31 

2-  7 weeks 

34 

T.  Rubrum 

14 

8-10  weeks 

9 

E.  Floccosum 

2 

11-25  weeks 

7 

Contaminant 

2 

(Overall  average 

treatment:  52  days) 

Streptomyces 

1 

SIDE  EFFECTS: 

Diarrhea,  3-4  weeks 

1* 

RESULTS: 

Pts. 

Excellent 

21 

Good 

21 

Poor 

4f 

Fair 

4f 

‘Patient  also  on  phenobarbital  and  arthritic  medication. 
tOne  patient  unreliable  in  taking  medication  in  each  category. 


766 


Illinois  Medical  Journal 


Table  II 

EFFECTIVENESS  OF  SINGLE  DAILY  DOSAGE  OF  GRISEOFULVIN 

IN  TINEA  CRURIS 
(10  Patients;  Ages  19-62) 


Initial  Culture: 

Pts. 

Final  Culture: 

T.  Rubrum 

6 

Negative 

T.  Mentagrophytes 

1 

E.  Floccosum 

E.  Floccosum 

3 

T.  Rubrum 

Contaminant 

* 

Duration  of  Treatment: 

Pts. 

2-6  .weeks 

10 

(.\verage,  25  days) 

Results: 

Excellent 

4 

Good 

5 

Fair 

1* 

Poor 

0 

Side  Effects 

"o 

‘Patient  did  not  take  medication 

1 as  directed. 

Pts. 


Table  m 

EFFECTIVENESS  OF  SINGLE  DAILY  DOSAGE  OF  GRISEOFULVIN 


IN  TINEA 
(9  Patients; 


Initial  Culture:  Pts. 


T.  Rubrum  6 

Mucoraceae  1 

E.  Floccosum  1 

Culture  negative  1 


Duration  of  Treatment: 

2-8  weeks 

(Average,  41  days) 

Results: 

Excellent 

Good 

Fair 

Poor 

Side  Effects: 

Results 

Table  I illustrates  the  diagnoses,  initial 
and  final  cultures,  duration  of  treatment, 
and  results  achieved  for  the  overall  study. 
Tables  II  through  VI  illustrate  the  cul- 
tures, duration  of  treatment,  and  results 
for  each  individual  condition. 

Good  to  excellent  results  were  achieved 
with  Fulvicin-U/F  500  mg.  per  day  in  nine 
out  of  ten  patients  (90%)  with  tinea  cruris, 
eight  of  the  nine  patients  (88%)  with  tinea 
corporis,  fourteen  of  the  sixteen  patients 
(87%)  with  tinea  pedis,  and  all  of  the  pa- 
tients with  tinea  capitis. 

Of  the  eleven  patients  with  onychomyco- 
sis, seven  showed  a good  response;  two 
showed  a fair  response.  This  could  be  con- 
sidered a significant  result  in  that  onycho- 


CORPORIS 
Ages  18-49) 

Final  Culture:  Pts. 

Negative  9 

Pts. 

9 

8 

0 

1 

0 

0 

mycosis  often  requires  long-term  therapy 
and  sometimes  fails  to  respond  to  any 
therapy  at  all.  It  is  very  likely  that  clinical 
cures  would  have  been  achieved  if  treat- 
ment had  been  continued  for  longer  than 
the  three  month  experimental  period. 

Figures  1-4  illustrate  the  clearing  accom- 
plished with  this  drug  in  onychomycosis 
over  a three  month  period.  The  duration 
of  treatment  ranged  from  two  to  twenty- 
five  weeks  for  the  overall  study  with  the 
shortest  period  of  therapy  in  Tinea  cruris 
(an  average  of  twenty-five  days)  and  the 
longest  in  onychomycosis  (an  average  of 
ninety- two  days). 

The  only  side  effect  was  diarrhea  in  one 
patient,  which  occurred  after  several  weeks 


for  December,  1968 


767 


I— > M JsO  Cji 


Fig.  3.  Toe  nail  before  onset  of  treatment. 

of  therapy.  This  same  patient  was  also  tak- 
ing phenobarbital  and  medication  for  arth- 
ritis concomitantly. 

Summary  and  Conclusions 

A total  of  fifty  patients  with  various 
types  of  fungous  infections  were  treated 
with  a single  daily  dosage  of  Fulvicin-U/F 
500  mg.  Good  to  excellent  results  were 
achieved  in  thirty-five  of  thirty-nine  pa- 
tients having  tinea  capitis,  corporis,  pedis, 
and  cruris.  Seven  out  of  eleven  patients 
having  onychomycosis  showed  a good  re- 
sponse. 

On  the  basis  of  the  clinical  response, 
photographs,  and  laboratory  results,  one 


Fig.  4.  Toe  nail  three  months  after  onset  of 
treatment. 


Fulvicin-U/F  500  mg.  tablet  daily  can  be 
considered  very  effective  therapy  in  fung- 
ous infections. 

Therapeutic  effectiveness,  elimination  of 
possible  dosage  error,  and  convenience  of 
administration  should  make  this  prepara- 
tion highly  desirable  to  both  physician  and 
patient  as  an  oral  antifungal  for  once-a-day 
use. 


Table  IV 

EFFECTIVENESS  OF  SINGLE  DAILY  DOSAGE  OF  GRISEOFULVIN 

IN  TINEA  PEDIS 


(16  Patients: 


Initial  Culture:  Pts. 


T.  Rubrum  8 

T.  Mentagrophytes  3 

Strep  tomyces  1 

E.  Floccosum,  T.  Mentagrophytes  1 

Culture  negative  3 


Duration  of  Treatment: 

4-11  weeks 

(Average,  52  days) 

Results: 


Excellent 

Good 

Fair 

Poor 

Side  Effects: 

Diarrhea,  3-4  weeks 

*One  patient  unreliable  in  taking  medication, 
t Patient  also  on  phenobarbital  and  arthritic  medication. 


Ages  9-57) 


Final  Culture: 

Pts, 

Negative 

12 

T.  Rubrum 

3 

Strep  tomyces 

1 

Pts. 

16 


6 

8 

0 

2* 


If 


768 


Illinois  Medical  Journal 


, Table  V 

EFFECTIVENESS  OF  SINGLE  DAILY  DOSAGE  OF  GRISEOFULVIN 

IN  TINEA  CAPITIS 

(4  Patients;  Ages  4-6) 


Initial  Culture: 

Pts. 

Final  Culture: 

Pts. 

T.  Tonsurans 

1 

Negative 

3 

M.  Canis 

3 

Contaminant 

1 

Duration  of  Treatment: 

Pts. 

3-8  weeks 

4 

(Average,  31  days) 

Results: 

Excellent 

3 

Good 

1 

Fair 

0 

Poor 

0 

Side  Effects: 

0 

Table  VI 

EFFECTIVENESS  OF  SINGLE  DAILY  DOSAGE  OF  GRISEOFULVIN 

IN  ONYCHOMYCOSIS 

(11  Patients;  Ages  9-51) 


Initial  Culture: 

Pts. 

T.  Rubrum 

10 

Culture  Negative 

1 

Duration  of  Treatment: 


6-25  weeks 

(Average,  92  days) 

Results: 

Excellent 

Good 

Fair 

Poor 

Side  Effects: 


Final  Culture: 

Pts, 

T.  Rubrum 

9 

Negative 

Pts. 

2 

11 

0 

7 

2 

2 

0 


References 

1.  Kraml,  N.;  Dubuc,  J.  and  Beall,  D.:  Gastro- 
intestinal Absorption  of  Griseofulvin:  I.  Ef- 
fect of  Particle  Size,  Addition  of  Surfact- 
ants, and  Corn  Oil  on  the  Level  of  Griseoful- 
vin in  the  Serum  of  Rats.  Canad.  J.  Biochem. 
& Physiol.  40:1449-1451,  1962. 

2.  Kraml,  M.;  Dubuc,  J.  and  Gaudry,  R.:  Gas- 
trointestinal Absorption  of  Griseofulvin:  II. 
Influence  of  Particle  Size  in  Man.  Antibiotics 
Chemother.  12:239-242,  1962. 


3.  Robinson,  H.M.  and  Dunseath,  W.R.:  Mi- 
cronized  Grieseofulvin.  J.  Invest.  Dermat. 
39:65-66  (August)  1962. 

4.  Sullivan,  F.J.:  The  Effectiveness  of  Ultrafine 
Griseofulvin.  Western  Med.  8:94-95  (March- 
April)  1967. 

5.  Bielinski,  S.  and  Falk,  A.  B.:  Griseofulvin 
U/F  in  Tinea  Capitis,  Illinois  M.J.  125:624- 
625  (June)  1964. 

6.  Zelickson,  A.S.:  Lower  Dosage  with  Ultra- 
fine  Griseofulvin.  Clin.  Med.  73:73-74  (Au- 
gust) 1966. 


Rural  Emergency  Services 


Complementing  the  five-point  rural 
emergency  medical  services  plan  recently 
developed  by  the  AMA’s  Council  on  Rural 
Health  is  its  vital  sequel— “Guidelines  for 
Implementation.  . . 

This  essential  aid  affords  countless  serv- 
iceable suggestions  which  no  doubt  will 
prove  instrumental  in  achieving  the  desired 
results  long  sought  by  rural  community 


leaders.  Its  four  pages  are  brimming  with 
ideas  relative  to  organizational  structure, 
mechanisms  by  which  presently  existing 
emergency  systems  may  be  evaluated  and 
general  recommendations  with  regard  to 
first  aid,  communications  and  transporta- 
tion. Single  copies  may  be  obtained— at  no 
cost— from  the  Council  on  Rural  Health, 
American  Medical  Association,  535  N. 
Dearborn  St.,  Chicago,  60610. 


for  December,  1968 


769 


KININS— A POTENT  BIOLOGIC  AGENT 


Kinins  are  a group  of  polypeptides  with 
all  the  properties  necessary  to  induce  an 
acute  inflammatory  process.  These  agents 
influence  smooth  muscle  contraction,  cause 
hypotension,  increase  capillary  permeabili- 
ty, produce  vasodilation,  incite  pain,  and 
may  also  cause  the  emigration  of  granu- 
locytic leukocytes.  Their  exact  role  in  any 
biological  system  is  not  known  but  kinins 
are  implicated  in  various  forms  of  acute 
arthritis,  gout,  asthma,  endotoxin  shock, 
migraine  headaches,  and  the  acute  inflam- 
mation associated  with  burns. 

Kinins  are  split  from  kininogens  by  the 
proteolytic  group  of  enzymes  called  kalli- 
kreins  that  are  found  in  the  pancreas,  sweat 
and  salivary  glands,  urine,  plasma,  intes- 
tines,  and  neutrophilic  granulocytes. 
Bradykinin  and  kallidin  were  discovered 
many  years  ago.  Wasp  and  snake  venom 
contain  many  kinins.  This  is  understand- 
able because  venom  is  a salivary  secretion. 

Kininases  is  the  only  specific  anti-kinin 
and,  as  such,  could  be  called  an  anti-inflam- 
matory agent.  On  the  other  hand,  kinin 
activity  can  be  altered  indirectly  by  deple- 
tion of  kininogens  or  by  the  inhibition  of 


any  of  the  preceding  enzymatic  steps. 

Kinins  have  been  found  in  the  inflam- 
matory synovial  fluids  of  those  with  gout 
and  rheumatoid  arthritis.  The  concentra- 
tion of  polypeptides  is  not  correlated  with 
the  severity  of  symptoms  or  signs.  The 
question  is,  what  activates  the  kallikrein 
system?  There  is  some  evidence  that  the 
therapeutic  effects  of  the  salicylates,  glu- 
cocorticoids, and  colchicine  is  brought 
about  because  the  products  interfere  with 
the  kinin  system.  The  evidence,  however, 
is  meager  and  from  a practical  side,  we 
must  search  for  agents  that  antagonize  the 
kinins  in  order  to  reap  the  benefits  of  this 
interesting  and  exciting  pharmacological 
finding. 

T.  R.  Van  Dellen,  M.D. 


References 

1.  Kinis  and  Arthritis.  Alan  S.  Nies  and  Kenneth 
L.  Melmon.  Bulletin  on  the  Rheumatic  Dis- 
eases (Sept.)  1968;  iP:l;  pgs.  512-516. 

2.  Kinins— Possible  Physiologic  and  Pathologic 
Roles  In  Man.  R.W.  Kellermeyer  and  Richard 
C.  Graham,  Jr.  New  England  Jl.  of  Med.  (Oct. 
3)  1968;  27P:  14;  pgs.  754-758. 


Illinois  has  122  institutions  of  higher  education.  Only  three  states  have 
more  colleges  and  universities.  More  students  attend  colleges  in  Illinois 
than  in  the  United  Kingdom,  Sweden,  Norway,  and  Denmark  combined. 


770 


Illinois  Medical  Journal 


New  Alcoholic  Treatment  Program  Developed 


A new  alcoholism  program  based  on  the 
philosophy  that  alcoholism  is  a progressive 
disease  which  may  be  therapeutically  inter- 
rupted at  any  point  in  its  course  is  being 
carried  out  jointly  by  psychiatric  personnel 
of  the  Loyola  University  Stritch  School  of 
Medicine  and  the  Hines  Veterans  Admini- 
stration Hospital. 

The  program  requires  that  a prospective 
candidate  sign  a contract  stipulating  that 
he  agrees  to  no  privileges,  no  passes  and 
no  visitors  for  a hospitilization  period  up 
to  six  weeks,  as  the  first  step  in  his  rehabil- 
itation process. 

This  approach  is  designed  to  accelerate 
the  alcoholic’s  involvement  in  the  inpa- 
tient treatment  process.  It  is  in  sharp  con- 
trast to  permissive  treatment  programs 
which  allow  passes,  privileges  and  visitors, 
and  reportedly  “lose”  15  to  25  per  cent  of 
their  patients  via  premature  discharges 
and  drinking  while  on  home  visits. 

While  an  inpatient  at  Hines,  the  pa- 
tient is  exposed  to  a broad  spectrum  of 
treatment  methods  including  drug  therapy, 
group  therapy  (both  traditional  and  by 
married  couples),  family  therapy.  Alcohol- 
ics Anonymous  and  occupational  therapy. 

Since  alcoholics  represent  a variety  of 
personality  disorders,  an  attempt  is  made 
to  tailor  the  treatment  as  much  as  possible. 
For  example,  a number  of  alcoholics  seem 
to  respond  very  well  to  the  combination  of 
Antabuse  (a  drug  which  produces  a toxic 
reaction  if  there  is  any  alcohol  in  an  indi- 


vidual’s bloodstream)  and  Married  Coup- 
les Group  Therapy,  whereas  others  seem 
to  benefit  more  from  Alcoholics  Anony- 
mous. 

Upon  discharge,  the  patient  is  encour- 
aged to  continue  treatment  at  either  the 
Loyola  Clinic  in  the  John  J.  Madden  Men- 
tal Health  Center  or  newly  formed  Hines 
PHC  (Post-Hospital  Care)  Clinic.  In  ad- 
dition, program  graduates  are  urged  to 
continue  their  use  of  Antabuse  (as  a pre- 
ventative measure)  and  their  involvement 
with  Alcoholics  Anonymous  groups  in 
their  communities. 

Thus  far  the  Loyola-Hines  program  has 
admitted  more  than  120  patients  during 
its  first  eight  months  of  operation.  There 
has  been  no  drinking  on  the  ward  and  only 
four  premature  discharges.  Of  the  first  100 
men  discharged,  the  readmission  rate  has 
been  14  per  cent  while  the  sobriety  rate 
has  been  78  per  cent. 

Plans  are  underway  for  the  establish- 
ment of  a Halfway  House  at  Hines  and 
increased  involvement  with  industrial 
firms  in  nearby  communities. 

Criteria  for  admission  to  the  program: 
The  patient  must  be  a U.S.  veteran,  male, 
under  50,  residing  within  50  miles  of 
Hines,  without  decompensating  physical 
illnesses  and  able  and  willing  to  accept  the 
contract  stipulation  of  no  privileges,  no 
passes  and  no  visitors  for  a period  of  up  to 
six  weeks. 


New  Medical  Schools 


Five  more  institutions  have  joined  the 
United  States  medical  school  ranks  this 
fall,  bringing  the  total  of  such  institutions 
to  99. 

Opening  the  door  for  the  first  time  to 
freshman  classes  are  the  University  of  Cali- 
fornia School  of  Medicine,  at  Davis,  the 
University  of  California  San  Diego  School 
of  Medicine,  the  University  of  Connecti- 
cut School  of  Medicine  in  Hartford,  the 
Mt.  Sinai  School  of  Medicine  of  the  City 
University  of  New  York  and  the  University 
of  Texas  Medical  School  at  San  Antonio. 

First  year  classes  at  the  five  new  medical 


schools  are  expected  to  range  in  size  from 
16  students  at  the  University  of  Connec- 
ticut Medical  School  to  56  students  at  the 
University  of  Texas  in  San  Antonio.  Both 
new  University  of  California  medical 
schools  expect  a first  year  enrollment  of 
around  50  students  each,  while  25  students 
are  expected  to  comprise  the  first  year  class 
of  the  Mt.  Sinai  School  of  Medicine  in 
New  York. 

This  year’s  total  medical  school  enroll- 
ment is  expected  to  be  about  9,600  iii 
comparison  to  last  year’s  enrollment  which 
totaled  approximately  9,400. 


for  December,  1968 


111 


IDPA 


Illinois  Department  of  Public  Aid 
Payment  Procedures  end  Policies  Explained 


Harold  O.  Swank,  Director 
Illinois  Department  of  Public  Aid 


Part  II  of  a Series. 


The  first  article  of  this  series  explained 
the  Medical  Assistance  program  under 
Title  XIX  and  the  direct  payment  of  phy- 
sicians for  medical  charges  which  are  usual, 
customary,  reasonable  and  prevailing. 

The  first  installment  ended  with  a list- 
ing of  the  questions  most  frequently  asked 
by  physicians.  Since  there  were  a number 
of  questions  asked,  DOES  THIS  MEAN 
DOCTORS  DO  NOT  UNDERSTAND 
THE  PROGRAM? 

No.  Most  doctors  understand  the  pro- 
gram and  experience  no  difficulty  in  re- 
ceiving their  payments.  However,  there 
continues  to  be  a sizeable  number  of  bill- 
ing errors  which  do  cause  delays  in  pay- 
ment. Any  bill  which  cannot  be  computer 
processed  requires  manual  handling  or  in- 
dividual consideration.  In  either  case,  a 
delay  ensues  which  may  vary  from  three 
to  eight  weeks  depending  on  the  nature  of 
the  error.  The  normal  processing  period 
—from  the  date  the  bill  is  received  to  the 
date  the  payment  is  mailed— is  about  forty- 
five  days. 


HAVE  YOU  A QUESTION? 

Physicians*  questions  concerning 
IDPA  methods,  procedures  and  poli- 
cies are  solicited  and  will  be  answered 
in  these  articles  or  by  direct  com- 
munication. The  Department  is  de- 
sirous of  eliminating  misunderstand- 
ings and  to  work  cooperatively  with 
Illinois  physicians.  Send  questions  to: 
IDPA  Editor 

Illinois  State  Medical  Society 
360  N.  Michigan  Avenue 
Chicago,  Illinois  60601 


DO  MANY  BILLS  REQUIRE 
INDIVIDUAL  CONSIDERATION? 

The  number  is  sizeable.  For  instance, 
102,695  physicians’  bills  were  processed  in 
July,  1968,  and  of  these,  17,366— or  about 
16.9  percent— required  such  handling.  Case 
identification  errors  require  a manual  and/ 
or  machine  check  of  records  and  sometimes 
the  help  of  county  staff.  Some  errors  of 
medical  procedure  can  be  checked  by 
IDPA  but  some  need  consultation.  All, 
however,  slow  the  processing  and  payment 
of  bills. 

The  17,366  rejected  bills  subdivided  into 
11,419  involving  some  phase  of  case  iden- 
tification and  2,657  involving  some  medi- 
cal procedure.  Case  identification  data  in- 
clude case  number,  case  eligibility  and 
patient’s  name.  Causes  of  medical  pro- 
cedure rejects  include  multiple  coding 
which  the  computer  is  not  programmed 
to  handle  and  procedures  involving  alter- 
natives for  which  there  is  inadequate  cod- 
ing, or  no  coding,  in  AMA’s  Current  Pro- 
cedural Terminology  booklet.  Some  pro- 
cedures—f o r instance,  consultations— are 
automatically  selected  out  for  individual 
consideration  because  it  isn’t  worthwhile 
to  go  to  the  programming  breadth  neces- 
sary to  handle  them. 

IS  IT  REALLY  NECESSARY  THAT 
PHYSICIANS’  BILLS  BE  COMPUTER 
PROCESSED? 

Yes.  IDPA  processes  more  than  600,000 
medical  bills  of  all  types  each  month,  in- 
cluding some  102,000  physicians’  bills.  It 
is  impractical  not  to  use  machines  to  the 
utmost. 


772 


Illinois  Medical  Journal 


DOESN’T  DATA  PROCESSING  ADD 
TO  THE  DOCTORS’  “PAPERWORK”? 

It  isn’t  a question  of  extra  work  but 
rather  a matter  of  extra  precision  in  writ- 
ing up  the  billing.  There  is  little  difference 
in  the  content  of  a physician’s  bill  for  serv- 
ices rendered  a public  aid  recipient  and 
for  his  services  rendered  a patient  with 
health  insurance  coverage.  Both  types  of 
billing  require  case  identification  to  include 
name,  age  and  address  of  the  patient,  name 
and  address  of  the  head  of  the  household 
if  patient  is  a dependent,  name  of  the 
administering  physician,  a description  of 
the  medical  procedure  rendered,  and  the 
charges. 

IF  THERE  IS  THAT  MUCH  SIMI- 
LARITY, THEN  WHY  ARE  THERE 
SO  MANY  ERRORS? 

As  said  earlier,  it  is  a question  of  preci- 
sion. First,  let’s  consider  the  question  from 
the  standpoint  of  the  computer.  The  pro- 
file of  each  active  public  aid  case  is  stored 
on  tape  and  placed  at  the  disposal  of  the 
computer.  The  intent  is  that  every  physi- 
cian’s bill  pertaining  to  a particular  profile 
be  referred  to  that  profile  and  to  no  other. 
To  accomplish  this,  each  person  eligible 
for  medical  assistance  is  issued  an  identi- 
fication card  which  contains,  among  other 
things,  a case  identification  number,  a 
group  or  county  number,  the  case  name 
(person  to  whom  the  card  is  issued)  and 
names  of  all  other  eligible  persons  in  the 
case. 

Proper  identification  of  the  case,  though 
simple,  cannot  be  overstressed.  The  doctor 
merely  transfers  the  information  from  the 
recipient’s  case  identification  card  to  the 
comparable  spaces  at  the  top  of  the  billing 
Form  132.  First  he  should  check  the  first 
block  of  the  case  identification  data  to 
make  sure  the  card  (hence  eligibility)  has 
not  expired.  The  patient’s  name  must  ap- 
pear on  the  card  either  as  the  person  to 
whom  the  card  was  issued  or  in  the  sep- 
arate block  where  other  eligible  family 
members  are  listed. 

The  doctor  should  copy  the  case  num- 
ber exactly  as  it  identifies  the  profile  stored 
in  the  computer  . . . and  no  other.  The 
group  or  county  number  must  be  exact  as 
it  identifies  the  geographical  location  of 
the  case.  Copy  the  first  and  last  names  of 
the  person  to  whom  the  CID  card  is  is- 
sued—do  not  abbreviate  or  use  a nick- 


name; for  instance,  don’t  write  down  Bobby 
if  the  name  is  Robert.  The  computer  can- 
not make  such  fine  distinction.  The  pa- 
tient’s name  should  also  be  copied  ver- 
batim—for  the  same  reason.  Sometimes  the 
name  of  the  person  to  whom  the  CID 
card  is  issued  is  also  the  patient  but  at 
other  times  the  patient  may  be  another 
person  in  the  household.  In  either  situa- 
tion, always  enter  the  patient’s  name.  The 
birth  date  of  the  patient  must  also  be  re- 
corded and  the  physician’s  AMA  medical 
education  number  should  be  typed, 
stamped  or  printed  in  the  appropriate  box. 

Upon  arrival  in  Springfield,  the  bill  is 
coded  on  a punched  card  and  fed  to  the 
computer  which  simply  matches  the  iden- 
tification number  of  the  bill  with  the  iden- 
tification of  the  stored  profile.  If  they 
match,  the  subsequent  action  is  swift  and 
unerring  but  if  there  is  a mismatch  of  any 
kind,  the  bill  is  rejected  for  manual  hand- 
ling. 

WHAT  IF  THE  IDENTIFICATION 
DATA  ARE  CORRECT  BUT  THERE 
IS  AN  ERROR  IN  MEDICAL 
PROCEDURE? 

Most  medical  procedures  are  programmed 
into  the  computer’s  stored  or  memory  sys- 
tem as  are  also  the  usual,  customary,  rea- 
sonable and  prevailing  physicians’  fees.  If 
the  procedure  is  coded  properly— as  de- 
scribed in  AMA’s  Current  Procedural 
Terminology  booklet— the  computer  proc- 
esses it,  computes  payment,  and  prints  out 
all  data  it  was  programmed  to  do.  If  there 
is  an  error  in  medical  procedure,  the  com- 
puter rejects  the  bill  after  which  it  must 
receive  individual  consideration  from  pro- 
fessional staff. 

IS  THE  CURRENT  PROCEDURAL 
TERMINOLOGY  IN  NEED  OF 
REVISION? 

Yes,  it  is  inadequate  in  many  areas. 
Some  procedures  are  not  coded  at  all  and 
in  some  the  possible  alternatives  are  not 
spelled  out.  Even  though  a great  effort 
went  into  delineating  medical  procedures 
and  assigning  codes,  the  CPT  was  pub- 
lished with  the  certain  knowledge  that  ex- 
perience would  disclose  inadequacies.  It 
is  IDPA’s  understanding  that  the  AMA  is 
revising  the  CPT  but  no  publication  date 
has  been  forecast. 

(Continued  on  page  824) 


for  December,  1968 


773 


The  Perils  of  Immobility 


A First-person  Case  Report 

By  Jane  Jeffris,  R.N. /Chicago 


Although  polio  is  considered  a con- 
quered infectious  disease,  there  were  93 
cases  of  paralytic  polio  in  the  United  States 
in  1966.  And  then,  there  are  the  severely 
paralyzed  victims  from  other  years.  Ac- 
cording to  the  National  Foundation  there 
are  approximately  1,800  patients  in  the 
U.S.  who  use  respiratory  equipment  for 
survival.  These  people  are  paraplegics  or 
quadriplegics  with  residual  paralysis  of  the 
respiratory  muscles,  and  they  present  a 
multiplicity  of  problems  for  the  medical 
profession. 

My  story,  while  unique  in  some  respects, 
may  be  used  as  a guideline  in  treating 
other  patients.  Whether  the  person  is  han- 
dicapped from  polio,  multiple  sclerosis, 
spinal  cord  injury  or  any  other  disease 
which  causes  immobility  and/or  a breath- 
ing deficit,  special  precautions  should  be 
taken. 

I have  been  a quadriplegic  polio  for 
fifteen  years.  My  vital  capacity,  while  su- 
pine, is  875  c.c.  and  my  activities  are  quite 
limited.  I spend  most  of  my  life  on  a rock- 
ing bed  in  order  to  get  air.  Despite  this,  I 
have  been  able  to  accomplish  my  goal  of 
helping  myself,  my  family  and  my  com- 
munity. However,  any  intercurrent  illness, 
if  severe,  complicates  my  life  and  causes 
me  great  anxiety. 


Case  Report 

The  episode  that  I am  reporting  here 
began  like  appendicitis,  with  low  abdomin- 
al pain  and  cramps,  followed  by  nausea, 
vomiting  and  fever.  My  white  blood  count 
was  16,500  with  polymorphonuclears  86, 
and  lymphocytes  14.  There  was  diffuse  ri- 
gidity of  the  lower  abdomen. 

A plain  film  of  the  abdomen  was  star- 
tling—I was  quizzed  intensively  as  to  wheth- 
er I had  swallowed  an  object,  or  had  an 
enema  or  douche  lately.  There  was  a radio- 
paque shadow,  5 cm.  in  diameter,  low  in 
the  abdominal  cavity.  The  answers  to  all 
the  questions  were  negative.  I had  not 
swallowed  anything,  nor  had  I had  an 
enema  or  douche.  It  seemed  incredible 
and  frightening  that  an  object  could  be  in 
my  abdomen  without  my  knowing  it. 

Additional  films  were  taken  from  sever- 
al angles.  As  in  the  previous  films  the  mys- 
terious shadow  was  definitely  there. 

The  surgeon  did  a vaginal  exam  and 
couldn’t  locate  anything  there.  He  then 
did  a rectal  and  found  the  mysterious  ob- 
ject. With  some  manipulation  and  a great 
deal  of  pain  he  was  able  to  remove  this 
rock-like  formation,  which  was  approxi- 
mately 2 inches  in  size.  It  was  found  to  be 
composed  of  barium  sulfate.  The  year  be- 
fore I had  been  treated  for  a duodenal  ul- 
cer, and  at  that  time  I had  a complete  GI 
series. 

Now,  most  people  ask:  “Didn’t  you  have 
any  symptoms  during  those  twelve 
months?  Yes,  I had  symptoms  throughout 
that  time— low  abdominal  pain,  at  times 
cramps,  and  a copious  amount  of  mucous 


774 


Illinois  Medical  Journal 


in  the  stools;  however  since  I also  had  emo- 
tional problems  it  was  thought  to  be  the 
usual  type  of  functional  colitis. 

After  the  barium  was  removed  the 
symptoms  continued.  It  was  felt  that  a 
perforation,  with  associated  lower  abdom- 
inal inflammatory  process,  now  existed.  I 
was  a poor  candidate  for  surgery.  My  doc- 
tors decided  to  use  conservative  treatment. 

Intravenous  fluids,  which  were  started 
on  hospital  admission,  were  continued 
through  the  next  five  days.  A rectal  tube 
was  inserted  for  the  gas  which  I couldn’t 
expel.  No  medication  was  given  for  pain 
because  peristalsis  was  already  nil  and 
narcotics  depress  peristalsis  in  the  colon. 
My  two  doctors  watched  me  far  into  the 
night,  debating  the  possibility  of  doing  sur- 
gery. 

The  next  morning  a proctoscopic  exam- 
ination and  Gastrografin  visualization  of 
the  lower  colon  were  done.  In  addition  a 
Miller-Abbott  tube  was  passed  from  above 
to  relieve  distention. 

During  that  second  day  in  the  hospital 
my  breathing  grew  worse,  due  to  the  pain, 
the  abdominal  distention,  and  the  in- 
creased oxygen  demand  occasioned  by  fev- 
er. The  motion  of  the  rocking  bed  in  con- 
junction with  the  rectal  tube  rubbing  up 
and  down  caused  such  severe  pain  I 
couldn’t  tolerate  it;  but  without  rocking  I 
couldn’t  get  enough  air.  The  only  solution 
seemed  to  be  the  tank  respirator,  which 
seemed  like  a disaster  to  me.  As  it  turned 
out,  that  one  night  in  the  tank  respirator 
enabled  me  to  get  more  air  with  less  pain, 
and  brought  the  first  rest  in  forty-eight 
hours. 

This  second  night  I was  put  into  the  in- 
tensive care  unit,  which  is  a benefit  to  any 
critical  patient,  especially  the  respiratory 
polio.  Again,  my  doctors  watched  over  me 
until  after  midnight  and  in  addition  they 
called  in  an  otolaryngologist  in  case  a 
tracheostomy  should  be  required. 

By  the  third  day  my  abdomen  became 
less  sore  and  the  distention  decreased.  The 
rectal  tube  was  removed  and  I was  able  to 
rock  again.  Naso-gastric  suction  and  intra- 
venous fluids  were  continued  until  the 
fifth  day  when  I was  able  to  take  liquids 
without  vomiting.  Temperature  elevation 
continued  for  two  weeks,  ranging  from 
F.  104°  to  100.4°,  despite  antibiotics. 

During  the  two  weeks  I ran  a fever  the 
doctors  felt  I had  developed  a pelvic  ab- 


scess. While  they  considered  an  attempt 
to  aspirate  the  abscess,  it  drained  spontan- 
eously into  the  rectum,  with  only  mild 
diarrhea.  My  temperature  dropped  to 
normal  and  recovery  thereafter  was  un- 
eventful. 

Comment 

Respiratory  polios,  as  well  as  all  others 
who  are  immobile,  present  a challenge  to 
the  medical  profession  when  intercurrent 
problems  supervene.  The  liklihood  of  pneu- 
monia, atelectasis  and  thrombophlebitis 
are  increased.^  The  paralyzed  or  elderly 
patient  is  most  vulnerable.  Keeping  a pat- 
ent airway  and  a tidal  exchange  sufficient 
to  meet  increased  demands  is  of  critical 
importance  with  these  patients.  I found 
that  positive  pressure  via  a face  mask  for 
five  minutes,  several  times  a day,  as  recom- 
mended by  the  anesthesiologist,  was  a 
great  help  during  those  days  of  fever  and 
dyspnea.  I believe  an  inhalation  therapy 
team  is  one  of  the  greatest  boons  to  the 
respiratory  problem  patient  in  recent 
years  by  lending  much  needed  reassurance 
to  both  patient  and  doctor. 

As  for  the  barium  being  retained  for  so 
many  months  after  the  X-rays,  I have 
found  nothing  in  the  literature  to  equal 
it.  Vulkmer  and  Trummer  record  a case  of 
barium  appendicitis  in  a 43-year-old  man 
12  days  after  a barium  study  of  the  colon.^ 
Seaman  and  Wells,  in  their  article  “Com- 
plications of  the  Barium  Enema,’’  report 
cases  of  perforation  and  leakage  of  colonic 
contents  during  the  diagnostic  enema,  but 
they  do  not  mention  barioliths  of  this 
type.^ 

Summary 

With  the  immobile  patient,  keeping  the 
administration  of  barium  for  just  the  ex- 
treme case  is  desirable,  but  not  always  pos- 
sible. The  use  of  other  types  of  contrast 
media  might  be  considered.  If  barium  must 
be  used,  then  a scout  roentgenogiam 
should  be  done  a week  or  two  after  the 
barium  study  in  order  to  get  an  “all-clear.” 

References 

1.  Asher,  Richard  A.  J.,  Dangers  of  going  to 
bed.  British  Medical  Journal,  2:967-968,  Dec. 
13,  1947. 

2.  Vulkmer,  George  J.  and  Trummer,  Max  J., 
Barium  appendicitis.  Archives  of  Surgery, 
91:630-632,  Oct.  1965. 

3.  Seaman,  William  B.  and  Well,  Josephine, 
Complications  of  the  barium  enema.  Gastro- 
enterology, 48:728-736,  June  1965. 


for  December,  1968 


llo 


AM  A Urges  Cooperation  of  Physicians  in 
Comprehensive  Health  Planning 


Following  the  enactment  of  the  Com- 
prehensive Health  Planning  Act  (Public 
Law  89-749)  in  November,  1966,  the  House 
of  Delegates  of  the  American  Medical  As- 
sociation adopted  a report  which  defined 
the  role  of  the  medical  profession  in  com- 
prehensive health  planning  and  urged  state 
and  local  medical  societies  to  participate 
vigorously  in  the  program.  It  concluded 
that  planning,  organization,  and  distribu- 
tion of  health  facilities  and  services  are 
a prime  responsibility  of  organized  medi- 
cine. 

Along  these  same  lines,  the  AMA  Coun- 
cil on  Rural  Health  and  its  Advisory  Com- 
mittee agreed  upon  the  following  observa- 
tions regarding  community  health  plan- 
ning during  a recent  meeting  held  in  Chi- 
cago: 

a)  Present  resources  to  aid  in  community 
health  planning  include  the  Compre- 
hensive Health  Planning  Act,  Public 
Law  89-749,  regional  medical  programs, 
and  inherent  community  resources  such 
as  current  health  programs,  health  fa- 
cilities and  personnel  and  recognized 
planning  groups. 

b)  The  need  for  community  health  plan- 
ning in  rural  areas  is  urgent  because  of 
the  maldistribution  of  health  man- 
power, limited  health  facilities  in 
sparsely  populated  areas,  duplication  of 
agencies  and  programs,  and  inefficient 


utilization  of  health  manpower  and 
facilities. 

c)  There  is  need  for  development  of  in- 
novative ways  to  utilize  present  health 
manpower. 

d)  The  health  team  approach  with  its  use 
of  allied  health  professionals  to  assist 
the  physician  will  expand  the  avail- 
ability of  health  services  in  many  rural 
areas. 

e)  The  role  of  national  organizations  con- 
cerned with  the  health  of  the  rural 
population  should  be  defined,  and  ef- 
fective communication  established,  with 
respect  to  rural  community  health 
planning. 

f)  Task  forces  on  comprehensive  health 
planning  should  establish  a structure 
to  deal  effectively  with  the  rural  sec- 
tor of  the  population. 

g)  Resources  should  be  made  available  for 
development  of  local  or  area  planning 
councils  to  help  in  the  development  of 
planning  for  the  sparsely  populated 
rural  areas. 

The  Council  on  Rural  Health  is  pre- 
pared to  provide  information  and  advice 
to  rural  groups  interested  in  becoming 
actively  involved  in  the  vital  area  of  health 
planning.  Inquiries  should  be  directed  to 
the  Council,  American  Medical  Association, 
535  North  Dearborn  Street,  Chicago,  Illi- 
nois 60610. 


Psychology  Courses  for  Medical  Students 


In  efforts  to  better  equip  today’s  medical 
student  wdth  more  tools  to  treat  non-medi- 
cal problems,  the  University  of  Illinois 
Graduate  College  has  initiated  a curricu- 
lum in  medical  psychology  leading  to  a 
master’s  degree. 

“There  are  no  similar  programs  in  the 
state  or  outside  of  Illinois,”  says  Dr.  Milan 
V.  Novak,  associate  dean  of  the  University’s 
Graduate  College  at  the  Medical  Center 
Campus,  Chicago. 

This  is  a pioneer  undertaking  made  pos- 
sible by  the  faculty  and  research  facilities 
in  the  Department  of  Psychiatry.  Candi- 
dates must  meet  the  admission  require- 
ments of  the  Graduate  College  at  the 
Medical  Center. 


Advanced  training  in  scientific  investi- 
gation of  emotional  illness  and  health  will 
be  the  focus  of  the  graduate  program. 
Studies  will  include:  the  theories  of  de- 
velopment of  emotional  disorders;  the 
models  and  concepts  used  to  organize  an 
understanding  of  biological,  personal,  and 
social  factors  involved;  and  the  method- 
ological and  statistical  tools  necessary  for 
designing  and  conducting  research  studies 
in  this  area. 


Illinois  has  over  130,000  forms  aver- 
aging 228  acres  each,  supporting  more 
than  40  different  crops.  Its  farms  are 
valued  at  $13  billion. 


776 


Illinois  Medical  Journal 


MEMBERSHIP  SURVEY 

RESULTS: 


Dr.  Frank  J.  Jirka,  Jr.,  chair- 
man of  ISMS  Board  of  Trus- 
tees, which  authorized  mem- 
bership survey. 


Whaf  You  Said  . . . 
What  ISMS  Is  Doing 


Dr.  Matthew  B.  Eisele,  chair- 
m an,  ISMS  Committee  o n 
Public  Relations. 


Part  II:  SOCIO/ECONOMIC  Issues 

THIS  MONTH  we  tell  you  what  you  collectively  told  us  on 

these  key  socio-economic  issues— 

Relative  adequacy  of  Medicare  and  public-aid  payments  . . . 
Short-term  steps  to  ease  the  M.D.  shortage  . . . 

Local  authority  in  Comprehensive  Health  Planning  . . , 

Alternatives  to  the  expansion  of  Medicare  . . . 

The  welfare  problem. 

On  these  issues  we  tell  you  the  results  of  the  August  membership  survey 
. . , background  information  . . , and  the  action  that  the  ISMS  leadership 
is  taking  in  response  to  your  opinion. 

Last  month  we  similarly  treated  survey  questions  of  a Legislative  and 
Legal  nature. 

In  January,  we’ll  cover  issues  involving  Professional  Practice.  Your 
reactions  on  these  will  be  guiding  us  on  such  matters  as  midweek  off-day 
schedules  ...  a 7-day  hospital  week  . . . health-care  costs  . . . and  our 
relations  with  hospitals  and  paramedical  groups. 

While  elated  by  the  responses  from  some  3,000  of  you,  we  realize  that 
any  survey— no  matter  how  carefully  prepared  or  well  received— has  certain 
limitations. 

We  are  aware  that  on  such  complex  topics,  our  questions— and  your 
checkmarks— could  not  always  convey  the  full  message. 

Such  qualifications  aside,  the  survey  has  been  invaluable  in  advising 
your  ISMS  leadership  of  your  views  and  wants.  You  have  given  us  plenty 
of  grist  for  our  mills. 

As  these  articles  point  out,  your  leaders  are  acting  in  response  to  your 
views  . . . the  mills  are  grinding. 

MATTHEW  B.  EISELE,  M.D. 

Chairman,  Committee  on  Public  Relations 


/or  December,  1968 


777 


MEMBERSHIP  SURVEY  RESULTS 


ADEQUACY  OF  MEDICARE  AND 
PUBLIC  AID  FEES? 

QUESTION  AND  GENERAL  RESPONSE; 


Controversy  exists  over  Medicare  and  Illinois  Depart- 
ment of  Public  Aid  payments,  and  disparities  between 
them. 


a.  If  you  accept  assignments  under  Medicare, 

are  you  generally  satisfied  with  the  amounts 
you  are  paid  by  the  fiscal  intermediary? 

b.  If  you  treat  public-aid  recipients,  are  you 

generally  satisfied  with: 

Payments  from  IDPA  for  patients  covered  by 
both  Medicare  and  public  aid? 

Payments  from  IDPA  for  non-Medicare  patients? 


% of  M.D.’s 
in  FAVOR 


67% 


46% 

37% 


BREAKDOWN: 


a.  b. 

a.  Generally  satisfied  with  amounts  paid  under  Medi- 
care by  fiscal  intermediary,  67%.  b.  Not  satisfied  by 
payments  from  IDPA  for  non-Medicare  patients, 
63%. 


About  72  per  cent  of  the  responding  physicians  answered 
on  Medicare,  and  about  two-thirds  on  public  aid. 

One  of  the  chief  findings  is  that  while  specialists  are 
more  satisfied  with  Medicare  payments  than  are  general 
practitioners,  the  reverse  is  true  with  non-Medicare  pay- 
ments. Here  is  the  overall  breakdown: 


778 


Illinois  Medical  Journal 


MEMBERSHIP  SURVEY  RESULTS 


MEDICARE 

COMBINATION 
MEDICARE/ 
PUBLIC  AID 

NON-MEDICARE 

By 

age: 

Under  40 

65% 

44% 

36% 

40-55 

68% 

45% 

35% 

Over  55 

65% 

49% 

41% 

By 

area: 

Chicago  Med.  Society 

67% 

48% 

39% 

Downstate 

67% 

45% 

36% 

By 

field  of  practice: 
General  practitioners 

63% 

42% 

40% 

Specialists 

69% 

48% 

36% 

By 

type  of  practice: 
Solo  practice 

64% 

43% 

37% 

Partnership  or  group 

70% 

47% 

34% 

Hospital-based 

72% 

57% 

47% 

BACKGROUND; 

Medicare— which  took  effect  in  mid- 1966— provided  for 
payment  of  physicians  on  the  basis  of  reasonable  charges. 
These  take  into  consideration  “the  customary  charge  for 
similar  services  generally  made  by  the  physician  or  other 
person  furnishing  such  services,  as  well  as  the  prevailing 
charges  in  the  locality  for  similar  services.” 

From  1958  until  1967,  fees  for  treatment  of  public-aid 
cases  were  paid  on  a flat-rate  basis  which  IDPA  Director 
Harold  O.  Swank  readily  admitted  was  umealistic. 

A new  IDPA  fee  formula— reached  with  ISMS— took  ef- 
fect in  January,  1967.  Modeled  on  Medicare  fee  principles, 
it  employs  “usual,”  “customary”  and  “reasonable”  criteria, 
as  follows: 

USUAL 

The  “usual”  fee  is  that  fee  usually  charged  for  a given  service,  by 
an  INDIVIDUAL  physician  to  his  private  patient  (i.e.,  his  own 
usual  fee). 

CUSTOMARY 

A fee  is  “customary”  when  it  is  within  the  range  of  usual  fees 
charged  by  physicians  of  similar  training  and  experience,  for  the 
same  service  within  the  same  specific  and  limited  geographical  area 
(socio-economic  area  of  a metropolitan  area  or  socio-economic  area 
of  a county). 

REASONABLE 

A fee  is  “reasonable”  when  it  meets  the  above  two  criteria,  or  in 
the  opinion  of  the  responsible  local,  district,  or  state  medical  society 
review  committee,  is  justifiable,  considering  the  special  circumstances 
of  the  particular  case  in  question. 

To  determine  the  fee  pattern  in  each  county  for  various 
medical  procedures,  the  ISMS  sent  its  membership  a ques- 
tionnaire on  their  1966  charges.  More  than  60  per  cent  of 
the  questionnaires  were  completed  and  returned. 

While  comparable  in  principle.  Medicare  and  public-aid 
payments  follow  these  differences  in  practice: 

1.  “In  Medicare,  the  carriers  have  an  open-end  appropria- 
tion, but  our  monies  are  tied  to  biennial  legislative  ap- 
propriations,” remarked  Robert  G.  Wessel,  IDPA  chief 
of  medical  administration. 


for  December,  1968 


779 


MEMBERSHIP  SURVEY  RESULTS 


2.  Under  Medicare,  the  carriers  recognize  higher  fees  for 
specialists,  within  the  customary  and  prevailing  limits. 
“But  in  IDPA  we  pay  on  the  basis  of  the  procedure, 
whether  administered  by  a general  practitioner  or  a 
specialist,”  said  Wessel. 

3.  The  Medicare  carriers  can  make  individual  fee  adjust- 
ments, provided  these  do  not  exceed  the  prevailing  rates. 
“But  in  IDPA  we  cannot  consider  any  individual  escala- 
tion of  fees,”  said  Wessel.  “Any  increase  has  to  be  state- 
wide for  the  procedures  involved.” 

Wessel  quoted  a 1967  statement  on  this  point:  “The  De- 
partment will  consider  unreasonable  any  escalation  of  fees 
above  the  current  levels  unless  this  escalation  follows  agree- 
ment between  the  ISMS  House  of  Delegates  and  the  De- 
partment.” 

Despite  the  disparities  with  Medicare,  IDPA  officials 
believe  their  fee  formula  has  accomplished  its  primary  aims 
of:  (1)  assuring  more  realistic  payments,  and  (2)  encourag- 
ing more  physicians  to  participate  in  public  aid,  notably 
in  areas  where  there  are  large  concentrations  of  public-aid 
cases  but  few  doctors. 

Payments  for  treatment  of  public-aid  recipients  have 
more  than  doubled  since  adoption  of  the  fee  schedule.  Dr. 
Henry  A.  Holle,  IDPA  medical  director,  recently  noted. 
The  number  of  participating  M.D.’s  rose  from  3,228  in 
June,  1967,  to  5,554  last  March. 

“The  fees  are  much  better  than  they  have  been,”  re- 
marked Dr.  Joseph  R.  O’Donnell,  chairman  of  the  ISMS 
Committee  on  Usual  and  Customary  Fees.  “I  think  the 
physicians'  dissatisfaction  results  primarily  from  delay  in 
the  payment  of  fees  that  the  Department  questions,  and 
lack  of  ability  to  communicate  with  IDPA.” 


ACTION  TO  BE  TAKEN; 

The  Board  of  Trustees  referred  the  survey  response  to 
the  Committee  on  Usual  and  Customary  Fees. 

Dr.  Philip  G.  Thomsen,  ISMS  president  and  immediate 
past  chairman  of  that  committee,  has  indicated  that  a com- 
prehensive review  of  the  public-aid  fee  program  will  be 
sought.  He  has  called  for  adjustments  in  the  fees  paid 
specialists. 

Also,  ISMS  is  taking  steps  to  promote  greater  under- 
standing between  physicians  and  IDPA.  It  is  urging  all 
county  medical  societies  to  form  review  committees  to  help 
doctors  in  their  dealings  with  the  agency.  It  is  holding 
workshops  on  public  aid.  Medicare  and  other  government 
health  programs  to  familiarize  M.D.’s  and  their  assistants 
with  proper  claim  procedures. 


780 


Illinois  Medical  Journal 


MEMBERSHIP  SURVEY  RESULTS 


[alternatives  to  expanded  medicare?! 

^ --  

QUESTION  AND  GENERAL  RESPONSE; 

Fearing  the  Federal  Government  will  expand  its  health 
insurance  beyond  Medicare,  some  observers  call  for  steps 

to  amplify  private  insurance  coverage.  Would  you  favor:  % of  M.D.s 

in  FAVOR 

a.  Legislation  requiring  all  employers  to 
provide  health  insurance— through 
private  carriers— to  all  employees  and 

their  families?  55% 

b.  Graduated  rebates  on  federal  income  taxes 

to  help  persons  under  65  buy  broader 
health-insurance  coverage?  85% 

BREAKDOWN: 

The  only  marked  differences  appeared  in  the  inquiry  on 
mandatory  company-furnished  health  insurance,  as  follows: 


By  area: 

Chicago  Medical  Society  59% 

Downstate  50% 

By  type  of  practice: 

Solo  practice  55% 

Partnership  or  group  54% 

Hospital-based  60% 

BACKGROUND: 


A committee  of  the  AMA  has  noted  that  while  80  per 
cent  of  the  U.  S.  public  has  some  form  of  health  insurance, 
the  benefits  pay  only  a third  of  health-care  bills.  The  pa- 
tient generally  has  to  make  up  the  difference. 

As  an  answer  to  the  problem  of  health-care  bills.  Presi- 
dent Johnson  has  urged  extension  of  Medicare  to  certain 
groups  under  65. 

Some  observers  believe  mandatory  coverage  by  employers 
would  be  a most  direct  way  to  strengthen  and  extend  the 
benefits.  However,  the  question  has  arisen:  Can  physicians 
advocate  compulsion  of  private  corporations  while  insisting 
on  freedom  for  themselves? 

An  alternative  to  compulsory  plans  was  offered  by  the 
AMA  Council  on  Medical  Service  last  June.  Under  this 
proposal,  lower-income  people  under  65  would  get  credits 
on  federal  income  taxes  to  help  them  buy  fuller  health-in- 
surance protection.  The  rebates  would  be  graduated  ac- 
cording to  ability  to  pay.  If  someone  earned  too  little  to  be 
liable  for  taxes,  the  government  would  issue  him  a voucher 
to  buy  adequate  insurance.  Private  companies  and  prepay- 
ment carriers  would  issue  the  policies. 

ACTION  TO  BE  TAKEN: 

The  Board  of  Trustees  referred  the  survey  response  on 
this  issue  to  the  Council  on  Legislation  and  Public  Affairs 
and  the  Council  on  Medical  Service  for  study  and  recom- 
mendations. ISMS  support  of  the  rebate  proposal  would 
strengthen  any  effort  by  the  AMA  to  implement  it  in  Wash- 
ington. 


for  December,  1968 


781 


MEMBERSHIP  SURVEY  RESULTS 


ACTION  AQAINST  PHYSICIAN 
SHORTAGE? 


QUESTION  AND  GENERAL  RESPONSE; 

To  meet  the  physician  shortage  on  a short-term 
would  you  favor  any  of  the  following  steps: 


basis. 


An  accelerated  inflow  of  foreign  doctors, 
provided  they  meet  state  qualifications? 

% of  M.D.s 
in  FAVOR 

36% 

Programs  to  help  Americans  get  under- 
graduate medical  training  abroad  until 
U.  S.  facilities  are  sufficient— provided  the 
student  returns  to  this  country  for  postgraduate 

study  and  licensure? 

56% 

Government  grants  to  newly  graduated 
physicians  who  agiee  to  practice  a certain 
number  of  years  in  medically  deficient 
areas? 

81% 

More  intensive  action  by  medicine  and 
hospitals  to  sponsor  and  coordinate 
health  facilities  in  deficient  areas? 

93% 

81  % of  Illinois*  physicians  favor 
government  grants  to  newly  gradu- 
ated physicians  who  agree  to  prac- 
tice in  medically  deficient  areas. 


BREAKDOWN: 


mm 

93%  of  Illinois’  physicians  would 
like  to  see  more  intensive  action  by 
medicine  and  hospitals  in  sponsor- 
ing and  coordinating  health  facili- 
ties in  deficient  areas. 


Generally  the  only  marked  differences  were  by  area  as 
follows: 


Chicago 

Medical 

More 

Foreign 

M.D.s 

Foreign 

Study 

Programs 

Grants  for 
Needy- Area 
Practice 

M.D./ 

Hospital 

Cooperation 

Society 

38% 

61% 

85% 

95% 

Downstate 

35% 

51% 

76%- 

92% 

782 


Illinois  Medical  Journal 


MEMBERSHIP  SURVEY 


On  one  question— foreign  medical-study  programs  for 
U,  S.  students— the  age  categories  differed  as  follows: 


Under  40 
40  - 55 
Over  55 


BACKGROUND; 

a.  Increasingly  many  physicians  have  been  brought  from 
abroad  to  ease  the  U.  S.  shortage.  The  foreign-born  ac- 
count for  more  than  one-tenth  of  the  U.  S.  total.  Some 

12.000  of  them  are  serving  as  residents  and  interns  in 
American  hospitals.  Controversy  exists  on  this  point:  Will 
America’s  strict  standards  be  diluted  by  continued  heavy 
reliance  on  imported  M.D.’s,  particularly  those  from  under- 
developed and  “developing”  countries? 

b.  U.  S.  medical  schools  each  year  reject  about  half  their 

18.000  applicants.  In  the  eyes  of  many  observers,  a high 
proportion  of  the  “rejects”  are  capable  students,  unfairly 
victimized  by  the  lack  of  openings.  These  observers  call 
for  formalized  programs  and  incentives  to  enable  more  such 
students  to  get  their  undergraduate  medical  training  over- 
seas. At  present  “perhaps  400”  Americans  a year  enter 
European  schools  of  medicine,  according  to  an  AMA  report 
last  year.  The  ISMS  has  been  keenly  interested  in  the  do- 
mestic growth  of  physician  training.  Its  House  of  Delegates 
last  May  called  for  state  legislation  to  provide  per-student 
subsidies  to  Illinois  medical  schools;  the  Board  of  Trustees 
in  1966  held  that  a med  school  was  needed  Downstate. 

c.  A North  Carolina  medical  educator  recently  proposed 
that  the  Government  give  new  physicians  $100,000  tax-free 
for  working  five  years  in  care-pinched  rural  areas.  A Mass- 
achusetts internist  commented:  “But  why  limit  it  to  rural 
poverty  areas?  The  urban  poor,  sometimes  almost  in  the 
shadow  of  the  big  reaching  centers,  often  seem  to  fare  even 
worse  in  the  realm  of  day-to-day  medical  care.”  The  North 
Carolinian’s  proposal— and  the  comment— appeared  in  last 
June’s  issue  of  Medical  Economics. 

d.  Medicine  and  hospitals  could  cooperate  in  different 
ways  to  create  and  coordinate  health  facilities  in  deprived 
areas.  Three  ideas  are:  (1)  cooperation  through  voluntary 
areawide  or  local  planning;  (2)  establishment  of  commun- 
ity health  centers  with  Office  of  Economic  Opportunity  or 
private  funding;  (3)  use  of  mobile  units  or  comparable 
methods  to  extend  services  into  medically  needy  commun- 
ities. 

ACTION  TO  BE  TAKEN; 

The  Board  of  Trustees  referred  the  survey  responses  on 
questions  “a”  and  “b”  to  the  Council  on  Medical  Educa- 
tion, and  on  “c”  and  “d”  to  the  Council  on  Legislation  and 
Public  Affairs.  The  responses  will  guide  these  councils  in 
making  recommendations  on  health  manpower  and  medi- 
cal education  in  Illinois. 


% of  M.D.s 
in  FAVOR 
47% 
54% 
64% 


llUnois  Medical  Journal 


78S 


MEMBERSHIP  SURVEY  RESULTS 


CURTAILMENT  OF  WELFARE? 

QUESTION  AND  GENERAL  RESPONSE: 


Should  the  medical  profession  take  a basic 
stand  against  welfare  programs  and  urge  steps 
that  would  enable  the  federal,  state  and  local 
governments  to  curtail  them? 


% of  M.D.s 
in  FAVOR 
65% 


If  “yes,”  would  you  favor  any  of  these  approaches: 

a.  A guaranteed  annual  income  to  provide  an 

economic  floor  for  each  family?  17% 

b.  A guaranteed  annual  work  plan,  so  that  each 
employable  family  breadwinner  can  earn 

$3,200  a year?  82% 

c.  Government-backed  private  loans  to  encourage 

qualified  residents  of  deprived  areas  to 
develop  their  own  enterprises  and 
opportunities?  83% 


BREAKDOWN; 

The  most  interesting  differences  occurred  on  the  basic 
question:  Should  the  medical  profession  take  a stand 
against  welfare  and  urge  alternatives?  On  this  question, 
the  divisions  were  appreciable  in  these  membership  cate- 
gories: 

By  area: 

Chicago  Medical  Society 
Downstate 
By  field  of  practice: 

General  practitioners 
Specialists 
By  type  of  practice: 

Solo  practice 
Partnership  or  group 
Hospital-based 

On  the  three  alternatives  to  welfare,  Chicago  Medical 
Society  members  responded  more  favorably  than  downstate 
members  by  several  percentage  points. 


60% 

70% 

74% 

60% 

66% 

66% 

51% 


BACKGROUND; 

The  National  Advisory  Commission  on  Civil  Disorders 
—popularly  known  as  the  Kerner  Commission— challenged 
the  present  welfare  system  in  its  report. 

It  observed  that  the  setup  “contributes  materially  to  the 
tensions  and  social  disorganization  that  have  led  to  civil 
disorders.  The  failures  of  the  system  alienate  the  taxpayers 
who  support  it,  the  social  workers  who  administer  it,  and 
the  poor  who  depend  on  it.” 

Public  figures  and  economists  have  advanced  several  al- 
ternatives to  welfare. 


784 


Illinois  \M:edical  Journal 


MEMBERSHIP  SURVEY  RESULTS 


The  idea  of  a guaranteed  minimum  income  calls  for  as- 
suring every  family  at  least  $3,200  a year— the  government 
making  up  the  difference  if  the  family  earns  less  than  this. 
Fifty-eight  per  cent  of  the  general  public— including  45  per 
cent  of  those  making  under  $3,000  a year— opposes  the  idea, 
according  to  the  Gallup  Poll. 

However,  that  poll  found  78  per  cent  of  the  people  favor- 
ing the  proposal  for  a guaranteed  annual  WORK  plan. 

The  proposal  for  government-backed  private  loans  to  en- 
courage enterprise  among  the  poor  is  related  to  what  Presi- 
dent-elect Richard  M.  Nixon  calls  “black  capitalism.”  It 
crosses  party  lines,  however.  The  late  Sen.  Robert  F.  Ken- 
nedy wanted  steps  to  “promote  the  ownership  of  retail, 
commercial  and  industrial  enterprise  by  members  of  dis- 
advantaged minority  groups  and  residents  of  poverty 
areas.” 

ACTION  TO  BE  TAKEN: 


The  Board  of  Trustees  referred  the  survey  results  on 
these  questions  to  the  Council  on  Legislation  and  Public 
Affairs.  The  council’s  recommendations  could  guide  the 
House  of  Delegates  in  urging  appropriate  action  at  the 
state  level  or  by  AMA  at  the  national  level. 


LOCAL  CONTROL  OF  COMPREHENSIVE 

PLANNING? 


QUESTION  AND  GENERAL  RESPONSE; 

In  the  development  of  Comprehensive  Health 
Planning  programs,  should  the  initiative  and 
decision-making  rest  primarily  with  local  rather 
than  state  or  area  bodies? 


% of  M.D.s 
in  FAVOR 
72% 


The  initiative  and  decision-making  in  the  development  of  Comprehensive  Health 
Planning  programs  should  rest  primarily  with  local  agencies,  according  to  72% 
of  Illinois*  physicians. 


for'  December,  1968 


785 


BREAKDOWN; 

The  only  marked  differences  were  in  these  two  cate- 
gories: 

By  field  of  practice: 


General  practice 

79% 

Specialty 

69% 

^ type  of  practice: 

Solo  practice 

76% 

Partnership  or  group 

70% 

Hospital-based 

59% 

BACKGROUND; 

The  question  has  arisen:  Can  Comprehensive  Health 
Planning  achieve  its  stated  aims  without  subordinating  lo- 
cal authority  to  the  state  agencies  and  areawide  councils? 

The  U.  S,  Surgeon  General  said  CHP  “does  not  repre- 
sent the  imposition  of  a Master  Plan  by  government  upon 
the  people.”  A CHP  official.  Dr.  James  H.  Cavanaugh,  said 
it  “is  not  intended  to  replace  existing  decision-making 
processes.” 

On  the  other  hand,  another  element  in  the  Government 
“places  little  credence  in  the  vitality  or  effectiveness  of  lo- 
cal initiative  and  decisions  on  health  planning,”  the  AMA 
Council  of  Medical  Service  asserted. 

The  AMA  House  of  Delegates  last  June  concurred  in 
this  council’s  plea  “for  continued  efforts  to  preserve  local 
initiative  in  health  planning.” 

ACTION  TO  BE  TAKEN; 

The  ISMS  Board  of  Trustees  is  interested  in  keeping 
Comprehensive  Health  Planning  on  a voluntary  basis  that 
would  safeguard  local  prerogatives.  Seeking  specific  recom- 
mendations on  the  issue,  it  referred  the  survey  response  to 
the  society’s  Council  on  Legislation  and  Public  Affairs  and 
Council  on  Medical  Service. 

IN  THE  JANUARY  ISSUE  OF  IMJ; 

Membership  Survey  Analysis  on  PROFESSIONAL  PRACTICE  ISSUES. 


Adolescent  Disk 

Because  a lesion  of  the  lumbar  intervertebral  disk  at  L4.5  or  L5-S1  is 
usually  assumed  to  occur  after  30  years  of  age,  this  diagnosis  is  infre- 
quently made  in  the  adolescent.  Ten  cases  of  disk  herniation  in  such 
patients  recently  treated  by  us  ore  reviewed.  Our  experience  has  led  us 
to  differ  with  other  authors  in  the  following  respects.  Except  that  trauma 
is  a predominant  cause,  the  clinical  picture  of  lumbar  disk  herniation  in 
the  adolescent  is  identical  with  that  in  the  adult.  Since  cord  tumor  is  a 
more  frequent  source  of  the  typical  symptoms  than  Is  disk  herniation  in 
the  young,  we  recommend  early  myelography  for  this  age  group.  While 
a trial  of  conservative  therapy  may  be  useful,  our  results  suggest  that 
earlier  surgical  excision  will  lead  to  recovery  in  a greater  number  and 
will  produce  much  less  morbidity  in  the  adolescent  than  in  the  adult  group. 
(Sanford  R.  Weiss  and  Robert  Raskind.  The  Teen-Age  "Lumbar  Disk  Syn- 
drome." International  Surgery  [June]  1968;  49;6;  pg.  531.) 


786 


Illinois  Medical  Journal 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  an  effort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  physi- 
cians, the  Journal  is  publishing  synopses 
submitted  to  the  Physicians  Placement 
Service  concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  who  know  of  any  out-of-state 
physicians  seeking  an  Illinois  residence  are 
asked  to  notify  the  placement  service. 
Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addi- 
tional physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave,, 
Chicago  60601. 

KNOX  COUNTY:  Manquon;  popula- 
tion: 400.  Town  without  a physician  for 
many  years.  Last  physician  practiced  here 
for  60  years.  Nearest  physician  12  miles; 
nearest  hospitals  at  Galesburg,  17  miles. 
Combined  office  and  home  available  if  de- 
sired. Agricultural  community.  Methodist 
Church,  Grade  and  junior  high  schools; 
bus  service  to  high  school  at  Fairview. 
Nearest  recreational  facilities  at  Galesburg. 
For  further  information  contact: 

Mr.  Walter  Platt,  Township  Supervisor 
Mrs.  Gene  Strode; 

Mrs.  H,  D.  Sulteen; 

Mrs,  Ira  Moats;  or 
Mr.  W.  L.  Shaffer,  Maquon 
KNOX  COUNTY:  Oneida;  population: 
700.  Town  without  a physician  since  1954. 
Nearest  physician  10  miles;  nearest  hospi- 
tals at  Galesburg,  13  miles,  Peoria,  50 
miles.  Quad-cities,  50  miles.  Office  space 
available.  Predominant  nationality  is  Swed- 
ish. Agricultural  area.  Churches:  Metho- 
dist, Presbyterian.  Grade  and  high  schools. 
Swimming  and  golf  facilities  within  14 
miles.  Located  on  route  34  and  main  line 
of  CB&Q  Railroad.  For  further  informa- 
tion contact:  President  of  Lions  Club  or 
Anderson  State  Bank,  Oneida.  Phone:  309- 
483-2341. 

LASALLE  COUNTY:  Lostant;  popula- 
tion: 500.  Several  small  towns  in  trade  area 
without  physicians.  Nearest  physician,  5 
miles;  nearest  hospital  at  Peru,  16  miles; 


50  miles  from  Peoria.  Office  space  avail- 
able. Houses  for  rent  and  for  sale.  Finan- 
cial assistance  could  be  arranged.  Predom- 
inant nationality  is  German.  Source  of  in- 
come: agriculture,  industry.  Churches: 

Methodist,  Catholic.  Grade  and  high 
schools.  Four  hospitals  within  18  miles. 
Nearest  college,  12  miles.  For  further  in- 
formation contact:  Mr.  Guy  Placker,  Lo- 
stant. 

LASALLE  COUNTY:  Mendota;  popu- 
lation: 6700.  Trade  area,  24,000.  Practicing 
physicians,  5,  Mendota  Community  Hos- 
pital, 70  beds,  50  miles  from  Rockford. 
Three  prescription  drug  stores.  Predomi- 
nant nationality  is  German,  Sources  of  in- 
come: agriculture,  industry.  Churches: 

Eleven  Catholic  and  Protestant.  Grade  and 
high  schools.  Nine  hole  golf  course.  New 
swimming  pool  and  tennis  courts.  Rapidly 
expanding  industries  in  area.  For  further 
information  contact: 

J.  F.  Wacker,  M.D., 

1404  W.  Washington  St.,  Mendota 

Phone:  2149 

LASALLE  COUNTY:  Oglesby;  popula- 
tion: 4,000.  Only  one  physician— town  for- 
merly supported  4.  Nearest  hospital  at  La- 
Salle, 5 miles,  89  miles  from  Peoria,  65 
miles  from  Rockford.  Two  local  drug 
stores.  Available  office  space  includes  recep- 
tion room,  office,  2 examining  rooms,  li- 
brary, store  room  and  lab.  Predominant 
nationality  is  Italian.  Sources  of  income: 
agriculture,  cement  mills  and  small  indus- 
try. Churches:  Catholic,  Union,  Baptist. 
Grade  and  high  schools  and  Junior  Col- 
lege. Two  nearby  country  clubs,  recreation 
center  and  bowling  alley.  Active  Rotary 
Club.  Chicago,  100  miles.  Starved  Rock,  3 
miles.  For  further  information  contact: 
Mrs.  John  Rock  at  TU-3-8257. 

LASALLE  COUNTY:  Seneca;  popula- 
tion: 1,800;  trade  area,  3,000.  Office  build- 
ing built  to  serve  two  physicians.  Physician 
could  do  his  own  surgery  and  obstetrics. 
One  physician  in  community.  Nearest  hos- 
pital at  Ottawa,  15  miles,  114  beds.  Sources 
of  income:  agriculture,  explosives  factory 
and  oil  processing  plant.  Churches:  Cath- 
olic, Protestant.  Nearby  country  club.  For 
further  information  contact:  T.  F.  Mullen, 
M.  D.,  Seneca  61360. 


for  December,  1968 


ni 


SOCIO  ECONOMIC 

news 


A service  of  the  Public  Relations  and  Economics  Division 


Modified  Wording 
Asked  in  IDPA/ 
Physician  Agreements 


Sympathy  to  Health 
Bills  Foreseen  in 
New  Assembly 


Chicago  Trails  L.  A.  in 
Medical  Costs  of 
Elderly 


ISMS  will  ask  the  Illinois  Department  of  Public  Aid  to 
modify  a proposed  agreement  to  be  signed  by  all  physi- 
cians treating  public-aid  patients.  Agreements  are  required 
under  a 1967  amendment  to  the  Social  Security  Act,  effec- 
tive January  1,  1969.  However,  IDPA  officials  felt  the  text 
should  include  various  “information”  as  well  as  the  terms 
prescribed  by  the  amendment.  In  the  simplified  form  recom- 
mended by  the  ISMS  Committee  on  Usual  and  Customary 
Fees,  IDPA  would  agree  to  pay  the  MD  for  medical  serv- 
ices provided  directly  to  public-aid  recipients.  The  physi- 
cian, in  turn,  would  agree  to  bill  the  department  monthly 
for  services  performed  by  him,  keep  proper  records  and 
furnish  information  upon  request.  Either  the  physician 
or  the  department  could  terminate  the  agreement  upon 
30  days  written  notice.  The  committee  felt  that  other  parts 
of  IDPA’s  draft— describing  such  matters  as  the  general  fee 
pattern— should  be  transferred  to  an  accompanying  state- 
ment that  would  not  be  signed. 

Election  results  promise  a favorable  climate  for  health 
and  safety  legislation  in  the  76th  General  Assembly,  ISMS 
observers  believe.  The  ISMS  Council  on  Legislation  and 
Public  Affairs  was  to  have  met  December  7 to  plan  a course 
of  action  for  the  Assembly  session  starting  in  January. 
Socio-economic  measures  advocated  by  the  society  include 
an  Implied  Consent  bill,  which  would  require  motorists 
arrested  on  suspicion  of  drunk  driving  to  take  a blood- 
alcohol  test;  establishment  of  a Medical  Review  Board  to 
weed  out  physically  and  mentally  unsafe  drivers;  permis- 
sion for  hospitals  to  consolidate  emergency-room  facilities 
“where  feasible  and  desirable,”  and  per-student  subsidies 
to  medical  schools.  The  House  of  Delegates  next  May  is 
expected  to  weigh  therapeutic  abortion  and  neuro-psychia- 
tric examination  of  ail  candidates  for  parole;  both  legis- 
lative steps  were  unofficially  endorsed  in  the  recent  ISMS 
membership  survey. 

A retired  Chicago-area  couple  living  on  a “moderate” 
budget  of  $3,970  a year  would  spend  an  average  of  $282 
for  medical  care,  including  $148  out-of-pocket  costs  under 
Medicare  programs.  Social  Security  Bulletin  listed  about 
the  same  figures  for  Champaign-Urbana  and  Greater  St. 
Louis.  In  the  Los  Angeles  area,  however,  a $3,991  budget 
would  include  $331  for  medical  care. 


788 


Illinois  Medical  Joumat 


Physicians  Cautioned 
on  IDPA  Drug-Request 
Steps 


General  Assistance 
Aide  Cites  M.  D.  Errors 
in  Billing 


Agency's  Child  Care 
Includes  4,000  in 
Boarding  Homes 


The  many  physicians  who  have  started  treating  Illinois 
Department  of  Public  Aid  cases  are  cautioned  on  the  steps 
to  follow  in  seeking  approval  of  drugs  not  listed  in  the 
IDPA  Manual,  The  request  forms  must  show:  (1)  Patient’s 
name  and  case  number;  (2)  patient’s  address;  (3)  physi* 
cian’s  name  and  address;  (4)  name  of  the  specific  drug; 
(5)  diagnosis  of  case,  and  (6)  circumstances  requiring  the 
drug’s  use.  One  reason  for  these  steps  is  that  IDPA  keeps 
a file  on  each  patient.  The  requests  should  be  mailed  to 
the  Illinois  State  Medical  Society,  Committee  on  Drugs 
and  Therapeutics,  360  North  Michigan  Avenue,  Chicago, 
Illinois  60601.  Many  doctors  incur  serious  loss  of  time  by 
sending  the  requests  to  IDPA  offices,  said  Dr.  Robert  C. 
Muehrcke,  chairman  of  the  ISMS  drugs  committee. 

The  most  frequent  mistakes  made  by  physicians’  offices 
in  filing  Form  ^737  claims  under  state-supported  General 
Assistance  are:  (1)  setting  a lump  charge  for  the  procedures 
—charges  should  be  broken  down;  (2)  omission  or  incom- 
plete listing  of  the  procedure  code,  and  (3)  failure  to  in- 
clude the  physician’s  signature  and  AMA  medical  educa- 
tion number.  These  mistakes  were  pinpointed  by  Donald 
Coates,  supervisor  of  the  General  Assistance  Unit  of  Illi- 
nois Department  of  Public  Aid,  in  addressing  ISMS-spon- 
sored  Workshops  on  Government  Health  Programs. 

The  Illinois  Department  of  Children  8c  Family  Services 
—which  will  mark  its  fifth  anniversary  in  January— has 
been  caring  for  about  13,000  youngsters  in  recent  months. 
Some  4,000  of  these  are  in  boarding  homes  and  constitute 
the  agency’s  chief  responsibility  in  medical  care.  C8cFS  is 
one  of  the  agencies  that  have  been  participating  in  the 
ISMS’  statewide  Workshops  on  Government  Health  Pro- 
grams, Three  years  ago  ISMS  was  instrumental  in  the  pas- 
sage of  the  Abused  Child  Law,  which  C8cFS  administers. 

By  Don  B.  Freeman 


ISMS  Annual  Convention 


May  19-21, 1969 

Sherman  House,  Chicago 


jor  December,  1968 


789 


Association  Building 

Plans  to  break  ground  for  the  new  asso- 
ciation building  to  be  constructed  by  the 
Illinois  Pharmacy  Foundation  in  Rolling 
Meadows  (near  O’Hare  Field)  have  been 
scheduled  for  spring,  1969,  with  occupancy 
planned  for  December  of  the  same  year. 

The  complex  is  to  provide  extensive  fa- 
cilities, catering  to  the  Association  opera- 
tion, extensive  reproduction  facilities,  a 
mail  room,  conference  areas,  board  rooms, 
and  joint  reception  area,  which  would  be 
shared  by  all  association  tenants. 

The  fully  carpeted,  all  electric  building 
offers  parking  for  176  cars,  a specially  de- 
signed meeting  room  for  the  Board  of  Di- 
rectors, with  elaborate  audio  visual  facili- 
ties, and  the  advantage  of  being  just  a few 
minutes  from  O’Hare  Field. 

National  attention  is  centered  on  the 
venture,  catering  speciRcally  to  associations 
and  designed  to  provide  extensive  facili- 
ties, which  any  one  association  could  not 
afford  individually. 

Package  Disaster  Hospitals  Project 

The  Illinois  Veterinary  Medical  and 
Medical  professions  have  launched  a joint 
project  to  establish  70  package  Disaster 
hospitals  throughout  the  state.  These  hos- 
pitals are  strategically  located  and  provide 
all  residents  with  readily  available  200  bed 
units.  The  hospitals  can  be  functional 
within  two  hours  following  a disaster.  Sev- 
eral training  areas  have  been  established  at 
Springfield,  Elmhurst  and  Chicago  to  pro-^^ 
vide  veterinarians  and  physicians  to  serv- 
ice these  hospitals.  This  unique  program 
and  the  first  for  the  U.S.  is  under  the  di- 
rection of  Dr.  Max  Klinghoffer,  Elmhurst 
Memorial  Hospital,  Chairman  of  Civil 
Defense  for  the  Association  and  Dr.  Dan 
Parmer,  Richton  Park,  representing  the 
Veterinary  Medical  Profession. 


The  pioneers  who  fought  taxation  with- 
out representation  should  see  it  with 
representation. 

Each  piece  of  litter  picked  up  along  a 
highway  costs  32  cents  of  taxpayers’  money. 
Three  pickups  a year  along  one  mile  of 
highway  cost  $2,500. 

New  State  Dental  Society  Officers 
President— Robert  L.  Straub,  D.D.S. 

1439  W.  103rd  St.,  Chicago 
Pres.-Elect— E.  E.  Hoag,  D.D.S. 

511  Central  Bldg.,  Peoria 
Vice-Pres.— Joseph  T.  Brophy,  D.D.S. 

Ill  S.  Harlem  Ave.,  Forest  Park 
Secretary— Ralph  A.  Dickson,  D.D.S. 

Piasa  1st  Federal  Savings  Bldg.,  Alton 
Treasurer— Robert  M.  Unger,  D.D.S. 

2656  W.  63rd  St.,  Chicago 

New  President  for  Pharmacy 

Assuming  the  presidency  of  the  Illinois 
Pharmaceutical  Association  at  the  88th 
Annual  Convention  Meeting  in  Septem- 
ber at  the  Chicago  Marriott  Motor  Hotel 
was  Jack  T.  Keefer  of  Mt.  Prospect. 

Philip  Sacks  of  Norridge  was  elected  as 
president  elect. 

Three  vice  presidents  are  Roger  Cahill 
of  Streator,  Herbert  Carlin  of  La  Grange 
Park,  and  Daniel  Mulcahy  of  Springfield. 

Elected  secretary  was  Paul  Neumann  of 
Aurora  and  Norman  Garfinkel  of  Chicago 
as  treasurer. 

Titillating  Titles 

William  Dart,  Executive  Director  of  the 
Illinois  Society  of  Professional  Engineers, 
must  be  credited  with  the  greatest  journal- 
istic imagination  among  lAP  Journals.  His 
column  is  labeled  “Dart’s.”  When  Louis 
Bacon  was  President,  his  column  was  head- 
lined “Once  over  with  Bacon.”  Current 
President  I.  P.  Murphy  calls  his  “Murphy's 
Chowder.” 


790 


Illinois  Medical  Journal 


ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 

A Message  for  You,  Doctor 

By  Lina  Trotter 


Certified  Medical  Assistant!  These  are 
humble  words— not  proud.  Your  Medical 
Assistant,  contrary  to  what  you  might 
think,  if  she  becomes  a certified  medical 
assistant,  will  not  feel  she  “knows  it  all.” 
She  will  be  amazed  that  there  is  so  much 
yet  to  learn. 

Do  you  know  that  most  medical  assis- 
tants who  are  studying,  either  for  certifi- 
cation or  just  to  learn  more  about  the 
field,  are  studying  on  their  own  free  time— 
and  that  of  their  families?  It  is  because  she 
is  a dedicated  person  who  likes  her  work 
and  is  trying  to  improve  it  that  she  gives 
this  time  when  she  would  probably  really 
rather  be  spending  it  elsewhere.  You  will 
find  that  these  ladies  really  are  anxious  to 
improve  for  your  sake  and  your  patient’s 
sake  more  than  for  their  own. 

Why  don’t  you  get  a copy  of  the  outline 
for  study  for  these  examinations  and  find 
out  just  tvhat  a wide  field  certification  will 
cover— then  when  your  Medical  Assistant 
comes  to  you  and  tells  you  she  wants  to 
study  for  certification  you  will  realize  this 
is  an  opportunity  you  really  cannot  afford 
to  miss.  And  if  you  ever  get  a chance  to 
talk  to  them  on  the  day  of  examination 
you  cannot  help  but  be  impressed  by  their 
dedication.  If  you  are  willing  to  help  them 
with  their  studies  so  much  the  better— be- 
lieve me  you  will  have  a very  grateful 
Medical  Assistant. 

As  of  December  1967  there  were  13  Cer- 
tified Medical  Assistants  in  the  State  of 
Illinois.  We  have  not  yet  received  the  to- 
tal who  became  certified  as  a result  of  the 
examinations  this  year.  Wouldn’t  you  like 
your  medical  assistant  to  become  certified? 


What  benefits  will  your  Medical  Assis- 
tant receive  from  IMAA?  In  the  field  of 
education  alone  the  following  is  available: 

1.  At  our  annual  meeting  we  have  ap- 
proximately one  and  one  half  days 
of  educational  lectures. 

2.  An  annual  symposium  is  held  usually 
in  September  with  one  whole  day  de- 
voted to  education  in  the  form  of 
panels,  discussions  and  lectures. 

3.  In  the  last  year  we  also  have  held  a 
seminar  which  is  also  a one  day  edu- 
cational project. 

4.  Our  Newsletter;  published  four  times 
a year;  is  filled  with  educational  items. 

5.  Our  executive  memo  is  put  out  regu- 
larly to  acquaint  members  with  new 
activities,  new  ideas  and  new  oppor- 
tunities. 

6.  Study  groups  formed  by  local  Medical 
Assistant  groups  throughout  the  State 
of  Illinois  bring  educational  mater- 
ials to  the  local  level.  These  groups 
are  formed  mainly  for  the  purpose  of 
education  but  quite  a few  of  those 
who  study  in  these  gioups  also  go  on 
to  certification. 

All  of  these  opportunities  have  been 
made  possible  through  the  combined  ef- 
forts of  the  doctors  and  their  loyal  em- 
ployees. Much  of  their  free  time  has  gone 
into  this  effort  to  help  the  Medical  Assis- 
tant improve  her  education,  increase  her 
efficiency  for  you  and  your  patient,  and  fill 
her  with  the  dedication  necessary  for  a job 
such  as  hers. 

^Vhy  don’t  you  encourage  your  Medical 
Assistant  to  investigate.  Both  you  and  she 
will  be  glad  you  did! 


for  December,  1968 


795 


l||fS/<?d|n,^''/e/i 
^utmMmme  c 


ach 


XPECTORANT 


fftxidounce  contains:  80  mg.  Benadryl® 
(diphdtihydramine  hydrochloride,  Parke- 
Davis);  12  grains  ammonium  chloride; 

5 grairis  sodium  citrate;  2 grains  chloroform; 
iflO  grain  menthol;  and  5%  alcohol. 

An  anti  tussive  and  expectorant  for  control  of 
coughs  due  to  colds  or  of  allergic  origin, 
BENYLIN  EXPECTORANT  is  the  leading 
cough  preparation  of  its  kind.  BENYLIN 
EXPECTORANT  helps  break  down  tenacious 
mucous  secretions . . . tends  to  inhibit  cough 
reflex... soothes  irritated  throat  membranes 
. . . reduces  congestion  in  the  bronchial  tree. 

And  its  not-too-sweet,  pleasant  raspberry 
flavor  makes  BENYLIN  EXPECTORANT  , 
easy  to  take. 

PRECAUTIQNS:  Persons  who  have  becomdC'^.f  , 
drowsy  on  this  or  other  antihistamine-cop^ 
taining  drugs^  or  whose  tolerance  is  not’JkhdwUf 
should  hot  drive  vehicles  or  engage  iffothot . 
activities  requiring  keen  response  while  using 
this  preparation.  Hypnotics,  sedatf^es^'or'" 
tranquilizers  if  used  with  BENYLIN 
EXPECTORANT  should  be  prescatihed  with . 
caution  because  of  possible  a^ifpie  effect..  - 
Diphenhydramine  has  an  aHo^iedike- action 
which  should  be  considered%^Snpre^rib- 
ing BENYLIN  EXPBCTOJtANTt 
ADVERSE  REACTIONS:  Sid^eacHons 
aSfect  the  nprvous,  gastroint^Hnah  anc 
cardiovascular  systems:  DroW^ess,  dizzine^^ 
dryms^^of  mouth,  nausea,  nervousness, 
p^pMptidn/and'Muiting  of  visi^^^^e  been 
report^:  Allergic  ructions  may  occur. 
PACKAGING:  BoittWof  4 oz..  16  oz.,  andtl 
Davis  ^Company  > 

‘-'fyetroit,  Micl^g^^j^232 


.5% 


PARKE-DAVIS 


wMB 


Poisoning  As  A Serious 
Problem 


Nearly  a million  persons  accidentally 
swallow  poisonous  materials  annually  in 
the  United  States.  Of  this  number,  about 
2,100  die  and  many  more  sustain  perma- 
nent and  crippling  injuries,  according  to 
statisticians  of  Metropolitan  Life  Insurance 
Company. 

Since  1963,  the  death  rate  from  such 
poisoning  has  remained  at  nearly  11  per 
million  population,  which  is  16  percent 
higher  than  in  1960,  suggesting  a worsen- 
ing situation  in  recent  years.  This  increase 
in  deaths  due  to  accidental  poisoning  by 
solid  and  liquid  substances  has  occurred 
primarily  at  the  young  adolescent  and 
adult  ages.  At  ages  15-24  the  1965  death 
rate  from  this  cause  was  7.6  per  million 
among  males  and  3.4  among  females— rep- 
resenting increases  of  36  and  100  per- 
cent, respectively,  over  the  mortality  rates 
five  years  earlier.  At  ages  25-44  the  cor- 
responding death  rates  have  increased 
about  two-fifths  in  each  sex,  while  at  ages 
45-64,  the  rate  has  remained  the  same  for 
men,  but  has  risen  sharply  for  women. 

At  the  preschool  ages,  such  fatal  poison- 
ing has  decreased  markedly  in  recent  years, 
but  the  danger  of  poisoning  continues 
greater  among  very  young  children  than 
at  any  other  period  of  life.  At  age  1,  the 
1965  mortality  from  this  cause  was  50.3 
per  million  among  boys  and  36.3  among 
girls.  At  age  2,  the  corresponding  rates 
were  26.3  and  23.0.  The  next  highest  mor- 
tality rates  were  registered  at  ages  45-64, 
totaling  18.0  and  17.3  deaths  per  million 
men  and  women,  respectively. 

The  relative  importance  of  the  various 
substances  that  cause  accidental  poisoning 
fatalities  also  has  changed  in  recent  years. 
Since  1963,  the  barbiturates  and  their  de- 
rivatives have  been  the  leading  cause  of 


fatal  poisonings.  In  1965,  they  accounted 
for  18  percent  of  all  accidental  deaths  due 
to  poisoning  among  males,  and  for  35  per- 
cent among  females.  Between  1960  and 
1965,  the  deaths  attributable  to  these  drugs 
increased  by  three-fourths  among  males, 
and  doubled  among  females.  Barbiturates 
take  their  largest  toll  at  the  adult  ages. 
The  recent  rise  in  fatalities  due  to  these 
drugs  has  been  greatest  at  ages  45-64,  where 
they  were  responsible  for  257  deaths  in 
1965. 

The  loss  of  life  from  nonbarbiturate 
drugs  and  medicines  also  has  shown  an  up- 
trend. The  sedatives  and  the  analgesic  and 
soporific  drugs  in  this  category  (other 
than  aspirin  and  related  salicylates)  caused 
one-sixth  of  all  the  fatal  accidental  poison- 
ings in  1965.  In  that  year,  they  were  re- 
sponsible for  202  deaths  among  males  and 
148  among  females,  representing  an  in- 
crease of  about  150  percent  for  males  and 
70  percent  for  females  as  compared  with 
1960. 

On  the  other  hand,  deaths  from  the 
ingestion  of  wood,  denatured,  and  other 
alcohol  dropped  sharply  from  357  in  1960 
to  201  in  1965.  The  new  figures  account 
for  14  percent  of  fatal  poisonings  among 
men  and  4 percent  among  females,  in  con- 
trast to  26  and  13  percent,  respectively,  in 
1960.  These  poisons  no  longer  constitute 
the  leading  cause  of  accidental  poisoning 
in  the  U.  S.  Metropolitan  statisticians 
point  out,  however,  that  the  figures  may 
nevertheless  understate  the  current  in- 
volvement of  alcohol  in  deaths  due  to 
poisoning.  A recent  study  of  death  certi- 
ficates indicated  that  there  were  54  deaths 
in  1964  due  to  the  combined  effects  of 
alcohol  and  barbiturates,  and  29  deaths 
in  1964  attributed  to  the  combined  effects 
of  alcohol  and  nonbarbiturate  substances. 


for  December,  1968 


797 


LAKESIDE  LABORATORIES,  INC.,  Milwaukee,  Wisconsin  53201 


IN  BRIEF:  ACTION  AND  USES:  A single  dose  of  Imferon  (iron  dex- 
tran  injection)  will  measurably  begin  to  raise  hemoglobin  and  a 
complete  course  of  therapy  will  effectively  rebuild  iron  reserves. 
The  drug  is  indicated  only  for  specifically-diagnosed  cases  of  iron 
deficiency  anemia  and  then  only  when  oral  administration  of  iron 
is  ineffective  or  impractical.  Such  iron  deficiency  may  include: 
patients  in  the  last  trimester  of  pregnancy;  patients  with  gastro- 
intestinal disease  or  those  recovering  from  gastrointestinal  sur- 
gery; patients  with  chronic  bleeding  with  continual  and  extensive 
iron  losses  not  rapidly  replenishable  with  oral  iron;  patients 
intolerant  of  blood  transfusion  as  a source  of  iron;  infants  with 
hypochromic  anemia;  patients  who  cannot  be  relied  upon  to  take 
oral  iron. 

COMPOSITION:  Imferon  (iron  dextran  injection)  is  a well-tolerated 
solution  of  iron  dextran  complex  providing  an  equivalent  of  50  mg. 
in  each  cc.  The  solution  contains  0.9%  sodium  chloride  and  has 
a pH  of  5.2-6. 0.  The  10  cc.  vial  contains  0.5%  phenol  as  a pre- 
servative. 

ADMINISTRATION  AND  DOSAGE:  Dosage,  based  upon  body  weight 
and  Gm.  Hb/lOO  cc.  of  blood,  ranges  from  0.5  cc.  in  infants  to 
5.0  cc.  in  adults,  daily,  every  other  day,  or  weekly.  Initial  test 
doses  are  advisable.  The  total  iron  requirement  for  the  individual 
patient  is  readily  obtainable  from  the  dosage  chart  in  the  package 
insert.  Deep  intramuscular  injection  in  the  upper  outer  quadrant 
of  the  buttock,  using  a Z-track  technique  (with  displacement  of 
the  skin  laterally  prior  to  injection),  insures  absorption  and  will 
help  avoid  staining  of  the  skin.  A 2-inch  needle  is  recommended 
for  the  adult  of  average  size. 

SIDE  EFFECTS:  Local  and  systemic  side  effects  are  few.  Staining 
of  the  skin  may  occur.  Excessive  dosage,  beyond  the  calculated 
need,  may  cause  hemosiderosis.  Although  allergic  or  anaphylac- 
toid reactions  are  not  common,  occasional  severe  reactions  have 
been  observed,  including  three  fatal  reactions  which  may  have 
been  due  to  Imferon  (iron  dextran  injection).  Urticaria,  arthral- 
gia, lymphadenopathy,  nausea,  headache  and  fever  have  occa- 
sionally been  reported. 

PRECAUTIONS:  If  sensitivity  to  test  doses  is  manifested,  the 
drug  should  not  be  given.  Imferon  (iron  dextran  injection)  must 
be  administered  by  deep  intramuscular  injection  only.  Inject  only 
in  the  upper  outer  quadrant  of  the  buttock,  not  in  the  arm  or 
other  exposed  area. 

CONTRAINDICATIONS:  Imferon  (iron  dextran  injection)  is  contra- 
indicated in  patients  sensitive  to  iron  dextran  complex.  Since  its 
use  is  intended  for  the  treatment  of  iron  deficiency  anemia  only 
it  is  contraindicated  in  other  anemias. 

CARCINOGENICITY  POTENTIAL:  Using  relatively  massive  doses, 
Imferon  (iron  dextran  injection)  has  been  shown  to  produce  sar- 
coma in  rats,  mice  and  rabbits  and  possibly  in  hamsters,  but  not 
in  guinea  pigs.  The  risk  of  carcinogenesis,  if  any  in  man,  follow- 
ing recommended  therapy  with  Imferon  (iron  dextran  injection) 
appears  to  be  extremely  small. 

SUPPLIED:  2 cc.  ampuls,  boxes  of  10;  5 cc.  ampuls,  boxes  of  4; 
10  cc.  multiple  dose  vials. 

See  package  insert  for  complete  prescribing  Information. 


Each  10  CC.  vial  provides  as  much  iron  as  2 pints 
of  whole  blood.  And  use  of  IMFERON  rather  than 
whole  blood  for  iron  replacement  eliminates 
the  potential  dangers  of  hepatitis  and  whole  blood 
sensitivity  reactions.  Whole  blood,  of  course, 
should  be  used  if  clearly  indicated. 

IMFERON  dependably  increases  hemoglobin 
and  rapidly  replenishes  iron  reserves— 
for  iron  deficient  patients  in  whom  oral 
iron  is  intolerable,  ineffective  or  impractical, 
and  in  those  who  cannot  be  relied  upon 
to  take  oral  iron  as  prescribed. 

Precise  dosage  is  easily  calculated. 


i 


798 


Illinois  Medical  Journal 


Dear  Doctor:  October  31,  1968 

The  Committee  on  Drugs  and  Therapeutics 
is  anxious  to  do  as  good  a job  as  possible 
in  the  area  of  medications  for  recipients  of 
Public  Aid.  Due  to  the  increasing  number  of 
physicians  treating  these  cases,  it  is  well  to 
re\dew  the  pertinent  points  regarding  ap- 
proval of  drug  requests  not  listed  in  the 
manual  and  subsequent  authorization  for  pay- 
ment. 

The  Illinois  Department  of  Public  Aid  main- 
tains a separate  file  on  each  patient.  The  rec- 
ommendation form  which  the  Committee  on 
Drugs  and  Therapeutics  submits  to  the  De- 
partment must  contain  the  following  infor- 
mation : 

1.  Patient’s  name  and  case  number 

2.  Patient’s  address 

3.  Physician’s  name  and  address 

4.  Drug  requested 

5.  Diagnosis 

6.  Circumstances 

Requests  from  the  physicians  should  be 
mailed  directly  to  the  Illinois  State  Medical 
Society,  Committee  on  Drugs  and  Therapeu- 
tics, 360  North  Michigan  Avenue,  Chicago, 
Illinois  60601. 

Many  physicians  are  sending  their  requests 
to  the  Public  Aid  Department  in  their  own 
counties.  As  a result,  a considerable  time  loss 
occurs  before  the  letter  finally  reaches  its 
appropriate  destination. 

Your  cooperation  with  respect  to  furnish- 
ing the  Committee  with  the  proper  and  neces- 
sary information  Avill  facilitate  a fair  appraisal 
of  your  drug  requests,  and  will  assist  in  the 
expeditious  handling  of  each  item. 

Sincerely. 

/S/  ' 

Robert  C.  Muehrcke,  M.D.,  Chairman 
ISMS  Committee  on  Drugs  and  Therapeutics 


Ed.  note:  Membership  Forum  is  a means  for  the 
ISMS  physician  to  express  opinion  and  viewpoint 
on  varied  topics.  If  you  have  an  item  you  would 
like  brought  before  your  fellow  practitioners,  please 
submit  it  to  Membership  Forum,  Illinois  State 
Medical  Society,  360  X.  Michigan  Ave.,  Chicago 
60601.  Communications  should  not  exceed  230 
words.  The  right  to  abstract  or  edit  is  reserved. 
Names  will  be  withheld  upon  request,  but  anony- 
mous letters  will  not  be  accepted. 


lEd.  note:  The  following  communication  was  addressed  to 
Dr.  Philip  Thomsen,  ISMS  president,  dated  Oct.  18,  1968.) 

Dear  Dr.  Thomsen: 

I am  aware  of  your  deep  interest  in  medi- 
cal education  and  particularly  the  questions 
of  who  goes  into  medicine,  who  become  fam- 
ily physicians,  and  who  become  specialists. 
I would  like  to  tell  you  of  research  data  that 
bears  on  these  questions.  As  part  of  a large 
research  project,  we  have  extensive  biograph- 
ical data  on  approximately  630  entering  first- 
year  students  in  six  medical  schools  widely 
distributed  throughout  the  United  States,  one 
in  Illinois.  We  have  four  types  of  data  about 
each  of  these  students: 

1.  Medical  College  Admission  Test  scores. 

2.  Personality  characteristics  and  values 
based  on  three  standardized  psychometric 
instruments. 

3.  Attitudes  as  developed  in  a psychometric 
instrument  from  our  laboratory  called 
Cancer  Attitude  Survey.  Three  sets  of  at- 
titudes are  explored: 

a.  Attitudes  towards  psychic  resources  of 
patients  to  carry  the  burden  of  cata- 
strophic illness  such  as  cancer. 

b.  Attitudes  towards  the  value  of  early  diag- 
nosis and  aggressive  management  of 
cancer. 

c.  Attitudes  towards  death  including  im- 
mortality and  acceptance  of  and  prepara- 
tion for  death. 

4.  Extensive  biographical  and  environmen- 
tal data  from  a three-page  biographical 
inventory.  This  explores  in  depth  the  geo- 
graphic, religious,  economic,  family,  and 
educational  backgrounds.  Included  are 
items  invohfing  doctors  in  the  family,  con- 
tacts with  sick  persons,  jobs  in  hospitals, 
etc. 

The  students  were  asked  on  admission  to 
medical  school  what  fields  of  medicine  they 
wished  to  enter.  About  half  specified  a choice. 
118  listed  surgical  specialties.  112  family 
practice,  98  internal  medicine  or  pediatrics. 

We  have  taken  each  of  these  three  groups 
— that  is,  the  would-be  generalists,  surgeons, 
and  internists — and  compared  them  in  each 
of  the  four  areas  described  above.  e have 
found  significant  differences  in  each  of  the 
four  areas.  For  example,  general  practition- 
ers were  highest  on  the  verbal  and  science 
scores  on  the  MCAT,  while  the  would-be 
surgeons  were  significantly  lower.  There  were 
significant  differences  in  values.  The  gener- 


for  December,  1968 


790 


alists’  value  scores  were  low  on  economic 
and  high  on  social  and  religious.  The  sur- 
geons-to-be were  high  in  economic  and  low 
on  social.  The  internists  were  low  on  religious 
values.  There  were  differences  between  gen- 
eralists and  internists  in  some  of  the  attitude 
categories. 

Some  differences  were  seen  in  environ- 
mental background.  A higher  percentage  of 
would-be  general  practitioners  were  appar- 
ently influenced  in  career  choice  by  personal 
contact  with  physicians.  Other  differences 


were  also  seen. 

Our  data  would  seem  to  point  out  some  of 
the  factors  in  personality  and  background 
that  are  involved  in  initial  desires.  On  the 
other  hand,  the  fact  that  some  items  are  so 
similar  suggests  that  ultimate  decisions  de- 
pend more  on  experiences  in  medical  school 
than  on  previous  conditioning. 

Sincerely  yours, 

Harold  B.  Haley,  Jr.,  M.D. 
Professor  of  Surgery 
Stritch  School  of  Medicine 


Clinics  for  Crippled  Children  Listed 


Twenty-three  clinics  for  Illinois’  physi- 
cally handicapped  children  have  been 
scheduled  for  January  by  the  University 
of  Illinois,  Division  of  Services  for  Crip- 
pled Children.  There  will  be  eighteen 
general  clinics  providing  diagnostic  ortho- 
pedic, pediatric,  speech  and  hearing  exami- 
nation along  with  medical  social,  and  nurs- 
ing service.  There  will  be  three  special 
clinics  for  children  with  cardiac  conditions 
and  rheumatic  fever,  and  two  for  children 
with  cerebral  palsy.  Clinicians  are  selected 
from  among  private  physicians  who  are 
certified  Board  members.  Any  private  physi- 
cian may  refer  or  bring  to  a convenient 
clinic  any  child  or  children  for  whom  he 
may  want  examination  or  consultative 
services. 


Jan.  8 
Jan.  8 

Jan.  9 

Jan.  9 
Jan.  9 


Jan.  9 
Jan.  9 

Jan.  10 

Jan.  14 
Jan.  14 

Jan.  14 

Jan.  15 
Jan.  15 


Joliet— St.  Joseph’s  Hospital 
Champaign-U  r b a n a — McKinley 
Hospital 

Springfield  Genera  1— St.  John’s 
Hospital 

Cairo— Public  Health  Building 
Peoria  Cerebral  Palsy  (AM.)  — 
Allied  Agencies  Building,  320  E. 
Armstrong 

Flora— Clay  County  Hospital 
Sterling— Community  General  Hos- 
pital 

Chicago  Heights  Cardiac  — St. 

James  Hospital 

Quincy— St.  Mary’s  Hospital 

East  St.  Louis— Christian  Welfare 

Hospital 

Peoria  General— Children’s  Hos- 
pital 

Hinsdale— Hinsdale  Sanitarium 
Evergreen  Park— Little  Company 
of  Mary  Hospital 


Jan.  16  Elmhurst  Cardiac— Memorial  Hos- 
pital of  DuPage  County 
Jan.  16  Rockford  — Rockford  Memorial 
Hospital 

Jan.  16  Decatur— Decatur  8c  Macon  Co. 
Hospital 

Jan.  24  Chicago  Heights  Cardiac— St. 
James  Hospital 

Jan.  28  East  St.  Louis— Christian  Welfare 
Hospital 

Jan.  28  Peoria  General— Children’s  Hos- 
pital 

Jan.  29  Elgin— Sherman  Hospital 
Jan.  29  Centralia— St.  Mary’s  Hospital 
Jan.  29  Springfield  Cerebral  Palsy— Dio- 
cesan Center 

Jan.  29  Mt.  Vernon— Good  Samaritan  Hos- 
pital 

The  Division  of  Services  for  Crippled 
Children  is  the  official  state  agency  estab- 
lished to  provide  medical,  surgical,  cor- 
rective, and  other  services  and  facilities  for 
diagnosis,  hospitalization  and  after-care  for 
children  with  crippling  conditions  or  who 
are  suffering  from  conditions  that  may  lead 
to  crippling. 

In  carrying  on  its  program,  the  Division 
works  cooperatively  with  local  medical  so- 
cieties, hospitals,  the  Illinois  Children’s 
Hospital-School,  civic  and  fraternal  clubs, 
visiting  nurse  association,  local  social  and 
welfare  agencies,  local  chapters  of  the  Na- 
tional Foundation  and  other  interested 
groups.  In  all  cases,  the  work  of  the  Divi- 
sion is  intended  to  extend  and  supplement, 
not  supplant  activities  of  other  agencies, 
either  public  or  private,  state  or  local, 
carried  on  in  behalf  of  crippled  children. 


800 


Illinnis  Medical  Journal 


You  can  be  there 
withNCMETV! 


The  first  nationwide  medical 
television  service,  NCME— The 
Network  for  Continuing  Medical 
Education— brings  you  visually  the 
important  achievements  of  leading 
medical  authorities.  By  means  of 
closed-circuit  television,  this  inde- 
pendent network  provides  your 
hospital  or  medical  school  with  a 
complete  videotape  service  that 
helps  shorten  the  gap  between  new 
medical  knowledge  and  its  availabil- 
ity for  clinical  or  teaching  purposes. 

The  Network 
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Medical 
Education 


NCME  TV  Offers  These  Practical 
Benefits: 

□ Every  two  weeks  a new  60-minute 
videotape  dealing  with  three  separate 
medical  subjects  is  sent  to  participat- 
ing institutions. 

□ Content  and  format  of  NCME  tele- 
casts fulfill  criteria  for  postgraduate 
medical  education,  permitting  Ameri- 
can Academy  of  General  Practice 
course  credits  under  specified  condi- 
tions. 

□ To  help  your  institution  make 
effective  use  of  closed-circuit  televi- 
sion, NCME  offers  a wide  range  of 
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Technical  consultation  in  setting  up  a 
closed- circuit  system;  advance  pro- 
gram information  on  the  contents  of 
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publicize  programs;  expense-paid 
seminars  to  improve  utilization  of 
medical  television. 

□ NCME  programs  are  brief  and  may 
be  shown  as  often  as  desired;  you  can 
view  the  telecasts  at  times  that  are 
most  convenient,  without  disrupting 
your  normal  schedule. 


A recent  NCME  hospital  telecast 

presented  Philip  N.  Sawyer,  M.D., 
Professor  of  Surgery  and  Head  of  the 
\^ascular  Surgical  Service  at  Down- 
state  Medical  Center,  Brooklyn,  N.  Y, 
in  a demonstration  and  evaluation  of 
“Gas  Endarterectomy.” 

In  this  program,  Dr.  Sawyer  performs 
the  operation  on  a patient  with  gross 
occlusion  of  the  right  iliac,  femoral 
and  popliteal  arteries. 

In  Dr.  Sawyer’s  view,  gas  endarterec- 
tomy has  several  advantages  over 
mechanical  methods;  the  operation 
can  be  completed  faster,  causes  less 
damage  to  the  arteries  and  offers  a 
more  successful  outcome. 

NCME  is  an  independent  network 
supported  by  Roche  Laboratories  to 
increase  the  use  of  closed-circuit  TV 
for  medical  education  under  direct 
hospital  and  school  control. 

If  your  hospital  or  school  does  not 
participate  in  the  biweekly  NCME 
program,  information  on  the  cost-free 
service  may  be  obtained  by  writing  to 
NCME,  342  Madison  Avenue 
New  York,  N.  Y.  10017 


□ Frequently  NCME  makes  available 
published  papers  related  to  subjects 
presented  on  closed-circuit  television. 


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NEW 

PHARMACEUTICAL 

SPECIALTIES 

by  Paul  deHaen 


For  detailed  information  regarding  indications, 
dosage,  contraindications,  and  adverse  reactions, 
refer  to  the  manufacturers’  package  insert  or 
brochure. 

Single  Chemicals — Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products — Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products — Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms — Of  a previously  introduced 
product. 

NEW  SINGLE  CHEMICALS 
REPOISE  Ataraxic  R 

Manufacturer:  A.  H.  Robins  Co. 

Nonproprietary  Name:  Butaperazine  Maleate 
Indications:  Chronic  schizophrenia 
Contraindications:  Coma,  circulatory  collapse, 

bone  marrow  depression,  history  of  jaundice, 
blood  dyscrasias  or  hypersensitivity  related  to 
other  phenothiazines. 

Dosage:  Adults:  5-10  mg.  tid,  increase  by  5-10 
mg.  every  few  days  until  maximum  response 
is  obtained.  Dosages  exceeding  100  mg.  daily 
are  not  recommended. 

Supplied:  Tablets — 5,  10  and  25  mg.  base;  bottles 
of  100  and  500. 


DUPLICATE  SINGLE  PRODUCTS 

AMCILL  Antibiotic — Penicillin  R 

Manufacturer:  Parke,  Davis  & Co. 

Nonproprietary  Name:  Ampicillin  trihydrate 

Indications:  Infections  due  to  susceptible  strains 
of  Gram-negative  or  Gram-positive  bacteria. 

Contraindications:  Hypersensitivity  to  penicillin, 
infections  due  to  penicillinase-producing  bac- 
teria. 

Dosage:  Adults:  250-500  mg.,  q6h. 

Children:  50-100  mg./kg./day  in  divided  doses 
3-4  times  daily. 

Supplied:  Capsules — 250  and  500  mg.;  bottles  of 
24  and  100. 


AMCILL-S  Antibiotic-Penicillin  R 


Manufacturer:  Parke,  Davis  & Co. 

Nonproprietary  Name:  Ampicillin,  sodium 

Indications:  Infections  due  to  susceptible  strains 
of  Gram-negative  or  Gram-positive  bacteria. 

Contraindications:  Hypersensitivity  to  penicillin, 
infections  due  to  penicillinase-producing  bac- 
teria. 

Dosage:  Adults:  250-500  mg.,  q6h. 

Children:  25-50  mg./kg./day  in  divided  doses, 
q6h. 

Supplied:  Vials  (powder) — 250  and  500  mg. 


GYNOREST  Hormone — Progesterone 

Manufacturer:  Mead  Johnson  Laboratories 
Nonproprietary  Name:  Dydrogesterone 

(Continued  on  page  804) 


R 


802 


Illinoh  Medical  Journal 


“Will  I ever 
catch  up  on 
my  work?” 


® tablets: i 

32  mg grain) 

50  mg .^^B^’grain) 

100  mg (IV2  grains) 


brand  of 


m 


ENDABLE  DAYTIME  SEDATION 


Winthrop  Laboratories 
New  Yor4<,  N.  Y.  10016 


yj^mfArop 


Mebaraf®  usually  calms  the  anx« 
ious  patient  without  the  degree 
of  languor,  or  decrease  in  alert- 
ness often  caused  by  other  bar- 
bituratesJ  Mebaral  is  particularly 
valuable  in  treating  anxiety-ten- 
sion states  when  minimal  hypnot-- 
ic  action  is  desired.^  Its  sedative 
action  is  prolonged^  and  pre- 
dictable. 


Contraindication:  Large  doses  are 
contraindicated  in  patients  with 
nephritis. 

Warning:  May  be  habit  forming. 

Precautions:  As  with  other  barbi- 
turates, caution  is  advisable  dur- 
ing use  in  debilitated  and  senile 
patients  and  in  patients  with  pul- 
monary disease. 

Adverse  reactions:  Although 
Mebaral  is  generally  well  tolerated 
over  long  periods,  the  possibility 
of  idiosyncrasy  to  barbiturates  (as 
manifested  by  drowsiness,  ver- 
tigo, and  cutaneous  eruptions) 
should  be  considered. 

Dosage:  Adults,  for  daytime  seda- 
tion—V2  gr.  (32  mg.),  % gr.  (50  mg.) 
and,  at  times,  II/2  gr.  (100  mg.), 
three  or  four  times  daily. 

References;  1.  Musscr,  Ruth  D.,  and  Shub- 
kagel,  Betty  L.:  Pharmacology  and  Therapeu- 
tics, ed.  3.  New  York,  Vacmillan  Company, 
1965,  p.  363.  2.  Council  c~  Drugs.  American 
Medical  Asscciatior:  New  Drugs  1965,  Chi- 
cago, American  Medical  Association.  1965, 
p.  157.  3.  Model!,  Walter  lEd  t:  D'ugs  in  Cur- 
rent Use  1966,  New  Yor<.  Porinsor  Publishing 
Company,  1966,  p.  77, 


anticostive* 

hematinic 


PERITINIC* 

Hematinic  with  Vitamins  and  Fecal  Softener 

A tablet^day  provides: 

• Elemental  Iron  (as  Ferrous  Fumarate) . 100  mg 

• Dioctyl  Sodium  Sulfosuccinate  ( to  _ 

counteract  constipating  effect  of  iron)  100  mg 


Vitamin  Bi 7.5  mg 

Vitamin  B2 7.5  mg 

Vitamin  Ba 7.5  mg 

Vitamin  B12 50  mcgm 

Vitamin  C 200  mg 

Niacinamide 30  mg 

Folic  Acid 0.05  mg 

Pantothenic  Acid 15  mg 


Bottles  of  60 

anticostive,  adj,  {anti  opposed  to 
+ costive  causing  constipation.) 
Against  constipation.  (Now  isn't 
that  a good  idea  in  an  iron-contain- 
ing hematinic  1) 


LEDERLE  LABORATORIES 


A Division  of  American  Cyanamid  Company 
Pearl  River,  New  York  10965 


488-7R-6062 


New  Pharmaceutical  Specialties 

(Continued  from  page  802) 

Indications:  Primary  dysmenorrhea,  primary  and 
secondary  amenorrhea,  endometriosis,  threat- 
ened and  habitual  abortion  due  to  progeste- 
rone insufficiency,  infertility  due  to  inadequate 
luteal  activity,  pregnancy  test. 

Contraindications:  None  known. 

Dosage:  Determined  by  indication  for  which  it 
is  used. 

Supplied:  Tablets — 5 mg.;  bottles  of  50 
10  mg.;  bottles  of  100 

COMBINATION  PRODUCTS 


TRIND-DM  Cough  Preparation  o-t-c 

Manufacturer:  Mead  Johnson  Laboratories 
Composition:  Each  5cc.  contains: 

Phenylephrine  HCl  2.5  mg. 

Acetaminophen  150.0  mg. 

Dextromethorphan  HBr  7.5  mg. 

Glyceryl  guaiacolate  50.0  mg. 

Alcohol  15  % 

Chloroform  0.1  % 


Indications:  Symptomatic  treatment  of  coughs 
and  colds 

Contraindications:  None  mentioned 
Dosage:  Children  3 to  6 years;  1 tsp.  q.3-4h. 

6 to  12  years:  2 tsp.  q.3-4h. 

Adults:  2-4  tsp.  q.3-4h. 

Supplied:  Syrup — ^bottles  of  4 fl.  oz. 
VI-DAYLIN  Plus  IRON  Vitamins— Multiple 

o-t-c 

Manufacturer:  Ross  Laboratories 
Composition:  Vitamins  A,  B complex,  C,  D,  nia- 
cinamide, ferrous  fumarate. 

Indications:  Nutritional  supplement 
Contraindications:  None  mentioned 
Dosage:  One  tablet  daily 
Supplied:  Tablets,  chewable;  bottles  of  60. 

NEW  DOSAGE  FORMS 
AMCILL  Drops  Antibiotic — Penicillin  R 

Manufacturer:  Parke,  Davis  & Co. 
Nonproprietary  Name:  Ampicillin  trihydrate 
Indications;  Infections  due  to  susceptible  strains 
of  Gram-negative  or  Gram-positive  bacteria. 
Contraindications:  Hypersensitivity  to  penicillin, 
infections  due  to  penicillinase-producing  bac- 
teria. 

Dosage:  Infants:  up  to  5 kg. — 62.5  or  125  mg.  q6h. 

5-7.5  kg. — 94  or  188  mg.,  q6h. 

7.6-10  kg. — 125  or  250  mg.  q6h. 
Supplied:  Pediatric  Drops — 100  mg./cc;  bottles 
of  20  cc  with  dropper,  (to  be  reconstituted) 
AMCILL  Suspension  Antibiotic — penicillin  R 

Manufacturer:  Parke,  Davis  & Co. 
Nonproprietary  Name:  Ampicillin  trihydrate 
Indications:  Infections  due  to  susceptible  strains 
of  Gram-negative  or  Gram-positive  bacteria. 
Contraindications:  Hypersensitivity  to  penicillin, 
infections  due  to  penicillinase-producing  bac- 
teria. 

Dosage:  Adults:  250-500  mg.  q6h. 

Children:  50-100  mg./kg./day  in  divided  doses 
3-4  times  daily. 

Supplied:  Oral  Suspension — 125  and  250  mg./5cc.; 

bottles  of  80  cc.  (To  be  reconstituted) 
PFIZERPEN  Antibiotic — Penicillin  R 

Manufacturer:  Pfizer  Laboratories 
Nonproprietary  Name:  Penicillin  G,  Potassium 
Indications:  Mild  to  moderately  severe  infections 
caused  by  penicillin-susceptible  pathogens. 
Contraindications:  Hypersensitivity  to  it. 

Dosage:  400,000  U.  q.i.d.,  taken  on  an  empty 
stomach. 

Supplied:  Powder  for  Syrup — 400,000  U./5  cc.; 
bottles  of  80  and  150  cc. 


804 


Illinois  Medical  Journal 


Is  it  depression? 

She  says  "I’m  always  on  edge...” 


% 


.but  her  other  symptoms: 
depressed  mood,  insomnia, 
anorexia,  feeiings  of  guiit 
strongly  suggest 
an  underlying  depression. 


when  the  diagnosis  is  depression 

ELAVIE™ 

(AtiiniprviJNEiiaini) 

Indications:  Mental  depression  and  mild  anxiety  accompany- 
ing depression. 

Contraindications:  Glaucoma  and  predisposition  to  urinary  re- 
tention. Not  recommended  in  pregnancy. 

Precautions  and  Side  Effects:  Drowsiness  may  occur  within  the 
first  few  days  of  therapy.  Patients  should  be  warned  against 
driving  a car  or  operating  machinery  or  appliances  requiring 
alert  attention.  When  depression  is  accompanied  by  anxiety 
or  agitation  too  severe  to  be  controlled  by  ELAVIL  HCI  alone, 
a phenothiazine  tranquilizer  may  be  given  concomitantly. 
Suicide  is  always  a possibility  in  mental  depression  and  may 
remain  until  significant  remission  occurs.  Supervise  patients 
closely  in  case  they  may  require  hospitalization  or  concomitant 
electroshock  therapy.  Untoward  reactions  have  been  reported 
after  the  combined  use  of  antidepressant  agents  having 
varying  modes  of  activity.  Accordingly,  consider  possibility 
of  potentiation  in  combined  use  of  antidepressants.  Mono- 
amine oxidase  inhibitor  drugs  may  potentiate  other  drugs  and 
such  potentiation  may  even  cause  death;  permit  at  least  two 
weeks  to  elapse  between  administration  of  two  agents;  in 
such  patients,  initiate  therapy  with  ELAVIL  HCI  cautiously  with 
gradual  increase  in  dosage  required  to  obtain  a satisfactory 
response.  Caution  patients  about  errors  of  judgment  due  to 
change  in  mood,  and  that  the  response  to  alcohol  may  be 
potentiated.  May  provoke  mania  or  hypomania  in  manic-de- 
pressive patients. 

Side  effects  include  drowsiness;  dizziness;  nausea;  excitement; 
hypotension;  fine  tremor;  jitteriness;  weakness;  headache; 
heartburn;  anorexia;  increased  perspiration;  incoordination; 
allergic-type  reactions  manifested  by  skin  rash,  swelling  of 
face  and  tongue,  itching;  numbness  and  tingling  of  limbs, 
including  peripheral  neuropathy;  activation  of  schizophrenia 
which  may  require  phenothiazine  tranquilizer  therapy;  epi- 
leptiform seizures  in  chronic  schizophrenics;  temporary  con- 
fusion, disturbed  concentration  or,  rarely,  transient  visual 
hallucinations  on  high  doses;  evidence  of  anticholinergic  ac- 
tivity, such  as  tachycardia,  dryness  of  the  mouth,  blurring  of 
vision,  urinary  retention,  constipation;  paralytic  ileus;  jaun- 
dice; agranulocytosis. 

Careful  observation  of  all  patients  is  recommended.  The  anti- 
depressant activity  may  be  evident  within  3 or  4 days  or 
may  take  as  long  as  30  days  to  develop  adequately,  and  lack 
of  response  sometimes  occurs.  Response  to  medication  will 
vary  according  to  severity  as  well  as  type  of  depression  pres- 
ent. Elderly  patients  and  adolescents  can  often  be  managed 
on  lower  dosage  levels. 

Supplied:  Tablets  ELAVIL  HCI,  containing  10  mg.,  25  mg.,  and 
50  mg.  amitriptyline  HCI,  bottles  of  100  and  1000;  Injection 
ELAVIL  HCI,  in  10-cc.  vials,  containing  per  cc.:  10  mg.  ami- 
triptyline HCI,  44  mg.  dextrose,  1.5  mg.  methylparaben,  and 
0.2  mg.  propylparaben. 

For  more  detailed  information,  consult  your  Merck  Sharp  & 
Dohme  representative  or  see  the  package  circular. 

® MERCK  SHARP  & DOHME  Ovision  0'  Merck  i Co  INC  Aest  Fbmt  Pa  19486 

WHERE  today’s  THEORY  IS  TOMORROWS  THERAPY 


Abstracts  of  Board  Actions 

(Continued  from  page  729) 

COOPERATION  IN  MEDICAL  TESTIMONY 

Mr.  Frank  Pfeifer,  ISMS  legal  counsel,  called  attention 
to  the  request  for  cooperation  in  the  provision  of  medical 
testimony  before  the  Medical  Examining  Board  on  the  ques- 
tion of  revocation  and  suspension  of  licenses.  He  outlined 
in  detail  the  procedure  to  be  followed  with  regard  to  the 
presentation  of  testimony. 

Counsel  further  indicated  that  the  Committee  on  Medical 
Practice  and  Quackery  had  requested  a report  to  the  Trus- 
tees that  the  committee  had  approved  a plan  of  cooperation 
with  the  Department  of  Registration  and  Education.  The  Com- 
mittee requested  that  it  be  allowed  to  implement  its  plan 
to  provide  physicians  in  medical  cases  where  medical  testi- 
mony was  needed  before  the  Department.  The  plan  of  coopera- 
tion with  the  Department  of  R.  and  E.  regarding  medical 
testimony  was  adopted. 

USUAL  AND  CUSTOMARY  FEES  PROCEDURES 

The  U.  & C.  Committee  has  discussed  two  major  issues;  one 
concerns  the  IDPA  method  of  processing  individual  physi- 
cian's claims,  the  other  methods  used  by  IDPA  in  arriving  at 
a statistical  report  on  physician  payments.  A frequent 
error  is  that  physicians  are  not  billing  at  their  usual  and 
customary  fee  but  at  figures  furnished  from  other  sources. 
A statistical  report  was  noted  with  regard  to  increases  in 
the  Consumer  Price  Index  and  in  doctors'  fees.  It  empha- 
sized that  the  rise  in  doctor's  fees  was  commensurate  with 
the  rise  in  the  Consumer  Price  Index. 

MALPRACTICE  SCREENING  PANEL  O.K.'D.  FOR  DISCUSSION 

The  Board  authorized  the  Medical-Legal  Council  to  pursue 
its  discussions  further  with  the  Illinois  Bar  Association 
regarding  the  possible  establishment  of  a Malpractice 
Screening  Panel.  The  proposed  panel  would  hear  evidence  and 
review  claims  on  a closed-door  basis  before  litigation  is 
pursued. 

ISMS  TO  ACT  AS  FRIEND  OF  THE  COURT 

A group  known  as  the  Illinois  Pure  Water  Committee  has 
filed  suit  in  Madison  County  challenging  the  legality  of 
the  new  Fluoridation  Act.  At  the  request  of  Dr.  Yoder,  ISMS 
has  taken  steps  to  intervene,  along  with  the  Dental  Asso- 
ciation. 

ISMS  TO  REQUEST  REDEFINITION  WITH  REGARD  TO  RMP 

The  ISMS  will  request  the  next  National  Administration 
on  Capitol  Hill  to  have  the  Secretary  of  HEW  supplement  his 
National  Advisory  Committee  on  RMP  with  a list  of  practicing 
physicians  (furnished  by  the  AMA)  who  will  attempt  to  de- 
fine more  specifically  what  related  diseases  are  to  be  in- 
cluded in  regional  medical  programs  before  enactment  of 
any  further  health  legislation.  This  is  the  substance  of  a 
resolution  to  be  presented  by  ISMS  at  the  AMA  convention. 

(Abstracts  continued  on  page  810) 


806 


TIJinois  Medical  Journal 


Don’t  use  Megan 
on  all  your  patients- 

consider  Megan 
for  those  patients 
who  cannot  take  aspirin 
because  of  gastric 
discomfort 

Private  Practice  Physicians  tried  Magan  on  almost 
700  patients  whom  they  judged  intolerant  to  aspirin 
and  other  salicylates. 

The  majority  of  these  patients  could  take  Magan 
and  obtain  the  benefit  of  salicylate  therapy. 


an  alternate  salicylate 

(magnesium  salicylate,  W-T) 

May  be  tolerated  by  some  persons  intolerant  to 
aspirin  by  reason  of  gastrointestinal  irritation. 

Magan  is  a new  salicylate  product  from  Warren-Teed. 

A single  chemical  entity ...  no  coating,  no  buffering, 
sodium  free  and  non-acetylated. 


Abstracts  of  Board  Actions 

(Continued  from  page  806) 

SCHOOL  HEALTH  EXAMINATION  RECORD  RECONSIDERED 

The  Board  was  informed  that  the  Committee  on  Child  Health 
approved  the  proposed  School  Health  Examination  Record  to- 
gether with  a suggestion  that  space  be  provided  for  record- 
ing blood  pressure  and  the  type  of  Tuberculin  test  admin- 
istered on  the  record,  as  well  as  dates.  A written  minority 
report  in  relation  to  this  was  read.  Following  extended  dis- 
cussion, the  matter  was  referred  back  to  the  Committee  on 
Child  Health  for  reconsideration. 

SURVEY  RESULTS  TO  BE  BASIS  FOR  ACTION 

Dr.  Frank  Jirka,  chairman  of  the  Board,  indicated  that 
Mr.  Roger  White,  executive  administrator,  had  been  directed 
to  prepare  a plan  for  referral  of  each  of  the  items  of  the 
membership  survey  to  appropriate  Councils  and  Committees 
for  follow-up  study  and  possible  implementation  plans. 

NURSING  COMMITTEE  TO  STUDY  SCHOOLS  OF 
PRACTICAL  NURSING 

The  Chicago  Council  on  Community  Nursing  requested  that 
ISMS  endorse  a resolution  on  Schools  of  Practical  Nursing 
aimed  at  forcing  the  closing  of  schools  of  practical  nursing 
operated  under  the  Vocational  School  Act.  Upon  the  recom- 
mendation of  the  Executive  Committee,  the  Board  agreed  that 
this  matter  be  referred  to  the  Nursing  Committee  for  further 
study. 

AUDIOMETRY  AND  HEARING  CONSERVATION 

Dr.  Edward  A.  Pizsczek,  chairman.  Public  Health  Committee , 
recommended  approval  of  a training  program  to  provide  in- 
struction in  audiometry  and  hearing  conservation.  A July 
12,  1968  letter  from  Dr.  Franklin  D.  Yoder,  outlined  the 
program  and  requested  endorsement  of  the  Society.  The  Board 
approved. 

ISMS  TO  PRESENT  RESOLUTION  TO  AMA 

Dr.  Willard  Scrivner  requested  that  the  ISMS  express  its 
concern  to  both  State  and  Federal  legislators  that  all  funds 
and  grants  henceforth  allowed  medical  schools  be  tied  in 
some  way  to  a formula  for  the  end  product  of  medical  schools, 
i.e. , graduates.  A resolution  will  be  presented  to  the  AMA 
House  of  Delegates  at  the  Miami  meeting  establishing  this 
as  national  policy. 

COOPERATION  WITH  NATIONAL  CENTER  ENDORSED 

Upon  the  request  of  Dr.  Franklin  D.  Yoder,  director,  Il- 
linois Department  of  Public  Health,  and  upon  the  recommen- 
dation of  the  Executive  Committee,  the  Board  endorsed  co- 
operation with  the  National  Center  for  Health  Statistics 
in  relation  to  scientific  studies  based  on  death  certifi- 
cates. 


810 


Illinois  Medical  Journal 


Index  To  Volume  134 


July  through  December,  1968 


Page  1-112  July 
113-216  August 
217-340  September 
341-592  October 
593-712  November 
713-826  December 


A 

Abdomen,  Blunt  trauma  (Surgical  Grand 
Rounds)  276 

Adler,  J.  J.,  Barrash,  M.  J.,  and  Lash,  S.  R., 
MYOCARDIAL  infarction  during  pregnancy, 
143 

Alpern,  W.  M.,  Charles,  A.  G.,  Friedman,  E.  A., 
Scommegna,  A.,  Silverman,  A.  R.,  and  Wu,  P., 
Medical  progress  in  the  severely  affected 
Rh-SENTISITIZED  pregnancy,  37 
Amador,  L.  V.,  jt.  auth.  See  Luis-Porras,  C. 
Automotive  injury 

And  the  practicing  physician  (Diamond  & 
Charles)  645 


B 

Barrash,  M.  J.,  jt  auth.  See  Adler,  J.J. 

Beal,  J.  M.,  Ed.,  Surgical  Grand  Rounds: 
Northwestern  University  Medical  Center  54; 
154;  276;  638;  749 

Becker,  B.  jt.  author.  See  Snively,  W.  D.,  Jr. 
Becker,  F.,  jt.  auth.  See  Bessinger,  H.  E. 
Bessinger,  H.  E.,  Silver,  J.,  Teng,  C-Y.,  Evaristo, 
E.,  Chua,  E.,  Becker,  F.,  and  Rothmund,  P., 
INTENSIVE  cardiac  care — two  years  ex- 
perience, 737 

Bigsby,  F.  L.,  and  Muniz,  C.,  MEDICAL  MAN- 
AGEMENT of  obese  people:  timely  observa- 
tions, 180 


BOOK  REVIEWS 

Bishop,  P.  A.,  Radiological  Studies  of  the 
Gravid  Uterus,  46 


Brochure  by  HEW — list  of  films  and  filmstrips 
of  member  agencies  of  the  National  In- 
teragency Council  on  Smoking  and  Health, 
152 

Brown,  C.  H.  (ed.).  Diagnostic  Procedures  in 
Gastroenterology,  656 

Ellis,  F.  H.,  Jr.,  Surgery  for  Acquired  Mitral 
Valve  Disease,  556 

Flowers,  C.  E.,  Jr.,  Obstetric  Analgesis  and 
Anesthesia,  278 

Hamburger,  J.,  Richet,  G.,  Crosnier,  J.,  Funck- 
Brentano,  J.  L.,  Antoine,  B.,  Ducrot,  H., 
Mery,  J.  P.,  and  deMontera,  H.,  Nephrol- 
ogy— volumes  I and  II,  46 

Hoskins,  J.  M.,  Virological  Procedures,  748 

Lewis,  J.  E.  (ed).  Atlas  of  Infant  Surgery,  556 

Paletta,  F.  X.,  Pediatric  Plastic  Surgery — vol. 
I,  Trauma,  557 

Roen,  P.  R.,  Atlas  of  Urological  Surgery,  748 

Smith,  J.  L.,  (ed.),  Neuro-Ophthalmology,  557 

Spratt,  J.  S.,  Jr.,  and  Donegan,  W.  L.,  Cancer 
of  the  Breast,  152 

Wells,  B.  B.,  and  Halsted,  J.  A.,  Clinical  Path- 
ology/Interpretations and  Application,  656 
Buell,  W.  F.,  jt.  auth.  See  McCain,  W.  H. 


C 

Cavins,  H.  M.,  and  Read,  H.,  DR.  SAMUEL 
Van  Meter  and  the  Illinois  Medical  Infirmary, 
1857-1877,  761 

Charles,  A.  G.,  jt.  auth.  See  Alpern,  W.  M. 
Charles,  S.,  jt.  auth.  See  Diamond,  E.  F. 

Chua,  E.,  jt.  auth.  See  Bessinger,  H.  E. 


for  December,  1968 


815 


Claudication 

Neurogenic  (Surgical  Grand  Rounds)  154 
Cohen,  E.  J.,  and  Nora,  J.  R.,  A case  of  POST- 
PERICARDIOTOMY syndrome  - pathogenical 
consideration,  57 


D 

de  Haen,  P.,  New  pharmaceutical  specialities, 
97;  122;  224;  550;  606;  802 
Diamond,  E.  F.,  and  Charles,  S.,  Medical  prog- 
ress— AUTOMOTIVE  injury  and  the  practic- 
ing physician,  645 

Diamond,  S.,  jt.  auth.  See  Lipschultz,  H.  S. 
Duel,  W.,  jt.  auth.  See  Lipschultz,  H.  S. 

Dukes,  R.  E.,  and  Stern,  R.,  CYSTIC  fibrosis  of 
the  pancreas,  147 

Dunea,  G.,  jt.  auth.  See  Versaci,  A.A. 


E 

Embolism 

Pulmonary  and  renal  failure  (Surgical  Grand 
Rovmds)  749 
Ethical  relations 
opinions  and  reports,  183,  310 
Evaristo,  E.,  jt.  auth.  See  Bessinger,  H.  E. 


F 

Feldsherism 

(Van  Dellen — editorial)  654 
Friedman,  E.  A.,  jt.  auth.  See  Alpern,  W.  M. 


G 

Gerber,  C.  T.,  Medical  progress — artificial  insem- 
ination, 755 

Giffin,  G.  E.,  jt.  auth.  See  Poppens,  A.  D. 

Gross,  J.  D.,  and  Schiffbauer,  W.  C.,  CORON- 
ARY artery  occlusion  with  myocardial  infrac- 
tion in  a twelve  year  old  boy — two  epi- 
sodes with  a fatal  outcome,  59 


H 

Halperin,  D.  C.,  jt.  auth.  See  Ravitch,  M.  M. 

Hay  fever 

Injections  (Van  Dellen — editorial)  164 

Heart 

Coronary  artery  occlusion  with  myocardial  in- 
farction in  a twelve  year  old  boy — two 
episodes  with  a fatal  outcome  (Gross  & 
Schiffbauer)  59 

Intensive  cardiac  care — two  years  experience 
(Bessinger,  et  al)  737 

Myocardial  infarction  during  pregnancy  (Ad- 
ler, Barrash  & Lash)  143 


Post-pericardiotomy  syndrome — pathogenical 
consideration  (Cohen  & Nora)  57 
Hecht,  R.  A.,  CLINICAL  experience  with  a 
new  topical  corticosteroid.  Betamethasone 
17- Valerate,  64 
Hematoma 

Medical  progress  in  the  care  of  SUBDURAL 
hematomas  in  infants  and  children  (Luis- 
Porras  & Amador)  165 
Histoplasmosis 

Outbreak  in  Illinois  associated  with  starlings 
(Younglove,  Terry,  Rose,  Martin  & 
Schnurrenberger)  259 
Hospitals 

Seven  day  utilization  (Stenn)  50 
Practice  of  medicine  in  hospitals,  118 
Hypertension  and  ileus  (Surgical  Grand 
Rounds)  638 


I 

Illinois 

Comprehensive  health  planning  (Weber)  288 
Illinois  Association  of  the  Professions,  192;  308; 
458;  665;  790 

Illinois  Department  of  Public  Aid 
Part  I — Payment  procedures  and  policies  ex- 
plained (Swank)  696;  Part  II,  772 
Illinois  Medical  Assistants  Association  Report, 
306;  (reference  issue)  457;  689;  795 
Illinois  Medical  Journal 

Annual  reference  issue,  October  1968  (See 
Reference  issue) 

Illinois  Medical  Political  Action  Committee,  457 
Illinois  Psychiatric  Society 
Treatment  of  schizophrenia  (reported  by  H.  L. 
Muslin)  150 

Illinois  Sesquicentennial  features 
Out  of  the  detail  man’s  satchel  (Renald)  47; 
Illinois  medicine — a century  ago  (Snively 
& Becker)  157;  122  years  of  Aesculapian 
(Mitchell  & Johnson)  279;  tragic  deaths  of 
the  Lincoln  sons  (Pearson)  650;  Dr.  Sam- 
uel Van  Meter  and  the  Illinois  Medical  In- 
firmary, 1857-1877  (Cavins  & Read)  761 
Illinois  state  government,  459 

Illinois  State  Medical  Society 
Board  of  Trustees 
abstracts  of  actions,  137;  365;  729 
Convention  highlights,  73 
House  of  Delegates 

abstracts  of  actions,  77 
action  on  resolutions,  81 
Membership  forum  668;  799 
Membership  survey  results 
Part  I,  657 
Part  II,  777 

Officers  and  board  of  trustees  1968-1969,  72 
Organization,  381 

Constitution  and  bylaws,  385 
Policy  manual,  400 
House  of  delegates,  407 
Trustee  district  committees,  417 
Delegates  to  AMA,  419 


816 


Illinois  Medical  Journal 


Councils,  ISMS,  421 
Committees,  ISMS,  423 
Placement  service  103;  324;  578;  673;  787 
President’s  page  (Thomsen)  26;  141;  231;  369; 

621;  719 
Services,  443 

Divisions  of  administration,  business,  leg- 
lation  and  public  affairs,  publications, 
public  relations  and  economics,  education 
and  science,  444 

Educational  and  scientific  foundation,  447 
Films  and  ^ecial  publications,  447 
Scientific  speakers  bureau,  448 
Placement;  student  loan  fund,  448 
Impartial  medical  testimony,  449 
Insurance  programs,  450 
Radio-TV  materials,  452 
Medical  self-help  training,  453 
Socio-Economic  News,  84;  184;  292;  552;  666; 
788 

Woman’s  auxiliary,  455 

Immunity 

Community  immtmity — ^How,  when  and  how 
much?  (Lipschultz,  Duel  & Diamond)  66 

Infertility 
Surgery  (Lash)  283 

Insemination,  artificial  (Gerber)  755 
J 

Jablokow,  V.  R.,  jt.  auth.  See  Rubenstein,  A.  B. 

Jeffris,  J.,  PERILS  of  immobility,  774 

Johnson,  E.  P.,  jt,  auth.  See  Mitchell,  G.  T. 

K 

Kinins — a potent  biologic  agent  (Van  Dellen — 
editorial)  770 

Kravitz,  H.  (editorials) 

Observations  of  a run  for  your  lifer  or  the 
loneliness  of  the  short  distance  runner, 
70;  children’s  accidents  and  medical  edu- 
cation, 655 

Kravitz,  H.,  Medical  progress 
In  the  severely  affected  Rh-sensitized  preg- 
nancy (Alpern,  et  al)  37;  in  the  care  of 
subdxiral  hematomas  in  infants  and  chil- 
dren (Luis-Porras  & Amador)  165;  in  the 
use  of  drugs  in  pregnancy  (Pitkin)  265; 
automotive  injury  and  the  practicing  phy- 
sician (Diamond  & Charles)  645;  artifi- 
cial insemination  (Gerber)  755 


L 

Lash,  A.  F.,  SURGERY  in  infertility,  283 
Lash,  S.  R.,  jt.  auth.  See  Adler,  J.  J. 

Lipschultz,  H.  S.,  Duel,  W.,  and  Diamond,  S., 
COMMUNITY  immunity — how,  when  and  how 
much?  66 


Lloyd,  F.  A.,  jt.  auth.  See  Rubenstein,  A.  B. 
Love,  L.,  The  view  box  36;  179;  264;  644;  754 
Lowinger,  P.,  DOCTORS,  patients  and  tranqmli- 
zers — recent  developments,  632 
Luis-Porras,  C.  and  Amador,  L.  V.,  Medical 
progress  in  the  care  of  subdural  hematomas  in 
infants  and  children,  165 

Lung 

Abscess  (Surgical  Grand  Roxmds)  54 


M 

Madden,  J.  D.  (editorial) 

Education  in  community  medicine  at  the  Uni- 
versity of  Chicago,  274 

Marren,  J.  W.,  To  better  imderstand  your  Cath- 
olic patient,  327 

Martin,  R.  J.,  jt.  auth.  See  Younglove,  R.  M. 
McCain,  W.  H.,  and  Buell,  W.  F.,  Primary  pul- 
monary sporotrichosis  in  Illinois,  255 
Medansky,  R.  S.,  SINGLE  daily  dosage  of  Grise- 
ofulvin  in  fungus  diseases,  765 
Medical-legal  information,  533 
Medicine  and  religion 

To  better  imderstand  your  Catholic  patient 
(Marren)  327;  to  better  understand  your 
Protestant  patient  (Nighswonger)  682 
Miller,  P.,  RESULTS  in  an  urban  private  psy- 
chiatric practice,  174 

Mitchell,  G.  T.,  and  Johnson,  E.  P.,  122  YEARS 
of  Aesculapian,  279 
Muniz,  C.,  jt.  auth.  See  Bigsby,  F.  L. 

Muslin,  H.  L.  (Reporter) 

Treatment  of  Schizophrenia  (panel  from  the 
Illinois  Psychiatric  Society)  150 


N 

Nighswonger,  C.,  TO  BETTER  understand  your 
Protestant  patient,  682 
Nora,  J.  R.,  jt.  auth.  See  Cohen,  E.  J. 


O 

Obesity 

Medical  management  (Bigsby  & Muniz)  180 
Obituaries,  87, 189,  322,  568,  704,  820 


P 

Pachman,  D.  J.,  THE  FIGHT  against  smoking  in 
children,  625 
Pancreas 

Cystic  fibrosis  (Dukes  & Stem)  147 
Pearson,  E.  F.,  TRAGIC  DEATHS  of  the  Lin- 
coln Sons,  650 
Pediatrics 

Hernia  of  the  esophageal  hiatus  in  infants 
(Ravitch,  Rowe  & Halperin)  269 


for  December,  196S 


817 


Peison,  B.,  SIMULTANEOUS  adenocarcinoma  of 
the  esophagus  and  stomach,  a case  report, 
742 

Petter,  C.  K.  (editorials) 

Tuberculosis — today,  69 

Pfeifer,  F.  M.,  LIABILITY  of  physicians  in  com- 
mitting patients  to  mental  hospitals,  699 

Pharmaceuticals 

New  specialties  (de  Haen)  97;  122;  224;  550; 
606;  802 

Pitkin,  R.  M.,  Medical  progress  in  the  use  of 
drugs  in  pregnancy,  265 

Poppens,  A.  D.,  Giffin,  G.  E.,  and  Tarsinos,  L.  D., 
AVULSION  perineal  injury — a case  report  of 
avulsion  of  skin  of  penis  and  scrotum,  171 

Pregnancy 

Medical  progress  in  the  use  of  drugs  (Pitkin) 
265 

Medical  progress  in  the  severely  affected  Rh- 
sensitized  pregnancy — a symposium  (Al- 
pern,  et  al)  37 

Myocardial  infarction  during  pregnancy  (Ad- 
ler, Barrash  & Lash)  143 


R 

Ravitch,  M.  M.,  Rowe,  M.  I.,  and  Halperin,  D.  C., 
HERNIA  of  the  esophageal  hiatus  in  infants, 
269 

Read,  H.,  jt.  auth.  See  Gavins,  H.  M. 

Reference  issue  of  IMJ,  October  1968 
(Detailed  index)  545 

Renald,  J.  P.,  OUT  of  the  detail  man’s  satchel, 
47 

Rose,  N.  J.,  jt.  auth.  See  Younglove,  R.  M. 
Rothmund,  P.,  jt.  auth.  See  Bessinger,  H.  E. 

Rowe,  M.  I.,  jt.  auth.  See  Ravitch,  M.  M. 

Rowe,  M.  I.,  FUSION  of  the  labia  minora,  62 
Rubenstein,  A.  B.,  Jablokow,  V.  R.,  and  Lloyd, 
F.  A.,  DIFFERENTIATION  of  a bifid  ureter 
from  ureteral  diverticula,  33 


S 

Schiffbauer,  W.  C.,  jt.  auth.  See  Gross,  J.  D. 

Schizophrenia 

Treatment  (reported  by  H.  L.  Muslin)  for  a 
panel  from  the  Illinois  Psychiatric  Society, 
150 

Schnurrenberger,  P.  R.,  jt.  auth.  See  Younglove, 
R.  M. 

Scommegna,  A.,  jt.  auth.  See  Alpern,  W.  M. 

Silver,  J.,  jt.  auth.  See  Bessinger,  H.  E. 

Silverman,  A.  R.,  jt.  auth.  See  Alpern,  W.  M. 

Smoking 

Fight  against  in  children  (Pachman)  625 

Snively,  W.  D.,  Jr.,  and  Becker,  B.,  ILLINOIS 
medicine — a century  ago,  157 

Soriano,  R.  V.,  jt.  auth.  See  Versaci,  A.  A. 


Sporotrichosis 

Case  report  of  primary  pulmonary  in  Illinois, 
first  epidemiological  link  to  Sphagnvun 
moss  (McCain  & Buell)  255 

Stenn,  F.,  SEVEN  day  utilization  of  our  hospi- 
tals, 50 

Stern,  R.,  jt.  auth.  See  Dukes,  R.  E. 

Surgical  Grand  Rounds  (Beal)  at  Northwestern 
University  Medical  Center,  54;  154;  276;  638; 
749 

Swank,  H.  O.,  Part  I—  IDPA  PAYMENT  pro- 
cedures and  policies  explained,  696;  Part  II, 
772 


T 

Tarsinos,  L.  D.,  jt.  auth.  See  Poppens,  A.  D. 
Teng,  C-Y.,  jt.  auth.  See  Bessinger,  H.  E. 
Terry,  R.  M.,  jt.  auth.  See  Yoimglove,  R.  M. 
Thomsen,  P.  G.,  President’s  page,  26;  141;  231; 
369;  621;  719 

Troxel,  J.  C.,  PRE-ADMISSION  testing — a Blue 
Cross  proposal,  295 


U 

Ureter 

Differentiation  of  a bifid  ureter  from  ureteral 
diverticula  (Rubinstein,  Jablokow  & 
Lloyd)  33 


V 

Van  Dellen,  T.  R.  (editorials) 

Hay  fever  injections,  164;  TRUANT  British 
Physicians,  570;  Feldsherism,  654;  Kinnins- 
a potent  biologic  agent,  770 

Versaci,  A.  A.,  Soriano,  R.  V.,  and  Dunea,  G., 
WASHING  machine  dialysis  with  a new  twin 
coil  kidney,  693 

View  Box  (Love)  Acute  traumatic  rupture  of 
the  left  hemidiaphragm,  36;  Rubella  syndrome 
in  infants,  179;  solitary  bone  cyst,  264; 
acute  appendicitis,  644;  cystitis  emphyse- 
matosa, 754 


W 

Weber,  F.  J.,  COMPREHENSIVE  health  plan- 
ning in  Illinois,  288 
Wu,  P.,  jt.  auth.  See  Alpern,  W.  M. 


Y 

Younglove,  R.  M.,  Terry,  R.  M.,  Rose,  N.  J.,  Mar- 
tin, R.  J.,  and  Schnurrenberger,  P.  R.,  AN 
OUTBREAK  of  histoplasmosis  in  Illinois 
associated  with  starlings,  259 


818 


Illinois  Medical  Journal 


Obituaries 

*Dr.  Melvin  L.  Afremow,  Chicago,  a phy- 
sician for  more  than  35  years,  died  Oct. 
18  at  the  age  of  63.  He  was  consulting  phy- 
sician at  American  and  Columbus  Hospi- 
tals, attending  physician  for  the  Illinois 
Nursing  Training  School. 

Dr.  John  Bellucci,  Frankfort,  founder  and 
owner  of  Bellucci  Medical  Clinic,  died 
Oct.  14  at  the  age  of  61. 

*Dr.  Grover  C.  Bullington,  Torrence, 
Calif.,  a longtime  Pana  physician,  died 
Oct.  4 at  the  age  of  83.  He  was  past  presi- 
dent of  Christian  County  Medical  Society. 
"^Dr.  Audley  F.  Connor,  Chicago,  who 
was  head  of  medicine  at  Provident  Hospi- 
tal for  20  years,  died  Oct.  30  at  the  age 
of  68. 

*Dr.  Claire  E.  Healey,  Chicago,  a physi- 
cian for  the  Illinois  Department  of  Public 
Health  for  the  past  20  years,  died  Oct.  4 
at  the  age  of  73. 

*Dr.  Charles  E.  Hildreth,  84,  a practicing 
physician  in  Mount  Pulaski  for  more  than 
50  years,  died  Oct.  21.  He  was  a member 
of  ISMS  Fifty-Year  Club. 

Dr.  Julius  B.  Kahn,  Jr.,  Winnetka,  died 
Oct.  18  at  the  age  of  47.  He  was  professor 
and  chairman  of  the  department  of  phar- 
macology in  the  Northwestern  University 
Medical  School. 

*Dr.  Charles  J.  Kurtz,  Chicago,  a faculty 
member  of  Northwestern  University  Medi- 
cal School  for  more  than  50  years,  died 
Oct.  29  at  the  age  of  96.  He  was  a mem- 
ber of  ISMS  Fifty-Year  Club. 

*Dr.  I.  W.  Lee,  Casey,  a practicing  physi- 
cian for  60  years,  died  Oct.  2 at  the  age 
of  91.  He  was  a member  of  ISMS  Fifty- 
Year  Club. 

*Dr.  Paul  Magnuson,  84,  founder  of  the 
Rehabilitation  Institute  of  Chicago,  died 
Nov.  5.  He  was  the  first  medical  director 
of  the  Illinois  Industrial  Commission  and 
a member  of  ISMS  Fifty-Year  Club. 

*Dr.  Clarence  C.  Saelhof,  Auburndale, 
Fla.,  a practicing  physician  for  nearly  40 
years,  died  Oct.  29  at  the  age  of  70. 

*Dr.  Vito  Vighi,  63,  of  Ottawa,  a physi- 
cian and  surgeon  for  35  years,  died  Oct.  27. 
Dr.  John  P.  Walker,  Lincoln,  a mem- 
ber of  the  medical  staff  at  Lincoln  State 
School,  died  Sept.  28  at  the  age  of  51. 
*Dr.  Doris  Wheeler,  Evanston,  died  Oct. 
29  at  the  age  of  52  in  Michael  Reese  Hos- 
pital where  she  was  on  the  hospital  staff. 
•Indicates  member  of  Illinois  State  Medical  Society. 


Full  speed  ahead, 
Fred.  These  solid 
Cough  Calmers 
can  control  that 
cough  for  6 to 
8 hours. 


Each  Cough  Calmer'”  contains  the  same  active  ingredients 
as  a haH-teaspoonful  of  Robitussin-DM*:  Glyceryl  guaiaco- 
late,  50  mg.;  Dextromethorphan  hydrobromide,  7.5  mg. 
A.  H.  Robins  Company,  Richmond,  Virginia  23220 


AH'[^OBINS 


CHRISTMAS  SEALS  FIGHT 
Tuberculosis. ..Emphysema 
Air  Pollution 


* 


IT'S  A MATTER  OF  LIFE  AND  BREATH 


for  December^  1968 


819 


Apply 

internally. 


Take  a relaxing  break 
for  Coca-Cola.  Couple 
of  times  a day.  Because 
Coke  has  the  taste 
you  never  get  tired  of. 
It’s  always  refreshing. 


820 


Illinois  Medical  Journal 


THE  VIEW  BOX 

(Continued  from  page  754) 
Diagnosis:  Cystitis  emphysematosa. 

Cystitis  emphysematosa  is  an  inflamma- 
tory lesion  of  the  bladder  associated  with 
gas  vesicles  in  the  bladder  wall.  The  con- 
dition is  usually  caused  by  gas  forming  ba- 
cilli of  the  colon  gioup  and  often  is  asso- 
ciated with  diabetes  mellitus  or  hyper- 
glycemia due  to  intravenous  fluid  therapy. 
Rarely,  diabetes  without  infection  can  pro- 
duce this  entity.  This  disease  is  usually  very 
transient  and  benign;  21  days  has  appar- 
ently been  the  upper  limit  of  the  extent 
of  the  duration  of  the  disease.  The  radio- 
graphic  picture  will  vary  with  the  stage  of 
the  disease.  Three  stages  are  described. 

Stage  1:  A clear  zone  1 mm.  wide  may 
be  seen  around  the  contrast  media  in  the 
bladder.  There  is  no  free  gas  in  the  lumen. 
The  gas  vesicles  are  so  small  that  they  can- 
not be  distinguished  radiographically. 

Stage  2:  The  bladder  wall  is  irregular, 
swollen,  and  thicker  due  to  increased  in- 
tramural gas  production.  The  gas  filled 
vesicles  can  now  be  made  out  clearly  in 
the  wall  of  the  bladder.  There  is  no  gas 
in  the  bladder  lumen.  Bladder  capacity  has 
diminished. 

Stage  3;  The  vesicles  are  ruptured  and 
free  gas  appears  in  the  lumen  of  the  blad- 
der with  less  gas  demonstrable  in  the  wall. 
The  capacity  of  the  bladder  returns  to 
normal  but  later  diminishes  in  size.  Still 
later  the  amount  of  free  gas  diminishes  and 
the  bladder  returns  to  normal.  As  the  in- 
fection is  brought  under  control  the  radio- 
graphic appearance  will  disappear  rapidly. 
Our  case  is  a good  demonstration  of  Stage 
2.  When  Stage  3 occurs  it  may  be  accom- 
panied by  clinical  pneumaturia. 

Reference : 

Xey  and  Friedenberg,  Radiographic  Atlas  of  the 
Genitourinary  System.  Lippincott,  1966,  pages 
490,  491. 


Hunters  who  use  corrective  glasses  are 
urged  to  make  certain  they  are  of  the 
safety  variety.  Impact-resistant  lenses  will 
more  adequately  protect  the  eyes  from 
stray  pellets,  ejecting  shells,  twigs  and 
other  dangers,  without  reducing  visibility, 
advises  the  National  Society  for  the  Pre- 
vention of  Blindness. 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1968  and  1969 

SPECIALTY  REVIEW  COURSE  IN  ORTHOPEDICS,  December  9 
SPECIALTY  REVIEW  COURSE  IN  PEDIATRICS,  December  9 
SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  II,  Feb.  24 
SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  Part  II,  March  3 
SPECIALTY  REVIEW  COURSE  IN  THORACIC  SURGERY,  March 
10 

SPECIALTY  REVIEW  COURSE  IN  GENERAL  PRACTICE,  March 
17 

PATHOLOGY  REVIEW  COURSES  FOR  SPECIALTIES,  Request 
Dates 

VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week, 
March  24 

FIBEROPTIC  CULDOSCOPY  & PELVIC  PERITONEOSCOPY, 
March  17 

PERITONEOSCOPY,  Two  Weeks,  March  17 
ULTRAVIOLET  CYSTOSCOPY,  1-1/2  Days,  March  24 
SYMPOSIUM  ON  SHOCK,  Two  Days,  December  20 
ESOPHAGEAL  SURGERY,  Three  Days,  March  27 
BASIC  INTERNAL  MEDICINE,  One  Week,  March  3 
BASIC  ELECTROCARDIOGRAPHY,  One  Week,  March  10 
RADIOISOTOPES,  One  or  Two  Weeks,  First  Monday  each 
Month 

ANESTHESIA,  Inhalation,  Endotracheal,  Regional,  Request 
Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request. 

TEACHING  FACULTY 
Attending  Staff  of 
Cook  County  Hospital 

6SS* 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


Tuberculosis?  Influenza? 
Pneumonia?  Leukemia? 
Hodgkin’s  Disease?  Syphilis? 
Systemic  Fungal  Diseases? 
Chronic  Chest  Diseases? 
or 

HISTO? 

(Histoplasmosis — “The  Masquerader”) 


A new  aid  in  differential  diagnosis 

HISTOPLASMIN,TINE  TEST 

(Rosenthal) 

The  LEDERTINE^i-i  Applicator  with  the  Blue  Handle 

Precautions— Nonspecific  reactions  are  rare,  but 
may  occur.  Vesiculation,  ulceration  or  necrosis 
may  occur  at  test  site  in  highly  sensitive  persons. 
The  test  should  be  used  with  caution  in  patients 
known  to  be  allergic  to  acacia,  or  to  thimerosal 
(or  other  mercurial  compounds). 


AsK  your  representative  for  details  or  write  Medical  Advisory  Dept., 
Lederle  Laboratories.  Pearl  River.  New  York  10965.  406-8 


for  December,  196S 


821 


on 

the^^ud^et... 

on 

the  5J[^other 

GAGATablets  ElixirV^V^ 
^J;^or  ^ron  ^^^J^eficiency  Q/^riemia 


FAMOUS 


BREON  LABORATORIES  INC. 

Subsidiary  of  Sterling  Drug  Inc. 

90  Park  Avenue,  New  York,  N.Y.  10016 


brand  of  FERROUS 


on 

GLUCONATE 


822 


Illinois  Medical  Journal 


IDPA  Payments  Procedures 

(Continued  from  page  773) 

DO  YOU  HAVE  ANYTHING  MORE 
TO  ADD  REGARDING  PRECISION 
IN  BILLING? 

I think  it  would  be  beneficial  to  relate 
more  specifically  the  functions  of  the  pa- 
tient’s identification  card,  the  CPT,  and 
the  form  132  for  billing  the  department. 
Perhaps  the  best  way  to  do  this  is  to  trace 
all  actions  from  the  moment  a patient  calls 
on  the  physician  until  the  money  warrant 
arrives  in  payment  of  services.  Some  com- 
plicated procedures  will  serve  as  examples 
with  commentary  on  how  to  accomplish 
precision  and  to  avoid  pitfalls. 

Answers  to  this  question  will  be  the 
theme  of  next  month’s  installment. 


Illinois  was  the  birth  place  of  the  atomic 
age,  the  birth  place  of  commercial  nuclear 
energy  and  soon  will  be  the  home  of  the 
world's  greatest  atom  smasher. 


]\ew  Brochure  Distributed 

Twenty  thousand  brochures  calling  at- 
tention to  an  amendment  to  Illinois’  Child 
Abuse  Law  have  been  mailed  to  physicians, 
hospitals,  child  welfare  personnel  and  law 
enforcement  agencies  by  the  Department 
of  Children  and  Family  Services. 

The  amendment,  signed  into  law  by  Gov. 
Samuel  H.  Shapiro,  specifies  “evidence  of 
malnutrition’’  as  a form  of  suspected  child 
abuse  that  must  be  reported  to  the  depart- 
ment by  doctors  and  hospital  administra- 
tors. 

“Child  abuse  is  an  even  greater  prob- 
lem than  we  suspected  when  the  Illinois 
Child  Abuse  Law  was  passed  in  1965,’’  said 
Edward  T.  Weaver,  department  director. 
Of  the  1,500  cases  of  suspected  abuse  oc- 
curing  in  the  last  39  months,  more  than 
200  cases  involved  malnutrition  as  a form 
of  abuse,  according  to  Weaver. 

“Starving  a child  to  death  is  just  as 
cruel,  or  possibly  more  cruel,  than  fractur- 
ing his  skull,”  said  Weaver,  “and  now  the 
law  spells  this  out  clearly.” 


Nervous 

Geriatrics 


Mental 

Custodial 


Est.  1909 

RESTHAVEN 

This  modernly  equipped  institution  located  in  the  beautiful  Fox  River  Valley  35 
miles  west  of  Chicago,  cooperates  with  physicians  to  the  fullest  extent. 

It  provides  accommodations  for  100  patients  in  single  and  double  rooms.  Rest- 
haven  accepts  patients  by  referral  and  direct  admission. 

RESTHAVEN  HOSPITAL,  600  VILLA  ST.,  ELGIN,  ILL. 

Phone:  SH  2-0327 


Long  Term 
and  Short 
Term  Care 


Day  Care 
and  Mental 
Health  Clinic 


for  December,  1968 


823 


2 Approvod  Group  Insuronc©  Plons 
for  members  of 
THE  ILLINOIS  STATE  MEDICAL  SOCIETY 

GROUP  DISABILITY  PLAN 


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9933  LAWLER  AVENUE 


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SKOKIE,  ILLINOIS 


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TheUhcola 

TUP®  The  Uncola  occupies  a special  place 
on  the  menus  of  many  hospitals  and 
nursing  homes.  Many  doctors  routinely 
prescribe  TUP  because  patients  enjoy 
it  and  because  it  provides  easily 
assimilated  sugar  for  needed  energy. 

Your  local  TUP  bottler  can  show  you  how 
easy  it  is  to  make  TUP  available  to 
your  patients,  staff  and  visitors. 

7-Up  Bottlers  of  Illinois 


824 


Illinois  Medical  Journal 


# 


X70-2980 

Illinois  medical  journal, 

V.I34,  1968. 




DATE  , /)  ISSUED  TO 


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